Special Patient Populations Chemeketa Community College Paramedic Program P. Andrews, Instructor W 09

Objectives; Manage Patients with:  Hearing impairments  Visual impairments  Speech impairments  Obesity  Paraplegia/quadripl egia  Mental illness  Developmentally disabled  Down syndrome  Arthritis  Cancer  Cerebral palsy  Cystic fibrosis  Multiple sclerosis  Muscular dystrophy  Myasthenia gravis  Poliomyelitis  Spina bifida  Previous head injury

Objectives, cont.  Culturally diverse  Terminally ill  Communicable disease  Financial impairment

Hearing Impairments  Types;  Conductive  Otitis media  Impacted earwax  Water  Hematomas

 Sensorineural  Congenital defects or birth injuries  Rubella  Labyrinthitis  Tumors  Repeated loud noises  Progressive deafness assoc. with aging  Nearly 80% is related to hgh- pitched sounds.

Tricks that work  Face the patient  Speak clearly, at a normal rate  Identify yourself  Speak in lower tones  Try to limit background noise  Try to find the patient’s hearing aids; if not…. Place stethoscope in patients ears and speak into diaphragm  Use ASL interpreter, prn

Visual Impairments  Injury  Enucleation  Chemical, thermal burns  Disease  Glaucoma  Diabetic retinopathy  Congential, degenerative disorders

Tricks that work  Identify yourself as you approach  Describe everything as you do it  Do NOT pet a service dog  You need to transport the dog also

Speech Impairments  Language disorders  Cerebral palsy  Hearing impairments  Stroke  Brain tumor  Hearing loss

Speech impairments, cont.  Aphasia  Sensory  Can’t understand spoken word  Motor (Expressive)  Can’t make words or speak wrong words  Global  Both sensory and motor  Brain tumor in Broca’s region

Speech impairment, cont.  Dysarthria  Sounds are put together incorrectly  Neural damage  Slurred speech  Voice production disorders  Hoarseness, harshness, loss of voice  Fluency disorders  stuttering

Tricks that work  Never assume they are not intelligent  Don’t rush patient, interrupt or complete their sentences  Try to ask questions that require short answers  Look directly at patient when asking questions.

obesity  > 40% in US  20-30% heavier than normal  Provide thorough exam and obtain thorough history  Make accomodations for their weight  Ecg  Lung sounds

Obesity, cont.  Bariatric ambulance, gurney  Get enough help  YOUR safety first

Paralysis  May be paraplegic or quadriplegic  Cord injuries at C3 – C5 may paralyze respiratory muscles and compromise breathing – ventilator?  Often from a previous injury – not the reason you’re there today

 If pt is on a vent., airway is priority  Keep suction handy  May need BVM  Reassure patient  If paralysis is recent, a halo may be present;  Stabilize before transport

 Paralyzed patients often have a colostomy bag  Take any other assisting devices;  Wheelchairs, canes

Mental Challenges & Emotional Impairments A special challenge to us.  Schizophrenia  Personality disorders  Psych conditions 2 nd to emotional or physical trauma How will YOU cope?

Developmental disabilities  Pt. can’t learn at usual rate  Genetic  Brain injury caused by hypoxic or traumatic event  May be difficult to recognize  Treat pt as you would any other  They recognize body language, tone, etc just like anyone else

Tricks that work  This group of pt has higher than average risk of abuse  Make it clear that you are part of EMS (pt’s are often taught ‘stranger danger’)  Reassure pt. – they are often frightened by equipment, vehicles, noise, etc.

 Keep primary caregiver with you at all times  Use terms they will understand  Demonstrate techniques on you or your partner

Down Syndrome  Common physical characteristics  Eyes slope up  Folds of skin on either side of nose, covers inner corner of eye  Small face and features  Large, protruding tongue  Flattening of back of head  Short, broad hands

Down syndrome, cont.  Common physical ailments  Heart defects  Intestinal defects  Chronic lung problems  Higher risk of cataracts, blindness, early onset Alzheimer’s

Fetal Alcohol Syndrome  A preventable disorder  Characteristic features;  Small head with multiple facial deformities  Small eyes with short slits  Wide, flat nose bridge  Lack of a groove between nose and lip  Small jaw  Delayed physical growth  Mental disabilities  hyperactivity

Arthritis  Juvenile rheumatoid arthritis  Connective tissue disorder  Sx before age 16  Rheumatoid arthritis  Autoimmune disorder  Osteoarthritis  Degenerative joint disease  Most common arthritis in elders

Arthritis, cont.  Symptoms;  Painful swelling and irritation of joints  Joint stiffness and limited ROM common  Smaller joints of feet and hands become deformed.  JRA pt’s; spleen or liver complications

Tricks that work  Pay attention to their meds; you may be there to treat s/s of med effects  NSAIDs  Corticosteroids  Transport;  Move gently  Pad joints with pillows

Cancer  Patients have greatly increased risk of infection  Rapid onset of sepsis  Difficult IV start  Involve patient in decision-making as much as possible

Cerebral Palsy  A group of disorders caused by damage to cerebrum in utero or during birth  Premature birth  Difficult delivery  Exposure to German Measles  encephalitis  Meningitis  Head injury

CP, cont.  Spastic muscles  Affects a single limb or entire body  2/3 CP pts have below normal intellectual capacity  ½ have seizures  3 main types  Spastic paralysis  Athetosis  Ataxia

CP, cont.  Spastic paralysis (most common)  Muscles in state of permanent stiffness and contracture  Athetosis  Involuntary writhing movement; usually extremities  May demonstrate drooling, grimacing

CP, cont.  Ataxic cerebral palsy (least common)  Problems with coordination of gait and balance

Tricks that work  Don’t assume you can’t communicate – some CP pts are highly intelligent  Use pillows and blankets to pad extremities  Have suction available

Cystic Fibrosis  Inherited disorder; involves exocrine glands in lungs & digestive system  Bronchoconstriction  Atelectasis  Blockages in small ducts of pancreas

CF, cont.  Common PMH:  Frequent lung infections  Clay colored stool  Clubbing of fingers and toes  Most CF pts are children and adolescents – life expectancy to 30’s

Tricks that work  Although chronically ill, still pediatric patients – treat children as children  Provide oxygen and suction  Take all medications along

Multiple Sclerosis  CNS disorder; most between 20 – 40 y/o  Autoimmune disorders  Repeated inflammation = scar tissue = blocked impulses to area  Slow onset

Tricks that work  Help pt to position limbs for comfort.  Don’t expect pt to walk  Bring wheelchair or other devices along

Muscular Dystrophy  Genetic disorder, leading to gradual degeneration of muscle fiber  Duchene MD most common form  Affects boys between 3 – 6 y/o  Eventually affects respiratory muscles and heart

Poliomyelitis  A communicable disease  Affects gray matter and spinal cord  Enters body through GI tract  Uncommon in developed countries

Previous head injuries  May display s/s similar to stroke (without hemiparesis)  Slurred speech  Visual or hearing changes  Short-term memory loss  PMH important

Spina Bifida  Congenital abnormality  Defect in closure of backbone and spinal cord  Spina bifida occulta (few s/s)  Spina bifida cystica (spinal cord protrudes from back)

Spina bifida, cont.  A large percentage have hydrocephalus  Up to 73% have latex allergies  Take along any assistive devices

Myasthenia Gravis  Autoimmune disease  Chronic weakness of voluntary muscles, progressive fatigue  Occurs most frequently in women, 20 – 50 y/o

Myasthenia gravis, cont.  Common c/c;  Complete lack of energy esp. in evening  Facial muscles most commonly effected; eyelid drooping or difficulty chewing or swallowing  Double vision  Respiratory muscles may be affected.

Tricks that work  If respiratory distress in noted, assist ventilation enroute to hospital

Culturally diverse patients  Ethically required to treat without regard for ethnic background –  How do you provide treatment AND respect the patient’s diversity?

Summary  Compassion and a basic respect for humans will get you through most any call!