Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Chapter 32 Patients with Special Needs

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Patients with Special Needs

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ EMTs are discovering that a number of people in their communities have advanced medical devices in their homes. Patients with Special Needs

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Patients who previously may have been unable to survive at home are now afforded the opportunity and relative comfort of living and working in a normal, non-hospital environment. Advanced Medical Devices in the Home

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Medically trained, such as an: – RN, CNA, or home health aide More often it will be a family member or friend. Knowledgeable Care Givers

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Congenital disease –Condition is one that is present at birth or may be genetic Acquired disease –Occurs after birth and may be the result of exposure to a virus or bacteria Diseases and Conditions

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Respiratory devices Cardiac devices Gastrourinary devices Central IV catheters Physical impairments Advanced Medical Devices

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Respiratory Devices

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Machine that provides constant pressure, through a tube and mask, to prevent airway passages from collapsing at the end of a breath Continuous Positive Airway Pressure Devices (CPAPs) (cont.) © Don Garbera/Phototake USA

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ CPAP helps the following diseases: –Pulmonary edema –Asthma –COPD Continuous Positive Airway Pressure Devices (CPAPs) © AP Photo/The Herald, Julie Busch

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Surgical opening in the neck into the trachea When the opening created is permanent, it is called a stoma. Tracheostomy Tubes (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Carefully assess the tracheostomy tube for any blockage, and clear it (under protocol, or by having care givers perform the task). If the patient is on a ventilator, he may need to be ventilated by a BVM between suctioning. Tracheostomy Tubes Assessment and Transport

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ A ventilator is a device that breathes for a patient. It is programmed to take over the functions of inhalation, exhalation, timing, and rate of breathing. Home Ventilators (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ While caring for a patient with a home ventilator, ensure that the ventilator tube does not have any mucus buildup, suctioning as needed. Home Ventilators Assessment and Transport

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ The pacemaker is designed to prevent the heart rate from becoming too slow. Early pacemakers were set at a fixed rate, but modern pacemakers are “rate-responsive”; that is, they detect what the patient is doing and modify the heart rate accordingly. Implanted Pacemakers Cardiac Devices (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Like a pacemaker, an AICD is placed under the skin with wires inserted into the heart. The implanted defibrillator is designed to detect life-threatening cardiac rhythms (ventricular fibrillation and ventricular tachycardia). Automatic Implanted Cardiac Defibrillator (AICD) Cardiac Devices (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Depending on the nature of the call and chief complaint, the EMT may wish to have ALS transport for a patient with a pacemaker or AICD device. Cardiac Devices Assessment and Transport

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ A recent advance in cardiac care is the left ventricular assist device (LVAD). The LVAD moves blood from the left ventricle through an inserted tube to a pump implanted in the abdomen where the blood is pressurized and sent to the aorta for transport to the body. Left Ventricular Assist Devices (LVADs) (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Transport: The patient with an LVAD will have an external battery pack that may be the size of a small backpack or briefcase. Failures of the battery system should first be addressed by attempting to plug the unit into an AC source in the home, inverter in an ambulance, or other. Left Ventricular Assist Devices (LVADs) (cont.) Assessment and Transport

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Left Ventricular Assist Devices (LVADs) © AP Photo/George Widman

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Gastrourinary Devices

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ A feeding tube is used in a patient who is unable to feed himself or can’t swallow. A feeding tube is most commonly seen in one of two forms: a nasogastric tube or a gastric tube. Feeding Tube (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Feeding Tube (cont.) © AP Photo/The Charlotte Observer, David T. Foster III

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Assessment and Transport Ensure that the feeding tube is secured with tape to the patient’s body before transport. If protocols allow, and nutrients are being administered during transport, keep the nutrient source higher than the level of the NG tube or G-tube. Feeding Tube

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ A urinary catheter is used for a patient who has lost the ability to urinate or has the lost the ability to regulate when he urinates. Urinary Catheters (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Urinary Catheters (cont.) © Phototake USA/Yoav Levy

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Urinary Catheters Assessment and Transport During transport, keep the catheter bag lower than the level of the patient but not on the floor.

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ An ostomy bag is connected to a colostomy or an ileostomy, which is a stoma in the abdomen that has external tubing to allow fecal drainage from the colon or ileum. Ostomy Bags (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Use care when moving a patient if an ostomy bag is present to prevent breakage or dislodgement through rough handling. Ostomy Bags Assessment and Transport

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ The kidneys are unable to remove the buildup of toxins that occurs with the metabolism of daily life. Dialysis removes these toxins and filters the blood, taking over some of the roles the kidneys play in detoxifying the blood. Dialysis (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Dialysis serves two important roles: –Waste removal –Fluid removal There are two forms of dialysis: –Hemodialysis –Peritoneal dialysis Dialysis (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Do not take a blood pressure on any arm with an AV shunt, fistula, or graft—it could cause damage that would require surgical repair. Dialysis Assessment and Transport

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Central IV catheters are inserted during surgery or under radiography. They prevent patients from having to endure multiple needlesticks. Central IV Catheters (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Peripherally inserted central catheter (PICC) line –Has an external tube slightly larger than IV tubing, which is inserted into a peripheral vein from which it is threaded into the central circulation Central IV Catheters (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Central venous line –May be inserted through a subclavian, jugular, or femoral vein. Central venous lines carry a variety of brand names, such as a Groshong ®, a Hickman ®, or a Broviac ® catheter. Central IV Catheters (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Implanted port –This port has no external tubing. Special needles are required to access these ports. Brand names include Port-a-Cath ® and Mediport ®. Central IV Catheters (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ In most cases, neither the EMT nor a family caregiver will use a central IV catheter to administer medications to the patient or for any other purpose. Central IV Catheters Assessment and Transport

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Impairments that affect hearing, sight, or speech Each limitation requires different approaches and considerations when you are assessing and treating the patient. Physical Impairments (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Approach and treat each patient with one or more physical impairments by providing whatever extra assistance they require. Physical Impairments Assessment and Transport

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ 1. List several advanced medical devices you might find when responding to patients with special needs at home. 2. Differentiate congenital diseases from acquired diseases or conditions. 3. If a tracheostomy tube is blocked and your protocols allow, describe a method of clearing the blockage. Review Questions (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ 4. If a ventilator that a patient relies on to breathe malfunctions, what life support care should you perform? 5. If a patient’s pacemaker or AICD malfunctions, in addition to transport to the hospital, what care should you provide? 6. If a patient cannot hear or cannot speak, describe several methods that might facilitate communication with him. Review Questions

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ What is this patient’s priority? What additional information do you need to treat the patient? Street Scenes (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ How should you reassess the patient? What equipment should you take to the hospital with Amber? Street Scenes

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Sample Documentation