Special Patient Populations

Special Patient Populations

Chemeketa Community CollegeParamedic Program

P. Andrews, InstructorW 09

Objectives; Manage Patients with:

Objectives; Manage Patients with:

Hearing impairments

Visual impairments Speech

impairments Obesity Paraplegia/

quadriplegia 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.Objectives, cont.

Culturally diverse Terminally ill Communicable

disease Financial

impairment

Hearing ImpairmentsHearing Impairments

Types; Conductive

Otitis media Impacted earwax WaterHematomas

SensorineuralCongenital defects or birth injuriesRubellaLabyrinthitisTumorsRepeated loud noisesProgressive deafness assoc. with aging

Nearly 80% is related to hgh-pitched sounds.

Tricks that workTricks 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 ImpairmentsVisual Impairments

Injury Enucleation Chemical, thermal burns

Disease Glaucoma Diabetic retinopathy

Congential, degenerative disorders

Tricks that workTricks 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 ImpairmentsSpeech Impairments

Language disorders Cerebral palsy Hearing impairments Stroke Brain tumor Hearing loss

Speech impairments, cont.Speech impairments, cont.

Aphasia Sensory

Can’t understand spoken word

Motor (Expressive)Can’t make words or speak wrong words

GlobalBoth sensory and motorBrain tumor in Broca’s region

Speech impairment, cont.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 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.

obesityobesity

> 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.Obesity, cont.

Bariatric ambulance, gurney Get enough help

YOUR safety first

ParalysisParalysis

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

Mental Challenges & Emotional Impairments

A special challenge to us. Schizophrenia Personality disorders Psych conditions 2nd to emotional or

physical trauma

How will YOU cope?

Developmental disabilitiesDevelopmental 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 workTricks 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 SyndromeDown 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.Down syndrome, cont.

Common physical ailments Heart defects Intestinal defects Chronic lung problems Higher risk of cataracts, blindness,

early onset Alzheimer’s

Fetal Alcohol SyndromeFetal 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

ArthritisArthritis

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.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 workTricks 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

CancerCancer

Patients have greatly increased risk of infection Rapid onset of sepsis

Difficult IV start Involve patient in decision-making

as much as possible

Cerebral PalsyCerebral 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.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.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.CP, cont.

Ataxic cerebral palsy (least common) Problems with coordination of gait

and balance

Tricks that workTricks 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 FibrosisCystic Fibrosis

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

CF, cont.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 workTricks that work

Although chronically ill, still pediatric patients – treat children as children

Provide oxygen and suction Take all medications along

Multiple SclerosisMultiple Sclerosis

CNS disorder; most between 20 – 40 y/o

Autoimmune disorders Repeated inflammation = scar tissue =

blocked impulses to area Slow onset

Tricks that workTricks that work

Help pt to position limbs for comfort.

Don’t expect pt to walk Bring wheelchair or other devices

along

Muscular DystrophyMuscular 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 Poliomyelitis

A communicable disease Affects gray matter and spinal cord Enters body through GI tract

Uncommon in developed countries

Previous head injuriesPrevious head injuries

May display s/s similar to stroke (without hemiparesis) Slurred speech Visual or hearing changes Short-term memory loss

PMH important

Spina BifidaSpina 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.Spina bifida, cont.

A large percentage have hydrocephalus

Up to 73% have latex allergies Take along any assistive devices

Myasthenia GravisMyasthenia Gravis

Autoimmune disease Chronic weakness of voluntary

muscles, progressive fatigue Occurs most frequently in women, 20

– 50 y/o

Myasthenia gravis, cont.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 workTricks that work

If respiratory distress in noted, assist ventilation enroute to hospital

Culturally diverse patients

Culturally diverse patients

Ethically required to treat without regard for ethnic background –

How do you provide treatment AND respect the patient’s diversity?

Summary Summary

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