Handle with Care - Virginia Department of Healthhandle with care bariatric, geriatric, and pediatric...
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Handle with Care BARIATRIC, GERIATRIC, AND PEDIATRIC CHALLENGES KATE PASSOW
Transcript of Handle with Care - Virginia Department of Healthhandle with care bariatric, geriatric, and pediatric...
Handle with Care
BARIATRIC, GERIATRIC, AND PEDIATRIC CHALLENGES KATE PASSOW
Why this topic?
Higher expectations Moving beyond scoop and run
Safety of patients and providers
Pre-planning is key Special equipment
Move beyond improvising
Find the experts now
Communication Challenges Airway Considerations
How would you handle this patient? 400 pound patient male sitting in a
recliner c/o abdominal pain Alert and oriented, pain has been
worsening over the last two days Six steps from the living room to
outside and three steps outside What if he was having a STEMI? What
if he coded? What if he was 700lbs?
Bariatric Patients
Definition WHO defines overweight as BMI
greater than 25 and obesity as BMI greater than 30 5’4” and 163 lbs = BMI of 28 6’1” and 235lbs = BMI of 31
Patient greater than 250 lbs Patient who cannot safely be
accommodated on a traditional stretcher
Bariatric Unique Patient Care Considerations
Weight centered most often: Abdomen Difficult to assess Chest Causes Dyspnea Supine Thighs/Buttocks Dense, very heavy to move Back Causes head to hang back Neck Airway Issues, c-collar issue Arms/Legs Easily injured in movement Joints unable to bear weight or move on own Airway M Score of 4 “Hump” may distort normal ET angles Chronic Hypoxia and Dyspnea Gender specific needs/concerns Incontinence Hygiene
BEMS - Bariatric Emergency Management Strategies
Why were you called?
Uninjured “Just help me up”
Unable to meet daily needs
Injured Falls
Bed/furniture collapse
Medical emergencies Cardiac
Respiratory
GI
Preplanning for the Bariatric Patient
Which tools are needed? What resources are needed? Where are you taking the patient too?
What tools might you have right now?
Tool Concern Reeves Breaking, strap length Stretcher Max Load 700# Tarp Tearing, hand holds Ropes Injury to patient
BEMS - Bariatric Emergency Management Strategies
Resources Needed
Who is available to help? Is there a specialty bariatric response unit in your
area? How do you call for it?
What resources are on it?
Destination
Can every facility accommodate a bariatric patient?
When should you make the notification? Do you need the same level of assistance on the
unload?
Transport Considerations
Make sure you have enough hands Make sure the stretcher can accommodate the
patients weight and always ensure a group of people have control of it
Avoid laying them supine/monitor airway Pad any voids Formulate a plan before you move the patient
and make sure everyone (including the patient) understands the plan
How would you transport this patient?
89 y/o female single vehicle crash into a tree Patient is alert and oriented c/o back pain and
lower left leg pain
What could be the cause of the accident?
What if this was a bus on a field trip from the senior center?
Geriatric Patients
Definition Usually over 75 years old (but no
set age) Chronic illnesses Physical Impairments Cognitive Impairments
Geriatric Unique Patient Care Considerations
Head More susceptible to brain bleeds Breathing “Hump” may distort normal ET angles Decreased muscle strength Neck/Back Spinal Stenosis/less flexibility/kyphosis Skin Very thin, easy to tear Arms/Legs Calcification/Osteoporosis
Joints Stiff, inflexible joints/Arthritis
Neuropathy weakness/numbness/balance issues
Thermoregulations Get cold sooner
Gender specific needs/concerns Incontinence/Foley Catheters
Shh…don’t tell my grandmother she is in a geriatric presentation
Types of Calls
Medical Emergencies Injuries Assists “Frequent Fliers”
Communication Challenges Stoic Cognitive issues Hearing/Seeing issues Aphasia
Other Challenges
Fears Loss of independence Never return home Being put in a nursing home Burdening others
End of life issues Advance Directives DNRs POST forms
Transportation Considerations Padding!! Gentle Slow Explain what is going on Listen Padding!!
How would you transport this patient? 2 y/o male swallowed a quarter
Alert and oriented Good breath sounds when sitting
quietly on dad’s lap, but cries and gets stridor when EMS touches him
What if there are siblings around?
Pediatric Definitions
Newborn – first hours after birth Neonates – Birth to 1 month Infants – 1 – 12 months Toddlers – 1-3 years Preschoolers 3-5 years School-Age – 6-12 years Adolescents – 13-18 years
Pediatric Unique Patient Care Considerations
Physiology
Anatomy Differences
Head
Top heavy
Abdomen
Liver and spleen below costal margin
Chest
Pliable thorax
Arms/Legs
Strong and resilient ligaments
Airway (under 8 years)
Larger tongue
Smaller airway structures
Abdominal breathers
Infants obligate nose breathers Thermoregulation
Not full developed in infants
Larger BSA to mass ratio
Metabolism
Higher rate of consumption of medication, oxygen, sugar, and other nutrients
Types of calls
Accidents of all types are the leading cause of death in pediatric patient 1-to 15 years
Both accidental & intentional injuries Poisonings Respiratory issues Infections
Other Challenges
Parents/Guardians (Siblings) Emotional factor “Special Needs” Kids
Technology Dependent Chronically ill Autism Spectrum
Autism Spectrum Sound sensitive Difficult communicating Very literal High pain threshold Sensitive to touch Like routine May exhibit “odd” behaviors
Be proactive and reach out to
specialized autism programs to help desensitize kids
“Doc” Alex is a young autistic patient initially afraid of ambulances who is now obsessed thanks to the help of his local community – visit him at EMSBuffs on Facebook
Pediatric Transport Tools
Car seat Pedimate Ped-immobolizer
Car Seat
Provided by Family Familiar to child Not design for easy access Not designed to easily fit on stretcher Should not use a car seat that was in a car
accident
Pedi-Mate
10-40lbs (4.5-18 kg) Fits well on the
stretcher Designed to allow
access to patient Straps similar to
car seat
Pediatric Immobolizer
Trauma patients Sedated patients
Pediatric Transport Considerations
Proper restraints for everyone Attempt to accommodate family members Monitor airway Pad voids Be aware of ambulance temperature Look for non-verbal cues of problems Proper transport destination
