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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!