Chapter 32 Patients with Special Needs - Triton · PDF fileChapter 32 Patients with Special...

Limmer et al., Emergency Care, 11th Edition

© 2009 by Pearson Education, Inc., Upper Saddle River, NJ

Chapter 32

Patients with Special Needs



Patients with

Special Needs



EMTs are discovering that a

number of people in their

communities have advanced

medical devices in their homes.

Patients with Special Needs



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



Medically trained, such as an:

– RN, CNA, or home health aide

More often it will be a family

member or friend.

Knowledgeable Care Givers



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



Respiratory devices

Cardiac devices

Gastrourinary devices

Central IV catheters

Physical impairments

Advanced Medical Devices



Respiratory

Devices



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



CPAP helps the following diseases:

– Pulmonary edema

– Asthma

– COPD

Continuous Positive Airway

Pressure Devices (CPAPs)

© AP Photo/The Herald, Julie Busch



Surgical opening in the neck into the

trachea

When the opening created is

permanent, it is called a stoma.

Tracheostomy Tubes

(cont.)



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



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.)



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




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.)



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.)



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




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.)



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.


(LVADs)

(cont.)





(LVADs)

© AP Photo/George Widman



Gastrourinary

Devices



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.)



Feeding Tube

(cont.)© AP Photo/The Charlotte Observer, David T. Foster III




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



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.)



Urinary Catheters

(cont.)

© Phototake USA/Yoav Levy



Urinary Catheters


During transport, keep the catheter

bag lower than the level of the

patient but not on the floor.



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.)



Use care when moving a patient if an

ostomy bag is present to prevent

breakage or dislodgement through

rough handling.

Ostomy Bags




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.)



Dialysis serves two important roles:

– Waste removal

– Fluid removal

There are two forms of dialysis:

– Hemodialysis

– Peritoneal dialysis

Dialysis

(cont.)



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




Central IV catheters are inserted

during surgery or under

radiography. They prevent

patients from having to endure

multiple needlesticks.

Central IV Catheters

(cont.)



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


(cont.)



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.


(cont.)



Implanted port

– This port has no external tubing.

Special needles are required to

access these ports. Brand names

include Port-a-Cath® and Mediport®.


(cont.)



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.





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.)



Approach and treat each patient with

one or more physical impairments by

providing whatever extra assistance

they require.

Physical Impairments




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.)



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



What is this patient’s priority?

What additional information do you

need to treat the patient?

Street Scenes

(cont.)



How should you reassess the

patient?

What equipment should you take to

the hospital with Amber?

Street Scenes



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