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
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© 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
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© 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
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Medically trained, such as an:
– RN, CNA, or home health aide
More often it will be a family
member or friend.
Knowledgeable Care Givers
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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
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Respiratory devices
Cardiac devices
Gastrourinary devices
Central IV catheters
Physical impairments
Advanced Medical Devices
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Respiratory
Devices
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© 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
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CPAP helps the following diseases:
– Pulmonary edema
– Asthma
– COPD
Continuous Positive Airway
Pressure Devices (CPAPs)
© AP Photo/The Herald, Julie Busch
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Surgical opening in the neck into the
trachea
When the opening created is
permanent, it is called a stoma.
Tracheostomy Tubes
(cont.)
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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
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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.)
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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
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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.)
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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.)
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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
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© 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.)
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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
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Left Ventricular Assist Devices
(LVADs)
© AP Photo/George Widman
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© 2009 by Pearson Education, Inc., Upper Saddle River, NJ
Gastrourinary
Devices
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© 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.)
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© 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
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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.)
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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.
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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.)
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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
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© 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.)
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Dialysis serves two important roles:
– Waste removal
– Fluid removal
There are two forms of dialysis:
– Hemodialysis
– Peritoneal dialysis
Dialysis
(cont.)
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© 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
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© 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.)
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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.)
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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.)
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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
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© 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.)
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© 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