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					Special Patient
Chemeketa Community College
     Paramedic Program
    P. Andrews, Instructor
            W 09
           Objectives; Manage
                            Patients with:

 Hearing                  Down syndrome
  impairments              Arthritis
 Visual impairments       Cancer
 Speech                   Cerebral palsy
  impairments              Cystic fibrosis
 Obesity                  Multiple sclerosis
 Paraplegia/quadripl      Muscular dystrophy
 Mental illness           Myasthenia gravis
 Developmentally          Poliomyelitis
  disabled                 Spina bifida
                           Previous head injury
Objectives, cont.

      Culturally diverse
      Terminally ill
      Communicable
      Financial
       Hearing Impairments

 Types;
   Conductive
      Otitis media
      Impacted earwax
      Water
      Hematomas
   Sensorineural
      Congenital defects or birth injuries
      Rubella
      Labyrinthitis
      Tumors
      Repeated loud noises
      Progressive deafness assoc. with aging
 Nearly 80% is related to hgh-
  pitched sounds.
Tricks 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
    Use ASL interpreter, prn
            Visual Impairments

 Injury
   Enucleation
   Chemical, thermal burns
 Disease
   Glaucoma
   Diabetic retinopathy
 Congential, degenerative disorders
              Tricks 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 Impairments

 Language disorders
   Cerebral palsy
   Hearing impairments
   Stroke
   Brain tumor
   Hearing loss
Speech impairments, cont.

 Aphasia
   Sensory
     Can’t understand spoken word
   Motor (Expressive)
     Can’t make words or speak wrong words
   Global
     Both sensory and motor
     Brain tumor in Broca’s region
  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

 Never assume they are not
 Don’t rush patient, interrupt or
  complete their sentences
 Try to ask questions that require
  short answers
 Look directly at patient when
  asking questions.

 > 40% in US
   20-30% heavier than normal
 Provide thorough exam and obtain
  thorough history
 Make accomodations for their
   Ecg
   Lung sounds
                  Obesity, cont.

 Bariatric ambulance, gurney
 Get enough help
   YOUR safety first
 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
    Stabilize before transport
 Paralyzed patients often have a
  colostomy bag
 Take any other assisting devices;
   Wheelchairs, canes
     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 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 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
 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 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.

 Common physical ailments
   Heart defects
   Intestinal defects
   Chronic lung problems
   Higher risk of cataracts, blindness,
    early onset Alzheimer’s
   Fetal 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

 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.

 Symptoms;
   Painful swelling and irritation of joints
   Joint stiffness and limited ROM
   Smaller joints of feet and hands
    become deformed.
   JRA pt’s; spleen or liver
               Tricks that work

 Pay attention to their meds; you
  may be there to treat s/s of med
   NSAIDs
   Corticosteroids
 Transport;
   Move gently
   Pad joints with pillows

 Patients have greatly increased risk
  of infection
   Rapid onset of sepsis
 Difficult IV start
 Involve patient in decision-making
  as much as possible
               Cerebral 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.
 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.

 Spastic paralysis (most common)
   Muscles in state of permanent stiffness
    and contracture
 Athetosis
   Involuntary writhing movement;
    usually extremities
   May demonstrate drooling, grimacing
                          CP, cont.

 Ataxic cerebral palsy (least
   Problems with coordination of gait
    and balance
              Tricks that work

 Don’t assume you can’t
  communicate – some CP pts are
  highly intelligent
 Use pillows and blankets to pad
 Have suction available
                 Cystic Fibrosis

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

 Although chronically ill, still
  pediatric patients – treat children as
 Provide oxygen and suction
 Take all medications along
            Multiple Sclerosis

 CNS disorder; most between 20 –
  40 y/o
 Autoimmune disorders
   Repeated inflammation = scar tissue =
    blocked impulses to area
   Slow onset
              Tricks that work

 Help pt to position limbs for
 Don’t expect pt to walk
 Bring wheelchair or other devices
        Muscular 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

 A communicable disease
   Affects gray matter and spinal cord
   Enters body through GI tract
 Uncommon in developed countries
      Previous head injuries

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

 A large percentage have
 Up to 73% have latex allergies
 Take along any assistive devices
          Myasthenia Gravis

 Autoimmune disease
   Chronic weakness of voluntary
    muscles, progressive fatigue
   Occurs most frequently in women, 20
    – 50 y/o
  Myasthenia gravis, cont.

 Common c/c;
   Complete lack of energy esp. in
   Facial muscles most commonly
    effected; eyelid drooping or difficulty
    chewing or swallowing
   Double vision
   Respiratory muscles may be affected.
               Tricks that work

 If respiratory distress in noted,
  assist ventilation enroute to hospital
           Culturally diverse
 Ethically required to treat without
  regard for ethnic background –
 How do you provide treatment
  AND respect the patient’s diversity?

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

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