Chapter 12 Special Populations EMR 12-1 1-

Introduction Emergency Medical Responders (EMRs) work with many different populations, including obstetric, neonatal, pediatric, geriatric, and the specially challenged EMRs also encounter patients with mental health disorders and substance abuse problems This chapter gives an overview of these special populations and the methods for assessing and managing these patients EMR 12-2 1-

Obstetrics and Related Emergencies Learning Objective 1 Obstetrics and Related Emergencies OBSTETRIC PATIENTS Overview Ectopic pregnancy Miscarriage Gestational diabetes EMR 12-3

Obstetrics and Related Emergencies Learning Objective 1 Obstetrics and Related Emergencies OBSTETRIC PATIENTS Preeclampsia and eclampsia Blunt force abdominal trauma Obstructed airway Motor vehicle crash EMR 12-4

Name and Explain the Stages of Labor Learning Objective 2 Name and Explain the Stages of Labor CHILDBIRTH Overview Obtain an OB history Bloody show Bag of waters (amniotic sac) Cont. EMR 12-5

Name and Explain the Stages of Labor Learning Objective 2 Name and Explain the Stages of Labor CHILDBIRTH Labor: 1st pregnancy 12-16 sometime up to 30 hours Stage one: dilation complete at 10cm Stage two: delivery Apgar score Stage three: placenta Delivery complications Breech Prolapsed umbilical cord Newborn Resuscitation EMR 12-6

Name and Explain the Stages of Labor Learning Objective 2 Name and Explain the Stages of Labor NEWBORN RESUSCITATION If color is not pink, oxygen may be needed Blow-by oxygen Unresponsive, check brachial pulse If less than 60 beat/min., start compressions Ventilate with BVM, 40 to 60 breaths/min. EMR 12-7

Name and Explain the Stages of Labor Learning Objective 2 Name and Explain the Stages of Labor POST DELIVERY CARE OF THE MOTHER Concentrate on mother’s bleeding Massage uterus Allow mother to breastfeed Use sanitary napkins to contain external bleeding Provide oxygen with a nasal cannula EMR 12-8

Assessment and Management of Neonates Learning Objective 3 Assessment and Management of Neonates NEONATES Birth up to one month of age Problems of transition Nose breathers, except during in pain or experiencing hypoxia Breathing dependent on diaphragm May lose 5–10 percent of body weight in first week of life EMR 12-9

Assessment and Management of Neonates Learning Objective 3 Assessment and Management of Neonates NEONATAL ASSESSMENT AND MANAGEMENT Assess airway, breathing, and circulation Hyperextension of neck Suspected obstruction and AHA guidelines Use blow-by oxygen Pediatric Glasgow Coma Scale EMR 12-10

Pediatric Assessment Triangle Learning Objective 4 Pediatric Assessment Triangle PEDIATRICS Medical specialty dealing with children AHA classifications for CPR Infant: birth to one year Child: one year to puberty Children have a good ability to compensate Important to closely monitor EMR 12-11

Pediatric Assessment Triangle Learning Objective 4 Pediatric Assessment Triangle PEDIATRIC ASSESSMENT TRIANGLE Overview Observational tool for assessment Appearance Work of breathing assessment Circulation assessment EMR 12-12

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient PEDIATRIC ASSESSMENT AND MANAGEMENT Obtain general impression from PAT Altered mental status assessment Breathing management Circulatory emergency management Vital signs EMR 12-13

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient TRAUMA EMERGENCIES Trauma causes more death in children than all other causes combined Other trauma emergencies Assessment tools for pediatric trauma patient Assessing a conscious child EMR 12-14

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient MEDICAL EMERGENCIES Calmly approach patient Engage child whenever possible Begin with feet and work toward head Distract child if possible Keep parent or caregiver close EMR 12-15

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient AIRWAY EMERGENCIES Some pathogen causes Croup Bacterial tracheitis Epiglottitis Pneumonia Asthma EMR 12-16

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient POISONINGS Children explore with their mouths Common pediatric medical emergency Secure ABCs National Poison Control Center Give suspected poison container to EMS EMR 12-17

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient DEHYDRATION Can occur very quickly in an infant or a child Inadequate fluid intake, vomiting, or diarrhea Signs and symptoms Loss of consciousness can happen quickly Seek rapid transport EMR 12-18

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient SEIZURES Most common are caused by high fever Febrile seizures Protect from injury Manage airway Seek transport immediately EMR 12-19

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient TYPE I DIABETES Pancreas secretes little or no insulin Complications Hypoglycemia Hyperglycemia EMR 12-20

Assessment and Management Learning Objective 5 Assessment and Management of Pediatric Patient SUDDEN INFANT DEATH SYNDROME (SIDS) Sudden and unexplainable death Healthy-looking infant First year of life Usually while sleeping Aggressively attempt to resuscitate Show compassion EMR 12-21

Assessment and Management Learning Objective 6 Assessment and Management of Geriatric Patient GERIATRICS Overview Common emergencies Aging factors Assessment and management Communication EMR 12-22

Assessment and Management Learning Objective 6 Assessment and Management of Geriatric Patient GERIATRIC INTERVENTIONS Overview Altered mental status Dementia Depression Skin Cont. EMR 12-23

Assessment and Management Learning Objective 6 Assessment and Management of Geriatric Patient GERIATRIC INTERVENTIONS Hypovolemia Diabetes Trauma Medications EMR 12-24

Management for Specially Learning Objective 7 Management for Specially Challenged Patients SPECIALLY CHALLENGED PATIENTS Overview Legal issues Considerations before an emergency Physically challenged Medical complications Assessment and management Cont. EMR 12-25

Management for Specially Learning Objective 7 Management for Specially Challenged Patients SPECIALLY CHALLENGED PATIENTS Wheelchair considerations Removing from wheelchairs Cognitive/behaviorally challenged Assessment and management Self-stimulating versus self-injurious behaviors Fire rescue of a challenged adult or child EMR 12-26

Methods for Managing Abuse and Neglect Learning Objective 8 Methods for Managing Abuse and Neglect ABUSE AND NEGLECT Pregnant women Child abuse and neglect Geriatric abuse and neglect Sexual abuse Assessment of abuse and neglect Management of abuse and neglect EMR 12-27

Seven Categories of Mental Health Disorders Learning Objective 9 Seven Categories of Mental Health Disorders MENTAL HEALTH DISORDERS Overview Pronounced emotional or behavior impairments Depression Anxiety disorders Personality disorders Cont. EMR 12-28

Seven Categories of Mental Health Disorders Learning Objective 9 Seven Categories of Mental Health Disorders MENTAL HEALTH DISORDERS Schizophrenia Dissociative disorder Somatoform disorder Eating disorder Anorexia Bulimia EMR 12-29

Stimulant, Hallucinogen, and Depressant Use Learning Objective 10 Stimulant, Hallucinogen, and Depressant Use SUBSTANCE ABUSE AND MISUSE Overview Affects processes of the mind, body, or both Substance abuse considerations Types of substances Substance abuse patient management EMR 12-30

Methods for Managing Crisis Situations Learning Objective 11 Methods for Managing Crisis Situations CRISIS MANAGEMENT Agitated or aggressive patients Signs and symptoms Management Depressed and suicidal patients EMR 12-31

Summary Must be knowledgeable of basic physical, cognitive, and behavioral conditions that may be present in special populations of all ages An EMR needs to be aware of medical conditions that frequently occur in OB patients, neonates, pediatric patients, and geriatric patients and the care that should be provided as well as medical problems that frequently affect specially challenged populations Cont. EMR 12-32 1-

Summary The EMR will also respond to emergency calls involving abused children and adults and substance abuse or overdoses Ensuring scene safety and activating law enforcement are common threads in the care of all behavioral and mental health disorders EMR 12-33 1-