1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 5 Special Considerations/ Operations

2. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 5 The Challenged Patient

3. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Physical Challenges Developmental Disabilities Pathological Challenges Other Challenges

4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction Expect to encounter a number of patients who live with a variety of impairments or special challenges Keys –Understand and recognize the special condition or situation –Make any accommodations that may be needed for proper patient care

5. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Physical Challenges

6. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Hearing Impairments An inability to hear is commonly described as deafness – May be completely deaf – May be partially deaf A person may be deaf in one ear or both ears

7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Types of Hearing Impairment Conductive Deafness –A blockage of the transmission of sound waves through the external ear canal to the middle or inner ear –Causes

8. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Types of Hearing Impairment Sensorineural Deafness –Caused by the inability of nerve impulses to reach the auditory center of the brain because of nerve damage to either the inner ear or to the brain –Causes –Conditions associated with aging

9. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Recognizing Deafness Asking questions repeatedly Misunderstood questions or inappropriate responses Presence of a hearing aid Sign language or gestures

10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Accommodations for Deaf Patients Address patient face to face Speak slowly in a normal voice Reduce background noise as much as possible Help find or adjust hearing aids Use pen and paper Utilize an interpreter

11. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Visual Impairments Note if the impairment is a permanent disability or if it is a new symptom as a result of the illness or injury Etiologies –Injury, disease, congenital conditions, infection, and degeneration of the retina, optic nerve, or nerve pathways

12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Recognizing and Accommodating Visual Impairments Identify yourself as you approach Describe everything you are doing as you do it Service dog –Harness indicates it is working –Do not disturb it

13. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Speech Impairments Types of Speech Impairments –Language disorders Impaired ability to understand the spoken or written word Aphasia –Articulation disorders Affects the way a person’s speech is heard by others –Voice production disorders Quality of the person’s voice is affected –Fluency disorders Present as stuttering

14. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Accommodations for Speech Impairments Never assume the person lacks intelligence Form questions that require short, direct answers Never pretend to understand when you don’t Let the patient write answers to questions © The Scotsman/Corbis Sygna

15. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Obesity 40% of people in the US are obese Excess weight can exacerbate the complaint for which you were called Obesity can lead to many serious medical conditions

16. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Obesity Etiologies –When a person has an abnormal amount of body fat 20-30% heavier than normal weight –Person’s caloric intake is higher than the amount of calories required to meet his energy needs –Genetic factors –Low basal metabolic rate

17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Accommodations for Obese Patients Don’t dismiss signs or symptoms as being a result of obesity Adipose tissue presents an obstruction –EKG electrodes may need to be placed on the arms and legs Do not compromise your health or safety –Ask for assistance when lifting or moving a patient © Stryker Corporation © Ferno-Washington, Inc.

18. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paralysis The patient may have a home ventilator; be sure to keep the airway clear and patent If the patient is in halo traction, be sure to stabilize the traction before transport Be aware of other assistive devices – Colostomy, canes, wheelchairs, etc.

19. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Developmental Disabilities

20. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Developmental Disabilities Patients with impaired or insufficient development of the brain –Unable to learn at the usual rate Causes –Genetic Down syndrome –The product of brain injury Hypoxic event Traumatic event

21. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Accommodations for Developmental Disabilities Persons with developmental disabilities can recognize body language, tone, and disrespect Communication issues

22. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Down Syndrome Results from an extra chromosome –Increases with the age of the mother Especially those greater than 40 Physical features May have other physical ailments –Heart defects, intestinal defects, and chronic lung problems © Silver Burdett Ginn

23. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Fetal Alcohol Syndrome Characteristics –Small head with multiple facial abnormalities –Small eyes with short slits –Wide, flat nose bridge –Lack of a groove between the nose and lip –Small jaw © Fetal Alcohol and Drug Unit [FAS]

24. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathological Challenges

25. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathological Challenges Arthritis Cancer Cerebral palsy Cystic fibrosis Multiple sclerosis Muscular dystrophy Poliomyelitis Previous head injury Spina bifida Myasthenia gravis

26. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Arthritis Types –Juvenile rheumatoid arthritis –Rheumatoid –Osteoarthritis You may be called on to treat a medication side effect rather than the disease Transport considerations © Photo Researchers, Inc.

27. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cancer Primary site of origin of the cancer cells determines the type of cancer –Carcinoma –Sarcoma Treatments for the disease do tend to produce telltale signs –Alopecia (hair loss) –Anorexia –Radiation tattoos –Physical changes

28. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cancer Management –Patient’s risk for infection Chemotherapy leaves patient neutropenic –Veins may have become scarred –Use of med ports Requires specialized training

29. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cerebral Palsy Group of disorders caused by damage to the cerebrum in utero or by trauma during birth Three main types of cerebral palsy –Spastic paralysis Forces muscles into a state of permanent stiffness and contracture –Athetosis Causes involuntary writhing movements –Ataxia Problems with coordination of gait and balance

30. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cerebral Palsy Many people with athetoid and diplegic cerebral palsy are highly intelligent Patients may rely on special devices to help them with their mobility When transporting patients with cerebral palsy, make accommodations to prevent further injury

31. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cystic Fibrosis An inherited disorder that involves the exocrine (mucus-producing) glands –Primarily in lungs and digestive tract Obtaining a complete medical history is important High probability of respiratory distress –Oxygenate –Suction as necessary

32. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Disorder of the central nervous system –Repeated inflammation of the myelin sheath results in scarring –Disordered nerve conduction Initial signs of MS are usually temporary –Repeat attacks result in longer lasting effects –Patient may become bed-bound Multiple Sclerosis

33. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Multiple Sclerosis Click here to view an animation on multiple sclerosis.here

34. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Multiple Sclerosis Generally need only supportive care Ensure all mobility devices are transported with the patient

35. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Muscular Dystrophy A group of hereditary disorders characterized by progressive weakness and wasting of muscle tissue –Duchenne’s is most common type Typically affects boys between the ages of 3 and 6 Respiratory support, such as oxygen, may be needed

36. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Poliomyelitis A communicable disease that affects the gray matter of the CNS –Outbreaks of polio extremely rare The polio virus enters the body through the gastrointestinal tract –Results in paralysis Post-polio syndrome

37. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Previous Head Injuries Symptoms will be related to the area of the brain that has been injured –Aphasia, slurred speech, loss of vision or hearing, or may develop a learning disability Obtaining a medical history from these patients is very important

38. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Spina Bifida A congenital abnormality that falls under the category of neural tube defects –A defect in the closure of the backbone and the spinal canal Spina bifida occulta Spina bifida cystica A large percentage of children born with spina bifida have hydrocephalus

39. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Spina Bifida Many patients have latex allergies Be sure to take along any devices that aid the patient Transport infant in car seat, if indicated

40. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Myasthenia Gravis An autoimmune disease characterized by chronic weakness of voluntary muscles and progressive fatigue –Frequently in women between the ages of 20 and 50 Signs and symptoms Ventilatory support may be necessary

41. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Challenges

42. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Challenges Culturally diverse patients –The ability to tolerate cultural differences will become an important part of your professionalism as a paramedic © Michal Heron

43. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Challenges Terminally ill patients –Many times, the patient will choose to die at home Family calls ambulance at last minute –Patient may call for an ambulance New condition Medication adjustments

44. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Challenges Patients with communicable diseases –Withhold all personal judgment –Take Standard Precautions Keep in mind the heightened sensitivity of the patient –Follow departmental procedures

45. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Financial Challenges Help the patient understand that he can receive health care regardless of his financial situation Become familiar with public hospitals and clinics that provide services © Michal Heron

46. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 5: Special Considerations/Operations, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Physical Challenges Developmental Disabilities Pathological Challenges Other Challenges