1. Paramedic Care Principles & Practice Volume 5 Special Considerations / Operations Second Edition Chapter 6 Acute Interventions for the Chronic Care Patient

2. Figure 6-1 The home health care provider usually knows the patient better than anyone else and will often spot subtle changes in the patient’s condition. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

3. Figure 6-2 Pressure sores are classified by the depth of tissue destruction. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

4. Figure 6-2b Stage 2. Skin blister or shallow skin ulcer. Involves the epidermis. Looks like a shallow crater. Area is red, warm, and may or may not have drainage. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

5. Figure 6-2c Stage 3. Full-thickness skin loss exposing subcutaneous tissue, may extend into the next layer. Edema, inflammation, and necrosis present. Drainage present, which may or may not have an odor. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

6. Figure 6-2d Stage 4. Full-thickness ulcer. Muscle and/or bone can be seen. Infection and necrosis is present. Drainage present, which may or may not have an odor. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

7. Figure 6-3 EMS personnel must become familiar with the common medical devices that they may encounter when providing interventions for the chronic care patient. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

8. Figure 6-4 When assessing a chronic care patient, tailor your questions to the home care setting. Remember that the stress in many home care settings, or fear of removal from the home, can increase patient confusion. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

9. Figure 6-5 If the home equipment for a COPD patient fails or is insufficient, you may have to replace it with equipment from the ALS unit. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

10. Figure 6-6 Artificial ventilation can be accomplished in the patient with a tracheostomy tube by attaching the bag- valve device directly to the tube. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

11. Figure 6-7 Sleep apnea patients will often use continuous positive airway pressure (CPAP) to keep their airways open. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

12. Figure 6-8 An A-V shunt is a loop connecting an artery and a vein, usually in the distal arm, where the dialysis apparatus draws and returns blood. It is used in home care patients requiring dialysis. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

13. Figure 6-9 An external urinary tract device. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

14. Figure 6-10 An internal urinary catheter with balloon. Note sites where bacteria can enter. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

15. Figure 6-11 A nasogastric feeding tube. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

16. Figure 6-12 A gastrostomy feeding tube. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

17. Figure 6-13 Examples of colostomy stoma locations. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

18. Figure 6-14 The incidence of AIDS and HIV infection in children is increasing worldwide. These children may be among the patients that you encounter in a hospice setting. Bryan E. Bledsoe, Robert S. Porter, and Richard A. Cherry Paramedic Care, Principles & Practice: Special Considerations / Operations Copyright ©2006 by Prentice-Hall, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.