Chapter 37: Patients with Special Challenges - Emergency Care and Transportation of the Sick and Injured (12th Edition)

Learning Objectives

• Understand the special needs of patients with developmental, sensory, and physical disabilities.
• Learn about the unique anatomy and physiology, and the assessment and treatment required for these patients.
• Explore care considerations for patients reliant on medical technology.
• Discuss management considerations for obese patients.

Introduction

• More individuals with chronic diseases live at home, using medical technology for assistance.
• Includes children born prematurely with respiratory issues, congenital heart disease, and neurologic diseases.
• Sensory defects like hearing or visual impairments and geriatric patients often require home health services.
• Focus on the patient, not the noise/mechanics of medical equipment. Follow ABCs.

Intellectual and Developmental Disabilities

Intellectual Disability

• Significant limitations in intellectual and daily living skills.
• Diagnosis before age 18, ranges from mild to profound.
• Causes: genetic, congenital, birth complications, environmental factors, traumatic brain injury.

Autism Spectrum Disorder

• Characterized by deficits in social communication and restrictive behaviors.
• Sensory abnormalities common.
• More common in males.
• Use simple phrases, calm environment, allow extra time for communication.

Down Syndrome

• Genetic chromosomal defect causing intellectual impairment.
• Physical traits: round head, large tongue, slanted eyes.
• Risk factors: increased maternal age, family history.
• Higher risk for leukemia, heart defects, other medical complications.

Physical Disabilities

Cerebral Palsy

• Poorly controlled body movement due to brain damage during fetal development.
• Watch airway closely, facilitate comfort, anticipate seizures.

Spina Bifida

• Incomplete closure of the spinal column during development.
• Associated issues: hydrocephalus, paralysis, bladder control loss.

Paralysis

• From stroke, trauma, or birth defects.
• May require ventilators or have communication challenges.

Obesity

• Excessive body fat, can affect mobility and quality of life.
• Plan for extra help and specialized equipment for transport.
• Communicate effectively to prevent injury.

Medical Technology Assistance

Tracheostomy Tubes

• Pathway between neck and trachea; requires frequent suctioning.
• Use D.O.P.E mnemonic for troubleshooting.

Home Oxygen

• Compressed oxygen cylinders or oxygen concentrators.
• Know patient's baseline oxygen requirements.

Mechanical Ventilators

• Used when patients cannot breathe independently.
• Know ventilator operation and procedure if malfunction occurs.

Cardiac Pacemakers and Ventricular Assist Devices

• Internal devices regulating heart rhythm.
• Ensure not to place defibrillator pads over the device.

Other Devices

• Apnea monitors, central venous catheters, gastronomy tubes, shunts, vagal nerve stimulators.
• Know care and troubleshooting for each device type.

Patient Assessment Guidelines

• Interaction with caregivers is crucial.
• Determine patient's baseline status and changes.
• Home care services vary widely and include many support services.

End-of-Life Care (Hospice)

• Provides comfort care, improving quality of life before death.
• Follow local protocols, respect patient and family wishes.

Special Considerations

• Poverty and homelessness impact access to care and health outcomes.
• Familiarity with local social services can aid in providing comprehensive care.

Quiz Review

• Autism is characterized by impaired social interaction.
• Known risk factor for Down syndrome: increased maternal age.
• Intubation is challenging in patients with Down syndrome.
• Shunts commonly used in patients with hydrocephalus/spina bifida.
• D.O.P.E mnemonic helps identify airway obstructions.
• G-tube is for feeding patients unable to ingest food orally.

Closing Remarks

• Remember the importance of dignity and respect when interacting with patients with special challenges.
• Continuing education and awareness are key to effective care.

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