Name

EMS for children with special needs

Carlos Villavicencio, MD, FAAPClinical Assistant Professor, UW School of MedicineEMS Conference, February 4, 2011DisclosuresI have no financial conflicts of interestI have a son with CPObjectivesAt the end of the presentation, participants should:

Recognize unique challenges in kids with special needsRecognize common challenges in kids with special needsUnderstand utility and layout of Emergency Information Form (EIF)Recognize some unique situations and how to address them clinicallyDefinitions

Who are children with special needs? Diagnoses CP Seizures CLD or Asthma Muscular DystrophyPrettify with pictures of kids, diagnoses4DefinitionsDevices Ventilators Feeding tubes

Cincinnatichildrens.org

VP shunt

Blogs.naver.com/youjinch

O2

www.articles.complexchild.com

Cincinnatichildrens.orgPrettify with pictures of kids, diagnoses5DefinitionsWho are children with special needs?

Special Needs:

MedicationsComplex Management Plans

Particularly vulnerable and prone to complicationsPrettify with pictures of kids, diagnoses6Some General Statistics

www.cartoonstock.comSeeking Emergency CareAge distribution

Prehospital Emergency Care 2000; 4:19-231.7% of the one years total 911 responses in the Tucson area, totals 55,892 and 924.8Seeking Emergency CareRelated or unrelated to underlying condition?

Prehospital Emergency Care 2000; 4:19-23Seeking Emergency CareRelated or unrelated by diagnosis

Prehospital Emergency Care 2000; 4:19-23Most Common InterventionsRelatedUnrelated

O2C-collarWoundsGlucose (IV or PO)Peripheral IVAlbuterolO2C-collarWounds / FracturesGlucosePeripheral IVAlbuterolWhat about transports? 72% of responses involved transport, but significantly fewer transports for related responses vs. unrelated responses.11

www.demotination.comWe say that Hindsight is 20/20 what if we can anticipate needs?12Emergency Information Form - EIF

http://www.aap.org/advocacy/eif.docDONT FORGET TO LOOK FOR MEDICAL ALERT BRACELETS, NECKLACES, OR SHOE TAGS

13Emergency Information Form - EIFhttp://www.aap.org/advocacy/eif.doc

If time, fill in some of the fields with random information would be good to fill in for Carlos!!

14Emergency Information Form - EIF

http://www.aap.org/advocacy/eif.docEmergency Information Form - EIFhttp://www.aap.org/advocacy/eif.doc

Emergency Information Form - EIF

http://www.aap.org/advocacy/eif.docEmergency Information Form - EIFhttp://www.aap.org/advocacy/eif.doc

Emergency Information Form - EIF

http://www.aap.org/advocacy/eif.docEmergency Information Form - EIFhttp://www.aap.org/advocacy/eif.doc

Emergency Information Form - EIF

http://www.aap.org/advocacy/eif.docEmergency Information Form - EIFhttp://www.aap.org/advocacy/eif.doc

Specific Conditions

www.legacystation.comSpecific Conditions: TracheostomiesFocus on chronic tracheostomy

Indications:Upper airway obstructionPierre-Robin (congenital) vs. AcquiredChronic mechanical ventilationInability to clear secretionsNeuromuscular disease

Specific Conditions: Tracheostomies

http://commons.wikimedia.orgCuffed

CufflessSpecific Conditions: TracheostomiesObstruction

Attempt suctioning using largest diameter possible for < 5 sec

If still obstructed, urgently replace with new cannula

Tracheostomy sizing chart

Tracheostomy sizing chart

Replacing a Tracheostomy Tube - Video

http://www.tracheostomy.comSpecific Conditions: Replacing a TracheostomySteps:

1 Remove inner cannula 2 Insert obturator3 Extend patients neck using shoulder roll

4 Insert tube into stoma in smooth, curved motion. No resistance should be felt. If excessive force used, can cause false track

5 Remove obturator6 Confirm position, inflate cuffed tubesClean up slide, condense language, highlight steps from previous video.

Remember in step 5 REMOVE OBTURATOR30Specific ConditionsGastrostomy Tubes

http://tofs.org.uk

Complication: Gastrostomy tube dislodgedKey emergency action:

Can replace with foleyUse same size or 1 smallerDont inflate balloon if