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EMS for children with special needs Carlos Villavicencio, MD, FAAP Clinical Assistant Professor, UW School of Medicine EMS Conference, February 4, 2011 Slide 2 Disclosures I have no financial conflicts of interest I have a son with CP Slide 3 Objectives At the end of the presentation, participants should: 1.Recognize unique challenges in kids with special needs 2.Recognize common challenges in kids with special needs 3.Understand utility and layout of Emergency Information Form (EIF) 4.Recognize some unique situations and how to address them clinically Slide 4 Definitions Who are children with special needs? Diagnoses CP Seizures CLD or Asthma Muscular Dystrophy Slide 5 Definitions Devices Ventilators Feeding tubes Cincinnatichildrens.org VP shunt Blogs.naver.com/youjinch O 2 www.articles.complexchild.com Cincinnatichildrens.org Slide 6 Definitions Who are children with special needs? Special Needs: Medications Complex Management Plans Particularly vulnerable and prone to complications Slide 7 Some General Statistics www.cartoonstock.com Slide 8 Seeking Emergency Care Age distribution Prehospital Emergency Care 2000; 4:19-23 Slide 9 Seeking Emergency Care Related or unrelated to underlying condition? Prehospital Emergency Care 2000; 4:19-23 Slide 10 Seeking Emergency Care Related or unrelated by diagnosis Prehospital Emergency Care 2000; 4:19-23 Slide 11 Most Common Interventions RelatedUnrelated O2O2 C- collar Wounds Glucose (IV or PO) Peripheral IV Albuterol Slide 12 www.demotination.com Slide 13 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 14 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 15 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 16 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 17 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 18 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 19 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 20 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 21 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 22 Emergency Information Form - EIF http://www.aap.org/advocacy/eif.doc Slide 23 Specific Conditions www.legacystation.com Slide 24 Specific Conditions: Tracheostomies Focus on chronic tracheostomy Indications: Upper airway obstruction Pierre-Robin (congenital) vs. Acquired Chronic mechanical ventilation Inability to clear secretions Neuromuscular disease Slide 25 Specific Conditions: Tracheostomies http://commons.wikimedia.org Cuffed Cuffless Slide 26 Specific Conditions: Tracheostomies Obstruction Attempt suctioning using largest diameter possible for < 5 sec If still obstructed, urgently replace with new cannula Slide 27 Tracheostomy sizing chart Slide 28 Slide 29 Replacing a Tracheostomy Tube - Video http://www.tracheostomy.com Slide 30 Specific Conditions: Replacing a Tracheostomy Steps: 1 Remove inner cannula 2 Insert obturator 3 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 obturator 6 Confirm position, inflate cuffed tubes Slide 31 Specific Conditions Gastrostomy Tubes http://tofs.org.uk Slide 32 Complication: Gastrostomy tube dislodged Key emergency action: Can replace with foley Use same size or 1 smaller Dont inflate balloon if