EMS Particular Patient Populations - Multiple Sclerosis

EMS providers should be aware of the following key points when responding to patients with multiple sclerosis (MS):

1. Understanding Multiple Sclerosis:

   • Multiple sclerosis is a chronic autoimmune disorder that affects the central nervous system (brain and spinal cord). It is characterized by inflammation, demyelination (damage to the protective covering of nerve fibers), and neurodegeneration.
   • MS can cause a wide range of symptoms, including fatigue, muscle weakness, numbness or tingling, balance problems, vision disturbances, and cognitive impairment.
   • The course of MS can vary widely among individuals, with periods of relapse (exacerbations) followed by periods of remission. Some individuals may experience progressive disability over time.

2. Neurological Symptoms:

   • Patients with MS may present with a variety of neurological symptoms, depending on the location and severity of nerve damage. Common symptoms include weakness or paralysis of the limbs, sensory disturbances, difficulty walking or balancing, and vision problems.
   • Be alert for signs of acute exacerbations, such as sudden worsening of symptoms or new neurological deficits, which may require immediate medical attention.

3. Mobility & Functional Status:

   • MS-related mobility impairments may affect the patient's ability to move independently, transfer between positions, or navigate stairs and uneven terrain.
   • Assist the patient with mobility aids or devices as needed, and take precautions to prevent falls or injuries during the transport process.

4. Fatigue & Weakness:

   • Fatigue is a common and debilitating symptom of MS that can significantly impact the patient's ability to perform activities of daily living.
   • Be aware that patients with MS may experience sudden onset of fatigue or weakness during times of stress, exertion, or temperature changes.

5. Bladder & Bowel Dysfunction:

   • MS can affect the function of the bladder and bowel, leading to urinary urgency, frequency, or retention, as well as constipation or fecal incontinence.
   • Be prepared to address any bladder or bowel-related concerns and provide appropriate assistance and support to the patient during the transport process.

6. Cognitive & Emotional Impacts:

   • MS can affect cognitive function, including memory, attention, and processing speed. Patients may experience difficulties with concentration, problem-solving, and multitasking.
   • Be patient and supportive when communicating with patients with MS, and allow extra time for processing information and making decisions.
   • Recognize the emotional impact of living with a chronic and unpredictable condition like MS, and provide reassurance and empathy to the patient and their caregivers.

7. Medications & Treatments:

   • MS patients may be prescribed disease-modifying therapies (DMTs) to reduce disease activity and slow the progression of disability.
   • Be aware of any medications that the patient is taking for symptom management, such as corticosteroids for acute exacerbations or medications for spasticity, pain, or bladder dysfunction.

8. Collaboration with Healthcare Providers:

   • Communicate with the patient's neurologist or MS specialist to obtain relevant medical history, treatment information, and guidance on managing acute exacerbations or complications.
   • Provide a detailed report to the receiving healthcare facility to ensure that the patient's ongoing medical needs are addressed and that appropriate follow-up care is arranged.

By being knowledgeable about the unique challenges and needs of patients with multiple sclerosis, EMS providers can deliver compassionate and effective care that supports optimal outcomes and enhances the patient's overall well-being.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell

EMS Particular Patient Presentations - Graves' Disease

EMS providers should have an understanding of Graves' Disease and its potential implications for prehospital care. 

Graves' disease is an autoimmune disorder characterized by overactivity of the thyroid gland, leading to hyperthyroidism. This condition is caused by autoantibodies that stimulate the thyroid gland to produce excessive amounts of thyroid hormone.

In terms of prehospital care, EMS providers should be aware of the signs and symptoms of Graves' disease, which may include:

Hyperthyroid Symptoms: Patients with Graves' disease may exhibit symptoms such as rapid heartbeat (tachycardia), palpitations, tremors, heat intolerance, excessive sweating, weight loss despite increased appetite, and fatigue.

Ophthalmic Manifestations: Graves' disease can also cause eye-related symptoms known as Graves' ophthalmopathy or thyroid eye disease. These symptoms may include bulging eyes (exophthalmos), eye irritation, redness, double vision, and vision changes.

Thyroid Gland Enlargement: Some patients with Graves' disease may have a visibly enlarged thyroid gland (goiter) due to thyroid hyperplasia or nodular growth.

Psychological Symptoms: Patients may experience anxiety, irritability, mood swings, and difficulty concentrating due to the effects of excess thyroid hormone on the nervous system.

In terms of potential issues for prehospital care, EMS providers should consider the following:

Cardiovascular Complications: Patients with Graves' disease may be at increased risk of cardiovascular complications such as atrial fibrillation, heart failure, or cardiac arrest due to the effects of excess thyroid hormone on heart function.

Thyroid Storm: In severe cases, Graves' disease can lead to a life-threatening condition known as thyroid storm, characterized by severe hyperthyroidism and systemic decompensation. EMS providers should be prepared to recognize and manage thyroid storm promptly, including supportive measures and administration of medications to control thyroid hormone levels.

Ophthalmic Emergencies: Patients with Graves' ophthalmopathy may present with severe eye symptoms requiring immediate attention, such as corneal ulceration, optic nerve compression, or vision loss. EMS providers should be prepared to provide appropriate eye care and ensure prompt transport to a facility capable of managing ophthalmic emergencies.

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The discovery of Graves' disease is credited to Dr. Robert J. Graves, an Irish physician. 

Dr. Graves first described the condition in 1835 in a paper titled "New Observations on the Diseases of the Thyroid Gland," where he detailed the clinical features of patients with hyperthyroidism associated with goiter and ophthalmic manifestations. 

Dr. Graves' pioneering work laid the groundwork for understanding and diagnosing Graves' disease, and he is recognized as a key figure in the history of endocrinology.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 1 (6th Ed) Pearson.  

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education