EMS Peculiar Patient Presentation - Acromegaly

EMS Providers should be aware of the condition know as acromegaly and the potential issues it may cause in the prehospital setting.

Acromegaly is a rare hormonal disorder characterized by the excessive production of growth hormone (GH), usually caused by a noncancerous tumor of the pituitary gland.

Here are some key points for EMS providers to consider:

Recognizing Symptoms:

Acromegaly is often associated with gradual changes in physical appearance, including enlargement of the hands, feet, and facial features.

Other symptoms may include joint pain, fatigue, headaches, and changes in vision.

Airway Management: Enlargement of facial features may pose challenges for airway management. EMS providers should be prepared to address potential difficulties in intubation.

Cardiovascular Considerations: Acromegaly can lead to cardiovascular complications such as hypertension and cardiomyopathy. Monitor blood pressure and be alert to signs of heart failure.

Medication History: Patients with acromegaly may be on medications to control GH levels. It's important to inquire about any prescribed medications and their potential interactions.

Communication Challenges: Enlargement of the tongue and other facial structures may affect communication. EMS providers should use clear and concise communication and consider alternative methods if necessary.

Temperature Regulation: Acromegalic patients may have difficulty regulating body temperature. Monitor for signs of hyperthermia or hypothermia.

Pain Management: Joint pain is a common symptom in acromegaly. Assess and manage pain appropriately, considering the patient's condition.

Transport Considerations: Patients with acromegaly may require special considerations during transport, such as ensuring adequate space and comfort due to their altered physical appearance.

Collaboration with Healthcare Providers: Communicate with receiving healthcare providers about the patient's acromegaly and any specific concerns or considerations that may impact ongoing care.

It's essential for EMS Providers to stay informed about rare medical conditions like acromegaly and be prepared to adapt their approach based on the unique challenges these patients may present. 

Further Reading:

Maione, L. & Chanson, P. (2022) Acromegaly. In: Tamagno, G., & Gahete, M.D. (Eds) Pituitary Adenomas. Springer Cham.

https://link.springer.com/cha.../10.1007/978-3-030-90475-3_5

EMS Particular Patient Populations - Geriatric Emergencies

EMS providers play a crucial role in managing geriatric emergencies, as the elderly population often presents with unique medical challenges.

Here are some key considerations, common presentations, and possible treatment plans for geriatric emergencies in the prehospital setting:

Key Considerations:

Physiological Changes: Aging leads to physiological changes, such as decreased organ function, altered drug metabolism, and reduced reserve capacity. Be mindful of these changes when assessing and treating elderly patients.

Atypical Presentations: Geriatric patients may present with atypical symptoms, making diagnosis challenging. For example, myocardial infarction may manifest as confusion or weakness rather than classic chest pain.

Polypharmacy: Elderly individuals often take multiple medications, increasing the risk of drug interactions and adverse effects. Obtain an accurate medication history and be alert to potential complications.

Frailty and Fall Risk: Falls are a common geriatric emergency. Assess for frailty, perform fall risk assessments, and address environmental factors that may contribute to falls.

Cognitive Impairment: Cognitive conditions like dementia can complicate patient assessment and communication. Collaborate with family members or caregivers for additional information.

Common Presentations:

Falls: Assess for injuries, especially head injuries and fractures. Consider the possibility of syncope, medication-related issues, or environmental factors contributing to the fall.

Chest Pain and Cardiac Issues: Look beyond classic symptoms; consider fatigue, shortness of breath, or altered mental status. Monitor for signs of heart failure or arrhythmias.

Respiratory Distress: Evaluate for pneumonia, chronic obstructive pulmonary disease (COPD) exacerbation, or heart failure. Be aware of potential complications related to decreased respiratory reserve.

Altered Mental Status: Determine the cause, considering infectious, metabolic, or neurological etiologies. Hypoglycemia, infections, and medication side effects are common contributors.

Abdominal Pain: Assess for gastrointestinal issues, urinary tract infections, or other abdominal pathologies. Consider the possibility of atypical presentations.

Common Treatment Plans:

Airway Management: Be prepared for airway management challenges, especially if the patient has altered anatomy or decreased respiratory reserve.

Pain Management: Manage pain appropriately, considering the potential for undertreatment due to fears of side effects or drug interactions.

Medication Administration: Administer medications cautiously, considering altered pharmacokinetics and potential drug interactions. Be aware of medications that may cause or exacerbate falls.

Fluid Management: Monitor fluid status carefully, especially in patients with heart failure. Adjust fluid administration based on the patient's hemodynamic status.

Transport to Appropriate Facilities: Consider transporting geriatric patients to facilities with expertise in the care of the elderly, as they may have specialized resources and staff.

Collaboration with Family and Caregivers: Communicate effectively with family members or caregivers to gather crucial information and involve them in the decision-making process.

Prevention Strategies: Provide education on fall prevention, medication management, and strategies to maintain overall health and well-being.

Conclusion:

EMS providers should approach geriatric emergencies with a comprehensive understanding of the unique challenges associated with the elderly population.

By considering the physiological changes, atypical presentations, and specific needs of geriatric patients, EMS providers can deliver more effective and tailored prehospital care.

Ongoing education and training in geriatric emergency medicine are essential for improving outcomes in this vulnerable population.

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