EMS Particular Patient Populations - Spina Bifida

When responding to patients with spina bifida, EMS providers should be aware of the following key points:

1. Understanding Spina Bifida:

   • Spina bifida is a congenital condition characterized by incomplete closure of the spine during fetal development. It can result in varying degrees of spinal cord and nerve damage, leading to physical and neurological impairments.
   • There are different types of spina bifida, including spina bifida occulta (mild, hidden form), meningocele (meninges protruding through a spinal defect), and myelomeningocele (most severe form, with the spinal cord and nerves protruding through an open spinal defect).

2. Neurological Impairments:

   • Patients with spina bifida may experience neurological impairments such as paralysis or weakness in the lower limbs, loss of sensation, bladder and bowel dysfunction, and hydrocephalus (build-up of fluid in the brain).
   • Assess the patient's neurological status, including motor function, sensation, and reflexes, and be prepared to manage any associated complications, such as urinary retention or neurogenic shock.

3. Skin Integrity:

   • Patients with spina bifida, particularly those with myelomeningocele, are at increased risk of skin breakdown and pressure ulcers due to impaired sensation and mobility.
   • Inspect the patient's skin for signs of pressure injuries, and provide appropriate padding and positioning to prevent further skin damage during transport.

4. Bladder & Bowel Management:

   • Bladder and bowel dysfunction are common complications of spina bifida, requiring ongoing management and monitoring.
   • Be prepared to address urinary retention, urinary tract infections, and fecal incontinence, and provide appropriate interventions, such as catheterization or bowel management techniques.

5. Orthopedic Considerations:

   • Orthopedic deformities, such as scoliosis (curvature of the spine), clubfoot, or hip dislocation, may occur in patients with spina bifida and may require surgical correction or orthotic devices.
   • Be aware of any orthopedic issues that may affect the patient's mobility and positioning during transport, and provide appropriate support and accommodations as needed.

6. Hydrocephalus Management:

   • Hydrocephalus is a common complication of spina bifida, resulting from impaired cerebrospinal fluid (CSF) circulation and absorption.
   • Monitor the patient for signs and symptoms of increased intracranial pressure, such as headache, vomiting, or changes in consciousness, and provide timely interventions, such as ventricular shunting or CSF drainage, if necessary.

7. Psychosocial Support:

   • Living with spina bifida can have a significant impact on the patient's emotional well-being, as well as on their family members and caregivers.
   • Provide emotional support and reassurance to the patient and their caregivers, and connect them with appropriate community resources and support networks as needed.

8. Collaboration with Healthcare Providers:

   • Communicate with the patient's primary care provider or specialists, such as neurosurgeons, orthopedic surgeons, urologists, or rehabilitation specialists, to obtain relevant medical history and treatment information.
   • 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 spina bifida, 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 Anatomy & Physiology - Curvature of the Spine

 

EMS Providers should have a basic understanding of skeletal issues like kyphosis, lordosis, and scoliosis, as well as related problems, to provide appropriate care for patients.

Here are a few key points:

Identification: EMS providers should be able to identify these skeletal issues through visual observation and patient history.

1. Kyphosis: Kyphosis refers to an excessive forward curvature of the upper spine, leading to a rounded or hunched posture. It can be caused by several factors, including poor posture, osteoporosis, spinal fractures, or certain medical conditions. EMS providers should be aware of the potential for compromised breathing and mobility in patients with severe kyphosis.

2. Lordosis: Lordosis is an excessive inward curvature of the lower spine, commonly known as swayback. It can be caused by various factors such as obesity, pregnancy, muscle imbalances, or certain medical conditions. EMS providers should be cautious of potential back pain and difficulty maintaining a supine position in patients with pronounced lordosis.

3. Scoliosis: Scoliosis is a medical condition characterized by an abnormal sideways curvature of the spine. This condition can manifest in various degrees of severity and is often idiopathic, meaning the cause is unknown. However, it can also result from congenital factors, neuromuscular conditions, or trauma.

Symptoms: Be aware of common symptoms associated with these conditions, such as pain, limited range of motion, and respiratory difficulties, which can occur due to the abnormal spinal curvature.

Assessment: Conduct a thorough physical assessment to evaluate the severity of the condition, including the degree of curvature, associated deformities, and neurological symptoms.

Stabilization: When immobilizing the patient, EMS providers should consider the unique spinal curvature and use appropriate spinal immobilization techniques to ensure patient comfort and safety. This may involve padding and positioning devices to accommodate the curvature.

Transport: Ensure safe and appropriate transport of patients with these conditions. They may require specialized equipment, such as scoop stretchers or vacuum mattresses, to maintain proper spinal alignment.

Communication: Effective communication with the patient is crucial. Ensure the patient is comfortable and aware of the care being provided. Also, obtain a medical history to determine if there are underlying causes or exacerbating factors related to the skeletal issue.

Related Problems: Understand that these skeletal issues can lead to other medical problems. For example, kyphosis and lordosis can cause respiratory issues by reducing lung capacity, so monitor the patient's respiratory status carefully. They might also be at a higher risk of spinal fractures or other spinal cord injuries. Additionally, scoliosis can sometimes be associated with cardiac and pulmonary complications, which should be considered during patient assessment.

Medication and Pain Management: Be aware of any medications the patient is taking, as well as their potential side effects and interactions. Patients with these conditions may require pain management during transport, so be prepared to administer appropriate pain relief under medical direction.

Special Considerations: Individuals with skeletal issues may require special handling, including assistance with transfers, lifting, or moving the patient. Consider the patient's comfort and any potential complications that may arise from moving them.

Collaboration: Work closely with other healthcare providers, including receiving facilities and specialists, to ensure a seamless transition of care and to address any specific needs related to the patient's condition.

Conclusion

Remember that each patient's needs may vary, so adapt your care accordingly. Additionally, staying updated on current guidelines and protocols for spinal immobilization and care of patients with skeletal issues is essential to providing appropriate care in the field.

It is always important to work collaboratively with other healthcare professionals to ensure optimal care for patients with these conditions.

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

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