Quadriplegia Lecture Note

Technology has provided relief to millions of people suffering from disabilities or chronic conditions. Answer each of the following three questions in a few sentences each. Each part should be at least 300 words. Part 1 - Quadriplegia What are two potential causes of this disability? How does each one work physiologically to render the patient disabled. - There are numerous causes of quadriplegia. But the most common causes is due to damage of the spinal cord. Vertebrae damage is one of the most common factors contributing to this. Quadriplegia is usually caused by damage to the cervical spine, whereas paraplegia is usually due to injuries of the lower sections such as the thoracic or lumbar spinal column. C1, C2, and C3 damage is usually the most severe, sometimes resulting in near total paralysis requiring specialized devices to allow the injured person to breathe (SpinalCord.com). C4 damage may result in the loss of diaphragm control, limited range of motion or paralysis of arms, torso, and legs, and trouble with bowel and bladder control. C5 damage may affect the vocal cords and result in paralysis to the legs, wrists, and hands. C6 and below is less likely to cause complete loss of the functions of arms, in which they may be paralyzed in the legs, torso, and hands, be unable to control their bladder/bowel, and have difficulty speaking normally (SpinalCord.com). Lastly, C7 damage rarely results in quadriplegia, and may result in burning pain in shoulders, back, and arms. The second potential cause of this disability may be due to ALS; also known as Amyotrophic Lateral Sclerosis. This disease causes permanent paralysis. There is sporadic and familial ALS. Sporadic ALS accounts for over 90% of all cases, where familial although less common has roughly a 50% chance of developing ALS (SpinalCord.com). What are two current pieces of technology that might help them have a higher quality of life? - One piece of technology that is improving quality of life in quadriplegics is a mind reading exoskeleton. This device puts two surgically placed implants in the head and is used to read brain activity and transfer them to a nearby computer. These activities read from the brain turn into instructions to control the exoskeleton. This allows one to move their arms and legs, and even possibly walk for the first time since being paralyzed. Second is a smartphone app called Tecla-e. This device connects to the cloud and gives users full access to smart devices, including laptops, Mobile phones, tablets, and smart home technology to control lighting and even thermostats. The app is iOS and Android and requires WiFi connection (Bell, 2019). What logistical and physiological concerns should paramedics have if they run on a patient with this disability? - Logistical and physiologic concerns with running on a quadriplegic patient including moving the patient especially if they are hooked up to ventilator devices, as well as devices to help control bowel movements and feeding devices. This is a logistical concern because obviously they cannot fit in an ambulance. Also it is physiologically challenging because you must maintain the same ventilations for the patients as well as make them comfortable knowing they are unable to move and sometimes unable to speak. Part 2 - Morbid Obesity What are two potential causes of this disability? How does each one work physiologically to render the patient disabled. - One cause of morbid obesity includes overeating, bad diet, and physical inactivity. Essentially an excessive caloric intake, with a low metabolism and low energy expenditure, resulting in a set point of stored energy that is too high. Secondly it could result in something physiologically such as a disease. Some of these diseases include hypothyroidism and insulin resistance. What are two current pieces of technology that might help them have a higher quality of life? - Gyms and the equipment in these facilities are some things that could improve the quality of life; as well as healthier foods and eating choices. There is a lot of information out there in regards to exercise programs, and nutritional programs. Most patients that are morbidly obese are due to lifestyle choices and not exactly metabolic or congenital issues. That is why most of the time it becomes the patient’s responsibility to take control of their own health. The main way to improve quality of life in this situation is to lose weight. Excess weight and body fat reduce the individual’s quality of life and one's ability to do things. What logistical and physiological concerns should paramedics have if they run on a patient with this disability? - Logistical concerns obviously include moving the patient. This patient will be extremely difficult to move, due to probably their inability to move on their own and their shear size. Patients will most likely have poor cardiovascular endurance, so having them move up or down stairs or over long distances will be very difficult to complete. Having help to move the patient from wherever they are, onto the stretcher, and to/into the ambulance will be a challenge in itself. Part 3 - Cystic Fibrosis What are two potential outcomes of this disease? How does the disease affect the body? - Cystic fibrosis is an inherited disorder that causes severe damage to the lungs, digestive system and other organs in the body. It affects the cells that produce mucus, sweat, and digestive juices. This disease can result in damaged airways, chronic infections, growths in the nose, coughing up blood, pneumothorax, respiratory failure, acuter exacerbations, and digestive system complications. These complications include nutritional deficiencies, diabetes, liver disease, intestinal obstruction, distal intestinal obstruction system (DIOS). Cystic fibrosis survivability is in the range of longer than 40 years. 80% of patients with CF should reach adulthood, while death is usually a result of lung disease. What are two current pieces of technology that might help them have a higher quality of life? - The CFTR protein that is defective leads to an imbalance of water and ion flow in and out of cells, which results in thick mucus obstructing airways and trapping bacteria. This causes chronic inflammation. Technology being implemented by a company CRISPR relies on gene editing. This CFTR protein is replaced by “CRISP/Cas-9” technology. It uses a protein RNA complex composed of an enzyme or protein “Cas9” which recognizes the wrong DNA sequence in CFTR and cuts it out (CRISPR/Cas9 Approach for Cystic Fibrosis Treatment, n.d.). A device named the Project Breathe Kit includes a free smartphone app, a fitbit to track activity and sleep, an oximeter to measure oxygen levels in blood and a spirometer that gauges lung function. Patient’s also self-report data such as how much they are coughing and how they are feeling overall. This allows patients to track their health and gives patients the ability to spot patterns of deterioration before it is too late (Bach, n.d.) What logistical and physiological concerns should paramedics have if they run on a patient with this disease? - Treatment concerns for this patient are most directly related physiologically and that is dealing with their respiratory issues. Some CF patients have two to three CF exacerbations a year which sometimes results in hospital stays up to two weeks. Typically these patient’s are treated with albuterol or nebulized treatments (Schauf, 2020). Hypertonic saline in a 3% or 7% concentration can and is also nebulized to clear secretions. Respiratory support is essential for these patients especially during an exacerbation. Respiratory failures is the leading cause of death in 94% of CF patients and is usually the result of a progressive airway obstruction (Schauf, 2020). Typically a nasal cannula with high flow oxygen is adequate; and the hospital may administer more, as well as heated and humidified oxygen. Although as a provider we need to remember that oxygen is a dry gas, and high flow oxygen for an extended period of time may result in mucus plugging (Schauf, 2020). Part 4 - PICC line What are two potential reasons a patient might need one long-term? - PICC lines are peripherally inserted catheters. They are a long thin tube that is inserted through a vein in a patient’s arm and passed through larger veins near their heart. They are very rarely placed in the leg. These lines give doctors access to large central veins near the heart, and are generally used to give medications or nutrition. This helps mitigate and avoid pain from repeated needle sticks and reduce the risk of irritation of the smaller veins. PICC lines could be used or needed long term for cancer treatments, and for liquid nutrition. Cancer treatments use medicines that are infused through the vein, such as chemotherapy and other targeted therapy drugs, in which they are sometimes delivered through a PICC line (Peripherally Inserted Central Catheter (PICC) Line, 2021). Secondly if your body cannot process nutrients from food because of digestive system problems, one may need a PICC line to receive liquid nutrition (Peripherally Inserted Central Catheter (PICC) Line, 2021). What logistical and physiological concerns should paramedics have if they run on a patient with this device - Physiologic concerns include knowing and identifying a patient has a PICC line when doing blood pressures as this could damage the line as well as give an incorrect and inaccurate blood pressure. Also if a patient has a PICC line they typically have an underlying health condition meaning depending on the condition the patient may need special treatment or attention. Secondly, these lines require careful care and monitoring. This is due to complications such as infections and blood clots.