Emergency Care Considerations
If your child suddenly becomes sick or injured, it is extremely important that you have the following information with you when talking to the emergency staff.
General Recommendations & Precautions
- Keep immunizations up to date and get influenza vaccine annually
- People taking daily, long term steroids should avoid live vaccines when possible
- Always wear seat belts – in the car AND the wheelchair/scooter
- Learn more about vaccination recommendations for people with Duchenne
If you/your child is having problems with breathing (shortness of breath, difficulty breathing, etc.), remember:
- Risk: Respiratory failure.
- Only give oxygen with close monitoring of CO2 levels; breathing may need to be supported (with BiPAP, for example).
- If oxygen levels are low, assisted coughing (with cough assist machine or Ambu bag) may help.
- Take your equipment (cough assist, BiPAP, etc.) with you to the hospital/emergency room (ER); alert your neuromuscular team that you are going to the ER/hospital.
- Learn more about pulmonary (lung) care in Duchenne.
Broken or suspected broken bone/fall/trauma
If you suspect that you/your child may have broken a bone or has has a fall/trauma, remember:
- If ambulatory: Ask if internal fixation/surgery rather than casting, may be possible. Surgery may help preserve walking.
- If your child has had a fall or a leg injury, and has rapid onset shortness of breath/difficulty breathing, changes in alertness (confusion, agitation, disorientation) this is an emergency; go immediately to the ER and alert staff that symptoms could be due to Fat Embolism Syndrome (FES).
Risk of Fat Embolism Syndrome (FES) Following a Fall /Fracture /Trauma:
- Extremely rare.
- Results when fat particles enter the blood circulation, causing decreased oxygenation to the heart and/or brain.
- Usually follow long bone/pelvic fractures or trauma; very rarely has occurred after orthopedic surgery.
- Should be considered if the child develops shortness of breath or neurological symptoms after a fall/fracture/trauma.
- Learn more about the symptoms of FES & how to care for it.
If you/your child is having a dental procedure, remember:
- Dentistry generally can, and should, be performed with the minimal amount of anesthesia possible while providing the patient maximal physical and emotional comfort.
- Local anesthetics, nitrous oxide, and an oxygen “wash out” are safe for most patients with Duchenne, especially patients who are ambulatory with normal pulmonary function (normal breathing).
- Patients with Duchenne who have pulmonary dysfunction (abnormal breathing) should consider receiving dental care requiring general anesthesia in a hospital or surgery center staffed with an anesthesiologist, and equipped to monitor intra-operative respiratory functioning and to manage potential respiratory and cardiac emergencies.
- Learn more about dental care considerations in Duchenne.
If you/your child is having severe pain, remember:
- In Duchenne, there are many issues that may be related to pain.
- It is important to take information about you/your child with you, so that the emergency room staff can do a thorough evaluation, diagnose the cause of pain quickly, and help manage the pain appropriately.
If you/your child is scheduled for surgery, or having emergency surgery, remember:
- Avoid inhaled anesthesia
- IV anesthesia is considered to be safe (with close monitoring)
- People with Duchenne should NOT receive succinylcholine
- Local anesthetics & Nitrous Oxide are safe for minor dental procedures
- See a complete list of Safe and Unsafe Anesthetics
Vomiting and/or unable to take daily corticosteroids for 24 Hours
If you/your child is vomiting and/or unable to take daily corticosteroids for 24 hours, remember:
- Call your neuromuscular specialist and let them know you are going to the emergency room and why
- Go to a hospital emergency room; bring the PJ Nicholoff Steroid Protocol (download)
- Request substitute IV corticosteroid until oral medications are tolerated (6 mg of deflazacort equals 5 mg of prednisone)
- Remind clinicians that high liver enzymes (AST/ALT) are normal for people with Duchenne
- Learn more about steroids
Keep this Information with You
There are three easy ways you can keep this information with you at all times: