Emergency presentations of people with developmental disability in primary care
People with developmental disability who present unwell may already have significant concurrent pathology and be deteriorating at initial assessment. They can be at risk of serious organ damage and rapid decompensation.
Considerations when assessing an acutely unwell person with developmental disability include the person’s:
- baseline physical function and comorbidities, including those associated with specific disability syndromes and disorders
- understanding of the illness and the need for intervention
- ability to communicate (eg difficulty communicating about pain).
If the person has atypical pain or distress behaviours, they may be misinterpreted by family, support staff or healthcare providers (see Pain assessment tools).
Important diagnoses and high-risk situations in people with developmental disability include:
- sepsis
- hydrocephalus and shunt complication
- symptoms of raised intracranial pressure (eg decreased level of consciousness, vomiting, irritability) may suggest a malfunctioning or blocked shunt
- symptoms of raised intracranial pressure plus signs of sepsis may indicate shunt infection
- acute appendicitis, acute bladder or renal obstruction, acute infected pancreatitis, biliary colic
- acute chest pain
- acute or chronic weight loss (may suggest cancer or metastatic disease)
- fractures or dislocations, osteomyelitis— also consider osteoporosis and the possibility of abuse or neglect
- atlantoaxial instability (eg in people with Down syndrome)
- corneal abrasions and foreign bodies
- dental abscess
- constipation with bowel obstruction or volvulus
- behavioural emergency.
If acute assessment and management in hospital is required, arrange immediate ambulance transport to an emergency department for the person with developmental disability and their support person. Ensure ambulance and emergency staff are provided with written information about the person’s:
- medical history (eg personal health record) and additional requirements (eg communication aid, mobility aid, sensitivities, behaviour support plan)
- medical decision maker
- primary care provider (contact information).
Sedation may be used for assessment and management in hospital, see here for considerations related to procedural sedation for people with developmental disability undergoing a dental procedure.