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Geriatric Emergencies Chapter 32 Objectives - No DOT Objectives are listed for National Registry. This information is incorporated will all EMS medical and trauma assessment. This summarizes that information. I. The geriatric patient – Any patient older than 65 years of age A. The most common reasons for EMS to be called to an older person include: 1. Cardiac problems 2. Respiratory problems 3. Neurological problems i. stroke and altered mental status 4. Injuries from a fall 5. Hazy complaints like dizziness, weakness, and malaise. B. Communicating with the geriatric patient 1. Hearing loss 2. Deterioration of vision 3. Issues with speech 4. Memory loss 5. Try to make sure the patient can hear and see you. 6. Address patient respectfully. 7. Try to get at eye level to communicate (crouch or kneel if necessary). C. Assessing the geriatric patient 1. Look for clues upon entering the residence. a. How well kept b. Safety issues c. Temperature 2. Initial Assessment a. General impression (1) Level of distress b. Mental status (1) Consider abnormal mental status as part of patient’s baseline. c. Airway (1) Difficulty extending or flexing the head (2) Dentures d. Breathing (1) Poorly chewed food, which may have become an airway obstruction e. Circulation (1) Difficulty obtaining a radial pulse (2) Irregular pulse f. Identifying priority patients (1) Less severe symptoms (patient may understate the problem or have fewer symptoms) 3.Focused history and physical exam a. History (1) Issues with communication (misunderstanding what is said by the EMT-B or the patient) (2) Speak slowly and clearly. (3) Give patient time to respond. (4) Possible inaccurate history (consider getting additional information from a family member or other reliable source) (5) Confabulation—replacing lost circumstances with imaginary ones b. Physical exam (1) Keep patient’s dignity in mind. (2) Baseline vital signs (a) Systolic BP increases (b) Side effects from medication (c) Consider side effects from medications. (3) Skin loses elasticity. (4) Pupils may not be round and react to light. 4. Detailed physical exam a. Head and neck (1) Injuries to face common with falls and motor vehicle crashes (2) Neck may be stiff. (3) Head may be forward due to changes in the spine—issues with immobilization. b. Chest and abdomen (1) Decreased sensitivity to pain c. Pelvis and extremities (1) Hip or proximal femur commonly fractured in falls, especially in women d. Spine (1) Common injury in a motor vehicle crash 5. Ongoing assessment a. Be alert because decline in condition may be slow, which can be deceiving. b. Perform at regular and, when indicated, frequent intervals. c. Keep in mind the following elements of the ongoing assessment. (1) Reassess mental status. (2) Maintain open airway. (3) Monitor breathing. (4) Reassess pulse. (5) Monitor skin color, temperature, and moisture. (6) Reassess vital signs. (a) Every 5 minutes—unstable (b) Every 10 minutes—stable (7) Assure all appropriate care is given. D. Reasons the elderly encounter EMS 1. Pharmacology a. Use more medications than other age groups b. Multiple medications c. Try to determine if patient is taking the correct dose and according to the prescribed schedule. d. Drug-patient interaction e. Drug-drug interaction 2. Shortness of breath a. More common with conditions such as emphysema and heart failure b. Many times it is the chief complaint with a myocardial infarction; have a high index of suspicion. 3. Chest pain a. Many conditions present with this chief complaint. b. A pain described as ―tearing‖ is a classic sign of a thoracic aortic aneurysm as it dissects (true medical emergency). c. pneumonia (patient may have a fever and cough) 4. Altered mental status (AMS) a. Common causes (1) Medications (2) Hypoglycemia (3) Infection (4) Hypothermia 5. Abdominal pain a. Sign of a serious condition b. Abdominal aortic aneurysm (Triple A) (AAA) c. Bowel obstruction d. Internal bleeding (ask patient if stools are black and tarry, indicating the remains of red blood cells going through the system) 6. Dizziness, weakness, and malaise a. These vague symptoms should not be taken lightly. b. Dizziness may be sign of internal blood loss. c. Weakness can possibly be from a cardiac dysrhythmia. 7. Depression and suicide a. Common among the elderly (1) Some causes (a) Medication (b) Limited activity (c) Loss of a loved one (d) Biochemical imbalance (2) Suicide attempts among elderly (a) More common among males 8. Unusual problems a. Herpes zoster b. Shingles c. Return of Chicken Pox Virus 9. Falls a. May be an indication of a more serious problem. Make sure a thorough assessment is done. b. Role of EMT-B in prevention of falls 10. Elder abuse and neglect a. Physically b. Psychologically c. Financially 11. Loss of independence a. Do not minimize the patient’s fears and concerns (acknowledge them). b. Treat the patient in a respectful and empathetic manner.
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