Summary of "Chp 36 Geriatric Emergencies"

Summary of “Chp 36 Geriatric Emergencies”

This comprehensive lecture on geriatric emergencies covers the unique challenges, physiological changes, common diseases, trauma considerations, communication tips, and social issues related to emergency medical care for older adults (typically defined as 65 years and older). The instructor emphasizes respect, patience, and understanding of the older patient’s life experience and medical complexity.

Main Ideas and Concepts

1. Definition and Scope of Geriatrics

Geriatrics focuses on assessment and treatment of patients aged 65+ (though definitions vary).
Older adults present unique challenges due to physiological changes, multiple chronic conditions, and social factors.
Important to avoid ageism and stereotypes (not all elderly are hard of hearing, demented, or immobile).

2. Communication with Geriatric Patients

Speak respectfully, clearly, slowly, and directly.
Identify yourself and maintain eye contact.
Use one speaker at a time; do not assume hearing loss or cognitive impairment.
Allow extra time for responses and listen actively.
Explain procedures and treatments clearly.

3. Common Geriatric Conditions and Physiological Changes

Cardiovascular: Decreased cardiac output, arterial sclerosis, risk of aneurysm, silent heart attacks, heart failure (right vs. left sided), and stroke risk factors.
Respiratory: Weakened airway muscles, decreased cough reflex, increased pneumonia risk, pulmonary embolism (PE) signs and risk factors.
Neurologic: Dementia (progressive cognitive decline), delirium (acute mental status change), stroke types (ischemic and hemorrhagic), transient ischemic attacks (TIAs).
Musculoskeletal: Decreased bone mass (osteoporosis), arthritis, decreased muscle strength, kyphosis, increased risk of fractures and falls.
Sensory: Vision (cataracts, glaucoma, macular degeneration), hearing loss (presbycusis), taste and touch changes.
Gastrointestinal: Dry mouth, reduced gastric secretions, decreased motility, risk of GI bleeding, diverticulitis, peptic ulcers.
Renal: Reduced renal function, decreased bladder capacity, urinary incontinence (stress and urge), urinary retention, increased risk of UTIs.
Endocrine: Decline in thyroid function, diabetes complications (HHNS), fluid imbalances.
Immune: Reduced immune response leading to increased infections like pneumonia and UTIs.

4. Trauma in Geriatric Patients

Slower physiological compensation and longer recovery.
Increased susceptibility to injury from low-impact trauma (e.g., falls).
Common injuries: hip/pelvic fractures, subdural hematomas, burns.
Consider pre-existing conditions, medications (e.g., anticoagulants), and altered vital signs.
Transport to trauma centers recommended.
Use padding and avoid forcing joints or spine into unnatural positions.

5. Environmental and Scene Considerations

Assess home environment for hazards (throw rugs, cords).
Obtain history from caregivers or family when patient is confused.
Infection control is critical in nursing homes (MRSA, C. diff, RSV).
Nursing home staff may be overwhelmed; gather as much info as possible.

6. Psychosocial Issues

Depression is common but not a normal part of aging; linked to isolation, loss, substance abuse.
Elderly men have the highest suicide rates; assess for suicidal ideation and plans.
Elder abuse and neglect are serious concerns: physical, psychological, financial, sexual abuse.
Signs of abuse include unexplained injuries, defensive caregivers, poor hygiene, and repeated ED visits.
Reporting suspected abuse is critical.

7. End-of-Life Care

Many elderly prefer to die at home with hospice care.
Understand and respect DNR and advanced directives.
DNR means do not resuscitate but does not mean do not treat.

8. Assessment and Treatment Methodology: The GEMS Diamond

G - Geriatric Patient: Know normal aging changes.
E - Environment: Scene clues to condition and cause.
M - Medical Assessment: Thorough history and medications.
S - Social Assessment: Support systems, living situation, activities of daily living (ADLs).

Detailed Methodology / Instructions for EMS Providers

Scene Size-Up

Assess environment for safety hazards.
Determine mechanism or nature of injury/illness.
Gather information from bystanders or caregivers.

Primary Assessment

Assess airway, breathing, circulation (ABCs).
Consider dentures and altered mental status.
Be aware of altered vital sign baselines (e.g., hypertensive patients may have “normal” BP that indicates shock).
Evaluate transport priority and destination (trauma center if trauma).

Secondary Assessment

Obtain thorough SAMPLE history: Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading up.
Perform head-to-toe exam, respecting patient modesty.
Check vital signs frequently; medications may alter readings.
Look for signs of abuse or neglect.
Document all findings carefully, including psychosocial aspects.

Treatment

Provide oxygen therapy as needed.
Splint fractures carefully; avoid forcing joints or spine.
Keep patient warm; elderly have impaired temperature regulation.
Manage pain and anxiety empathetically.
Transport with all medications and medical records if possible.
Communicate clearly with receiving facility.

Key Takeaways

Older adults have complex medical and social needs requiring patience and respect.
Physiological changes affect presentation and treatment response.
Trauma is often underestimated in geriatrics; low-impact injuries can be severe.
Communication and thorough history taking are essential.
Be vigilant for elder abuse and neglect.
Understand and respect end-of-life wishes and directives.
Use the GEMS Diamond framework to guide assessment and care.

Speakers / Sources Featured

Primary Speaker: Unnamed instructor/lecturer (likely a paramedic or EMS educator) sharing personal experiences and clinical knowledge.
Referenced Sources:
- Stroke nurse from Sarasota, Florida (discussed stroke and alcohol withdrawal management).
- Personal anecdotes involving family members (mother-in-law with dementia, father with heart failure).
- EMS colleagues and paramedic friends (discussing clinical exam challenges).
- Various medical textbooks and guidelines (implied).