1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Introduction to Emergency Medical Care 1

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 36.1Describe common changes in body systems that occur in older age. Slide 99 36.2Discuss adaptations that may be required in communicating with and assessing older patients. Slides 10–12, 14–2210–1214–22 continued

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson continued OBJECTIVES 36.3Discuss the need for awareness of and the special considerations regarding medical conditions and injuries to which older patients are prone, including effects of medications, shortness of breath, chest pain, altered mental status, gastrointestinal complaints, dizziness/weakness/malaise, depression/suicide, rash, pain, flulike symptoms, and falls and the possible significance of general or nonspecific complaints in older adults. Slides 24–3324–33

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson OBJECTIVES 36.4Recommend changes to improve safety in the home of an elderly person. Slide 1313 36.5Discuss possible indications of elder abuse. Slide 3434 36.6Discuss psychosocial concerns of older patients, including the fear of loss of independence. Slide 3535

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson MULTIMEDIA Slide 37Information About Alzheimer’s Disease VideoSlide 37Information About Alzheimer’s Disease Video Slide 38Elder Mistreatment and Abuse VideoSlide 38Elder Mistreatment and Abuse Video

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson CORE CONCEPTS Age-related changes in the elderly Communicating with older patients Assessing and caring for older patients Illness and injury in older patients

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Topics The Geriatric Patient

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson The Geriatric Patient

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Age-Related Changes After age 30, organ systems lose 1 percent of function each year Maximum heart rate declines Older patient with internal bleeding won’t exhibit heart rate as rapid as expected If unaware, EMT may miss that older patient is in shock

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Communicating with Older Patients Causes of patient’s communication difficulties –Changes in hearing, vision, memory –Loss of teeth –Loss of brain function (Alzheimer’s most common) First assume altered mental status result of present injury/illness

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson History and Assessment of Older Adult Patient Scene size-up and safety Primary assessment Secondary assessment

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Scene Size-up and Safety Look inside and outside residence for clues to physical and mental abilities –Condition of residence –Half-eaten food –House dirty or clean –Items left out that patient can trip on

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Primary Assessment General impression Mental status Airway Breathing Circulation

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Identifying Priority Patients

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Secondary Assessment History –Take time needed to get full information –Find out whether patient is compliant with medical advice –Ask family members, others familiar with patient’s condition Physical exam Baseline vital signs

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Components of Physical Exam Head and neck Chest and abdomen Pelvis and extremities Spine

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Head and Neck

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chest and Abdomen

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Pelvis and Extremities Hip and proximal femur commonly fractured in fall Weakening of bone results in injuries to wrists and proximal humerus, also Check extremities for edema and swelling –When significant, these can be signs of underlying heart, vascular, or liver disease

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Spine Very commonly injured in motor-vehicle collisions Abnormal curvature may make immobilization challenging Do best to keep vertebrae in alignment and reduce patient’s discomfort

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Reassessment

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Think About It What is commonly seen when assessing an elderly patient’s blood pressure? What is most commonly fractured in female elderly patients? What are some challenges you might face in immobilizing elderly patients?

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Illness and Injury in Older Patients Elderly patients prone to some problems because of age-related changes Problems present differently than in younger patients May present with vague signs or symptoms

25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Medication Side Effects and Interactions Drug-patient interactions Drug-drug interactions

26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Shortness of Breath

27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chest Pain

28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Altered Mental Status

29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Abdominal Pain and Gastrointestinal Bleeding

30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Dizziness, Weakness, and Malaise Don’t take complaints lightly Can be associated with a number of serious conditions Can be life threatening Be diligent in assessment, even for vague symptoms

31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Depression and Suicide Causes in elderly patients –Conditions that limit activity –Medications that sap energy –Loss of friends and spouse –Biochemical imbalance

32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Rash, Pain, Flulike Symptoms Shingles –Virus reawakens after years –Appears as belt-like band around torso –Scabs over after a few days –Pain on side of torso –EMT can contract it from fluid

33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Falls Death may result from complications of fall –Bruised ribs, can’t cough because of pain, develops pneumonia May indicate more serious problem –Abnormal heart rhythm, stroke, internal bleeding Assess for cause of fall as well as injuries from fall

34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Elder Abuse and Neglect

35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Loss of Independence Help patient who is losing independence due to illness/injury –Treat patient with dignity –Don’t minimize fears and concerns –Lock up house –Arrange for care for pets –Be reassuring –Empathize

36. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Think About It What are some important facts to remember when treating elderly patients? What are the best preventative measures for an EMT who comes in contact with shingles? What is a side effect of NSAID use?

37. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Information About Alzheimer’s Disease Video Click here to view a video on the subject of Alzheimer’s disease.here Back to Directory

38. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Elder Mistreatment and Abuse Video Click here to view a video on the subject of elder mistreatment and abuse.here Back to Directory

39. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review

40. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review Despite generalizations, older people are individuals who can differ significantly in their health needs. The prevalence of many diseases increases with age, increasing the portion of the older population that requires health care. continued

41. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review Age-related decline in system function alters the body’s response to illness and injury, requiring modified interpretation of assessment findings and complaints. Multiple medical problems and medications can lead to unpredictable problems and drug interactions. continued

42. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Chapter Review Nervous system changes, along with isolation, financial problems, loss of loved ones, and chronic health problems increase the risk for depression in the elderly. This can interfere with a person’s self-care and ability to communicate.

43. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Remember Aging produces common body changes, with different impacts on different patients. Evaluate older patients individually. In some cases, EMT must adapt assessment and treatment procedures to account for age-related anatomic and psychosocial changes. continued

44. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Remember Medication difficulties are common in older patients. EMTs must keep this in mind when assessing and treating this age group. Elder abuse is a far too common problem. EMTs must learn to recognize the signs of abuse and neglect.

45. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Questions to Consider What size blood pressure cuff might be better suited to an elderly patient? What challenges might you encounter when assessing the mental status of an elderly patient?

46. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Critical Thinking You are called to the nursing facility for an 85-year-old female who is having trouble breathing and is very confused. What do you suspect may be wrong with this patient? What actions would you take in treating this patient?

47. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer O’Keefe Dickinson Please visit Resource Central on www.bradybooks.com to view additional resources for this text. www.bradybooks.com