National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 31 Geriatric Emergencies

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 31.1 Describe six physiologic changes that occur with aging Describe effective methods for communicating with geriatric patients. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 31.3 Describe the effects of the following illnesses and diseases on geriatric patients: a.cardiovascular and respiratory disease b.neurological diseases c.gastrointestinal (GI) diseases d.altered mental status 31.4 Describe how the chronic use of medication can affect the results of an assessment of geriatric patients. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 31.5 List four trauma considerations that are unique to geriatric patients Describe the general management of geriatric patients Describe how to manage a geriatric patient with advanced directives. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Physiologic Changes of Aging Common Geriatric Illnesses and Conditions Medication Use in the Elderly Trauma Considerations in the Elderly Additional Considerations Assessment Management

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You find an elderly man standing near the off-ramp of a lift. The patient states he fell. “I just bumped my head.” Upon questioning the patient, he states that he briefly “saw stars” and now is “a little dizzy.” A small hematoma begins to form on his forehead. He denies any cervical spine tenderness and has no other complaints. His pulse is strong, but slow and slightly irregular. The rest of the physical exam is unremarkable. His wife tells you he is on high-blood pressure medication and medication for a “mechanical heart valve.”

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Physiologic Changes of Aging Neurological system Cardiovascular system Respiratory system Gastrointestinal system Renal function and electrolyte balance Musculoskeletal systems Other physical changes continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Physiologic Changes of Aging continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Physiologic Changes of Aging continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Physiologic Changes of Aging continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Geriatric Illnesses and Conditions Altered mental status Hypertension Myocardial infarction Congestive heart failure Syncope continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Geriatric Illnesses and Conditions Stroke Chronic obstructive pulmonary disease Abdominal emergencies continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Geriatric Illnesses and Conditions

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Geriatric Illnesses and Conditions

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Medication Use In The Elderly Cardiovascular medications Calcium channel blockers Blood Thinners

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Medication Use In The Elderly Copyright Beverly Henrickson

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update On examination of the patient, you find he has a BP of 180/92, HR of 58, and normal respirations. Your partner reviews the patient’s medications with a family member and reports that he is taking warfarin, lopressor, and aspirin. As you continue with your evaluation, the patient vomits and says, “It must have been something I ate for lunch.” His mental status is unchanged and he is alert, oriented, and cooperative. The rest of his neurological evaluation is normal. His only request is for someone to help him back to the lodge so that he can lie down and rest for the remainder of the day.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Trauma Considerations in the Elderly Falls ◦ Hip and pelvic fractures ◦ Traumatic brain injury ◦ Cervical spine injury Elder abuse

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Trauma Considerations in the Elderly

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Trauma Considerations in the Elderly

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Additional Considerations Artificial joints Implantable devices External openings, ports, and apparatus Advanced Directives Communicating with the elderly

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Additional Considerations

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Assessment ABCDs SAMPLE OPQRST DCAP-BTLS

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Assessment

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Management More complex SAMPLE OPQRST DCAP-BTLS

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Patient Management Copyright Craig Brown

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You are concerned the patient may have a head injury. You also are worried about the patient’s high blood pressure. You place him on high-flow oxygen, keep him comfortable, and mobilize resources to transport him to the hospital. The patient goes by ambulance to the emergency department at a trauma center. The ambulance crew gives you an update. He became increasingly lethargic while en route. Diagnosed with a subdural hematoma, his medication, which was warfarin, increased the bleeding from a relatively trivial head injury. Following treatment and surgery, his prognosis is good. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary The elderly population is the fastest growing population in the country. Aging causes physiologic changes that increase the geriatric patient’s risk for disease and injury. Geriatric patients should be considered high-risk patients due to multiple medical conditions. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Polypharmacy can affect clinical findings. Speak directly to the geriatric patient using a clear voice. Address seniors as “Mr.”, “Mrs.” or “Ms.” Never assume the patient cannot understand you simply because of old age. “Atypical” complaints are normal for geriatric patients. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Have a low threshold for further evaluation. Consider the underlying cause of a fall. The elderly have a higher mortality risk from trauma. The elderly have low reserves and benefit from aggressive intervention. Have a high index of suspicion for cervical spine injuries in the elderly patient. Never attribute altered mental status to old age.