1. Geriatric Emergencies
Chapter 31
Geriatric Emergencies 1

2. Objectives
31.1 Describe six physiologic changes that occur with aging Describe effective methods for communicating with geriatric patients.
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3. Objectives
31.3 Describe the effects of the following illnesses and diseases on geriatric patients:
cardiovascular and respiratory disease
neurological diseases
gastrointestinal (GI) diseases
altered mental status
31.4 Describe how the chronic use of medication can affect the results of an assessment of geriatric patients.
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4. 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.
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5. Topics Physiologic Changes of Aging
Common Geriatric Illnesses and Conditions
Medication Use in the Elderly
Trauma Considerations in the Elderly
Additional Considerations
Assessment
Management
Discussion Point:
Describe six physiologic changes that occur with aging.

6. 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.”
Discussion Point:
What facts would make you concerned with this patient?

7. Physiologic Changes of Aging
Neurological system
Cardiovascular system
Respiratory system
Gastrointestinal system
Renal function and electrolyte balance
Musculoskeletal systems
Other physical changes
Discussion Point:
Give an example of physical changes with each system.
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8. Physiologic Changes of Aging
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9. Physiologic Changes of Aging
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10. Physiologic Changes of Aging
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11. Common Geriatric Illnesses and Conditions
Altered mental status
Hypertension
Myocardial infarction
Congestive heart failure
Syncope
Discussion Points:
Describe the effects of the following illnesses and diseases on the geriatric population:
 Cardiovascular and respiratory disease
 Neurological diseases
 Gastrointestinal (GI) diseases
 Altered mental status
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12. Common Geriatric Illnesses and Conditions
Stroke
Chronic obstructive pulmonary disease
Abdominal emergencies
Discussion Points:
Describe the effects of the following illnesses and diseases on the geriatric population:
 Cardiovascular and respiratory disease
 Neurological diseases
 Gastrointestinal (GI) diseases
 Altered mental status
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13. Common Geriatric Illnesses and Conditions
Discussion Points:
Describe the effects of the following illnesses and diseases on the geriatric population:
 Cardiovascular and respiratory disease
 Neurological diseases
 Gastrointestinal (GI) diseases
 Altered mental status

14. Common Geriatric Illnesses and Conditions
Discussion Points:
Describe the effects of the following illnesses and diseases on the geriatric population:
 Cardiovascular and respiratory disease
 Neurological diseases
 Gastrointestinal (GI) diseases
 Altered mental status

15. Medication Use In The Elderly
Cardiovascular medications
Calcium channel blockers
Blood Thinners
Discussion Points:
Describe how chronic use of medication can affect the results of an assessment of the geriatric patient.

16. Medication Use In The Elderly
Copyright Beverly Henrickson

17. 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.
Discussion Point:
What do think is wrong with the patient? 17

18. Trauma Considerations in the Elderly
Falls
Hip and pelvic fractures
Traumatic brain injury
Cervical spine injury
Elder abuse
Discussion Point:
List four trauma considerations that are unique to the geriatric population.

19. Trauma Considerations in the Elderly

20. Trauma Considerations in the Elderly

21. Additional Considerations
Artificial joints
Implantable devices
External openings, ports, and apparatus
Advanced Directives
Communicating with the elderly
Discussion Point:
Describe effective methods for communicating with a geriatric patient.

22. Additional Considerations
Discussion Point:
Describe effective methods for communicating with a geriatric patient.

23. Patient Assessment
ABCDs
SAMPLE
OPQRST
DCAP-BTLS

24. Patient Assessment Discussion Point:
Describe effective methods for communicating with a geriatric patient.

25. Patient Management More complex SAMPLE OPQRST DCAP-BTLS
Discussion Point:
Describe the general management of a geriatric patient.

26. Patient Management
Copyright Craig Brown

27. 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.
Discussion Point:
What knowledge of geriatrics may have saved this patient’s life?
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28. 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.
Discussion Point:
What symptoms would be a concern in a geriatric patient?
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29. 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.
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30. 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. 30