chapter 17 geriatric emergencies. national ems education standard competencies (1 of 4) trauma uses...

Chapter 17Chapter 17Chapter 17Chapter 17

Geriatric Emergencies

National EMS Education Standard Competencies (1 of 4)


Trauma

Uses simple knowledge to recognize and manage life threats based on assessment findings for an acutely injured patient while awaiting additional emergency medical response.



Special Considerations in Trauma

Recognition and management of trauma in

• Pregnant patient

• Pediatric patient

• Geriatric patient



Special Patient Populations

Recognizes and manages life threats based on simple assessment findings for a patient with special needs while awaiting additional emergency response.



Geriatrics

• Impact of age-related changes on assessment and care

Patients With Special Challenges

• Recognizing and reporting abuse and neglect

Introduction (1 of 2)Introduction (1 of 2)

• A geriatric patient is a patient who is older than 65 years.– By 2010, more than 40 million people will be

older than 65 years.

• The natural aging process results in a decline in the functioning of all body systems.

Introduction (2 of 2)Introduction (2 of 2)

• Do not prejudge the physical or mental condition of older patients.

• Most EMS systems respond to many calls involving geriatric patients.

– You must conduct a complete full-body examination on all patients.

© Photodisc

Sensory ChangesSensory Changes

• Two of the most socializing senses are hearing and sight.

• Many people experience some loss of hearing and sight as they age.– Driving and walking can become hazardous.

– Impaired vision and confusion often contribute to mistakes in taking medications.

Hearing-Impaired or Deaf Patients (1 of 3)


• Some older adults require the use of a hearing aid.

• People with certain inner ear disorders are more prone to poor balance and falls.

• Communication– Be certain an elderly patient can hear and

understand what you say.

– Identify yourself and speak slowly and clearly.



• Communication (cont’d)– Do not shout; ask the patient if he or she can

hear you.

– Speak directly into the patient’s ear or maintain eye contact for lip readers.

– If you are still having difficulties communicating, offer paper and a pencil.

– Use sign language if you know it.

Visually Impaired or Blind Patients (1 of 2)


• Look for signs indicating visual impairment during the scene size-up:– Eyeglasses

– Cane

– Service dog

Courtesy of the Guide Dog Foundation for the Blind. Photographed by Christopher Appoldt.



• A visually impaired patient may feel vulnerable during an emergency scene.– Tell the patient what is happening, identify

noises, and describe the surroundings.

– Find out the patient’s name and use it.

– Provide psychological support.

– Keep eyeglasses with the patient if possible.

Techniques for Communicating With Older Patients (1 of 2)


• Identify yourself.

• Look directly at the patient.

• Speak slowly and distinctly.

• Explain what you are going to do in clear, simple language.

• Listen to the patient.



• Show the patient respect.

• Do not talk about the patient in front of the patient.

• Be patient.

Musculoskeletal and Mobility Issues (1 of 2)


• As a person ages, several changes occur to the musculoskeletal system.– Muscles lose strength.

– The disks between the vertebrae narrow, which can cause loss of height, curvature of the spine, and loss of flexibility.

– Bones in the skeletal system lose strength.

– Older people experience some loss of balance.



• These changes result in an increased incidence of falls among elderly patients.– Falls result in an increased risk for brain injuries

because the blood vessels are more fragile and the brain gets smaller as a person ages.

Slowed MovementsSlowed Movements

• As a person ages, movements become slower.

• Lend a helping hand or supporting arm.

• Allow enough time for patients to move safely rather than trying to rush them.

Fractures (1 of 3)Fractures (1 of 3)

• Fractures occur frequently in the geriatric population because the loss of bone density often results in osteoporosis.

• Fractures of the wrist, spine, and hip are particularly common.

• Geriatric patients may have a diminished awareness of pain.


• Hip fractures are a common result of osteoporosis.– Occur most frequently in elderly women

– The injured leg is usually (but not always) shortened in relation to the other leg.

– The toes of the injured leg are externally rotated.

• Splint the patient and transport promptly.

Medical ConsiderationsMedical Considerations

• As people get older:– They are generally less able to fight off

diseases.

– Their immune systems become less effective.

– They are not able to cough as effectively.

– They have increased difficulty handling secretions.

Cardiovascular Diseases (1 of 2)Cardiovascular Diseases (1 of 2)

• Cardiovascular diseases are conditions that affect the heart and blood vessels.

• As a person ages, the body loses its ability to speed up heart contractions and the blood vessels become stiffer and narrowed by fatty deposits.– These changes increase the occurrence of

heart attacks, angina, and congestive heart failure.

Cardiovascular Diseases (2 of 2)Cardiovascular Diseases (2 of 2)

• Strokes and abdominal aortic aneurysms are two common conditions related to problems with blood vessels.

• Geriatric patients may not have the classic signs and symptoms.– Older patients have a decreased awareness or

sensation to the pain.

– Treat older patients with a high degree of suspicion.

Respiratory Diseases (1 of 3)Respiratory Diseases (1 of 3)

• As a person ages:– The alveoli lose some of their elasticity.

– The muscles associated with respirations become weaker.

• Two major types of respiratory diseases:– Chronic respiratory diseases

– Acute respiratory diseases


• Patients with COPD may live with this condition for many years.– A cold or other respiratory infection can result in

a medical emergency.

• Acute respiratory diseases strike quickly.– Pneumonia is common in elderly patients.

– A physician should examine an elderly patient who has congestion and a possible fever.


• Treatment– Carefully examine the patient.

– Secure an accurate medical history (past and present).

– Treat the patient’s presenting symptoms.

– Arrange for transport.

CancerCancer

• Cancer can strike any part of the body.

• Patients call for help when complications from cancer result in:– Acute pain

– Shortness of breath

– Shock

– Some other medical condition

• Provide support and transport.

Altered Mental StatusAltered Mental Status

• Common causes of decreased responsiveness in elderly patients– Lack of adequate oxygen to the brain

– Low blood glucose level

– Hypothermia

• Assess patients and provide treatment according to the signs and symptoms you note.

Medications (1 of 2)Medications (1 of 2)

• Many older people take a large number of medications every day.– They may see several doctors for different

conditions.

– Some medications may interfere with the action of other medications or cause adverse side effects.

– They may not take their medications as instructed.

Medications (2 of 2)Medications (2 of 2)

• Determine which types of medication a patient takes.

• If the patient is being transported, bring the medications to the hospital.

Long-Term Care Patients (1 of 4)Long-Term Care Patients (1 of 4)

• Many patients with chronic conditions are now treated at home by nurses or family.

• A variety of complex medical devices are used with these patients.– Devices that help patients breathe include:

• Ventilators

• Oxygen-enrichment devices

• Surgically inserted breathing tubes

• Monitors


• Complex medical devices (cont’d)– Patients with certain heart conditions may have

pacemakers and automatic defibrillators.

– Tubes inserted into a patient’s arm, neck, or stomach may provide fluids or food.

– Catheters may drain urine from the patient’s bladder.

• These patients often take a wide variety of medications.


• Remember your role as an EMR.– Assess the immediate problem.

– Take the appropriate steps in providing care.

– Do not get overwhelmed or distracted by the complex equipment.

– Question the patient and the caregivers.

– In most situations, you need to stabilize the patient for only a few minutes until more highly trained EMS personnel arrive.

Depression (1 of 2)Depression (1 of 2)

• Most common psychiatric condition experienced by older adults– Occurs in 6% of the geriatric population

– More common in women than in men

• Contributing factors– Living in nursing homes and/or living alone

– Loss of a spouse or a close friend

Depression (2 of 2)Depression (2 of 2)

• Contributing factors (cont’d)– Declining health, chronic health conditions, or

terminal illnesses

• Be alert for signs and symptoms of persistent feelings of sadness or despair.

• If you observe signs of depression, bring them to the attention of other EMS providers or other medical professionals.

Suicide (1 of 2)Suicide (1 of 2)

• Older men have the highest suicide rate of any age group in the United States.– Older people choose more lethal means,

resulting in more deaths from suicide.

• Factors that contribute to this problem:– Physical illnesses, especially terminal ones

– Loss of a loved one

– Alcohol abuse

Suicide (2 of 2)Suicide (2 of 2)

• Listen carefully to the patient and be alert for indications of hopelessness, depression, or attempts at suicide.

• If you suspect a patient may be considering suicide, arrange for transport.

© dundanim/ShutterStock, Inc.

Dementia (1 of 5)Dementia (1 of 5)

• A pattern of decline in mental function

• Marked by impairment in memory and may result in decreases in:– Reasoning

– Judgment

– Comprehension

– Ability to communicate verbally


• 20% to 40% of people older than 85 years have some degree of dementia.

• Causes of dementia– Small strokes

– Hardening of the arteries

– Heredity


• Alzheimer disease– Most common type of dementia

– Chronic degenerative disorder that attacks the brain and results in impaired memory, behavior, and thinking

– Affects an estimated 5 million people in the United States


• Alzheimer disease (cont’d)– In the terminal stages, patients may be unable

to walk, lose control of their bowels and bladder, and become unable to swallow.

• When caring for patients with dementia:– Speak clearly and use the patient’s name.

– Let the patient know what you are doing at each step of your assessment and treatment.


• When caring for patients with dementia: (cont’d)– You may need to

rely on family members or caregivers to provide a medical history.

– Use a kind and caring approach.

© Glen E. Ellman

Hospice Care (1 of 2)Hospice Care (1 of 2)

• A hospice is a health care program that brings together a variety of caregivers to provide physical, emotional, spiritual, social, and economic care for patients who have terminal illnesses and who are expected to die within the next 6 months.

• Interdisciplinary programs provide pain relief and other supportive care.

Hospice Care (2 of 2)Hospice Care (2 of 2)

• Pain relief is provided through:– Oral medications

– Special pain-relieving patches

– Medicine placed in the mouth between the gum and the cheek

• EMS is usually called when the patient experiences unexpected problems such as shortness of breath.

Advance Directives (1 of 2)Advance Directives (1 of 2)

• Document that outlines the care patients want to receive if they are not able to make their own medical decisions

• May include do not resuscitate (DNR) orders– A DNR order is a request to withhold CPR and

other lifesaving measures if a person’s heart stops or if he or she stops breathing.

Advance Directives (2 of 2)Advance Directives (2 of 2)

• It is important for you to know the regulations concerning these documents in your state.

• If you cannot determine whether an advance directive is valid, begin appropriate medical care and leave the questions to physicians.

Elder Abuse (1 of 3)Elder Abuse (1 of 3)

• Elderly people who are physically weak or mentally compromised are at a high risk for abuse by a:– Spouse

– Family member or friend

– Caregiver

• Elder abuse may be physical, sexual, or emotional.


• Signs and symptoms of abuse– Bruises

– Burns

– Trauma in the genital area

– Signs of neglectCourtesy of Rhonda Beck


• If you suspect abuse, report it to the authorities.

• Many community-based programs assist in supporting geriatric patients who need:– Physical assistance

– Nutritional support

– Emotional help

Summary (1 of 3)Summary (1 of 3)

• The natural aging process results in a decline in the functioning of all body systems, including sensory and musculoskeletal changes.

• Fractures occur often in older people because of the loss of bone density that can lead to osteoporosis.


• Common medical concerns for geriatric patients include cardiovascular and respiratory diseases.

• Three common causes of altered mental status are lack of adequate oxygen to the brain, low blood glucose level, and hypothermia.


• Do not overlook signs of mental health problems in elderly patients. Three types of mental problems seen frequently in older people are depression, suicidal thoughts, and dementia.

• Elder abuse may take the form of physical abuse, sexual abuse, emotional abuse, financial abuse, or neglect.

Review Review

1. When caring for an older patient who is hearing-impaired, you should:

A. speak very loudly to be sure the patient can hear you.

B. speak directly into the patient’s ear or maintain eye contact for lip readers.

C.assume that the patient can read lips.

D.not attempt to communicate because it will only frustrate the patient.

ReviewReview

Answer:

B. speak directly into the patient’s ear or maintain eye contact for lip readers.

ReviewReview

2. Fractures occur frequently in the geriatric population due to a condition that weakens bones known as:

A. syncope.

B. osteoporosis.

C. dementia.

D. dislocation.

ReviewReview

Answer:

B. osteoporosis.

ReviewReview

3. Which of the following statements regarding suicide in the elderly is MOST accurate?

A. Older women have the highest rate of suicide.

B. Most elderly people seek counseling when they become depressed.

C. Elderly patients tend to use more lethal means than younger patients.

D. Alcohol abuse is not a contributing factor.

ReviewReview

Answer:

C. Elderly patients tend to use more lethal means than younger patients.

CreditsCredits

• Opener: © Glen E. Ellman

• Background slide image (ambulance): © Comstock Images/Alamy Images

• Background slide images (non-ambulance): © Jones & Bartlett Learning. Courtesy of MIEMSS.

chapter 17 geriatric emergencies. national ems education standard competencies (1 of 4) trauma uses...

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