Chapter 36: Geriatric Emergencies

Welcome to the lecture on Chapter 36 of the "Emergency Care and Transportation of the Sick and Injured," 12th edition, focusing on geriatric emergencies.

Learning Objectives

• Understand physiologic and psychological aging changes.
• Recognize common illnesses and injuries in geriatrics.
• Understand the GEMS triangle and elder abuse signs.

Key Topics

Overview of Geriatrics

• Geriatrics: Care for individuals aged 65+. Expected population doubling by 2050.
• Challenges: Chronic conditions and medication use alter presentations.
• Respect and Communication:
  • Avoid ageism; appreciate generational differences.
  • Effective communication strategies include addressing patients respectfully, identifying yourself, speaking clearly, maintaining eye contact, and allowing response time.

Common Conditions and Causes of Death

• Simple injuries can have severe outcomes (e.g., rib fractures leading to pneumonia).
• Physiological Decline: Begins in late 20s-30s, affecting organ functions over time.
• Respiratory System:
  • Decreased breathing capacity due to weakened musculature.
  • Common illnesses: pneumonia and pulmonary emboli.

Cardiovascular System

• Changes:
  • Heart hypertrophy, decreased cardiac output, and stiffer blood vessels.
  • Risks: aneurysms, myocardial infarction with atypical symptoms, heart failure, and strokes.

Nervous System

• Changes:
  • Reduced brain weight/volume, neuron loss affecting various functions.
  • Conditions: dementia, delirium, neuropathy.

Gastrointestinal System

• Changes:
  • Reduced saliva, gastric secretions, and liver blood flow.
  • Issues: GI bleeding, acute abdomen conditions.

Renal and Endocrine Systems

• Renal: Decreased function, incontinence issues, and electrolyte imbalances.
• Endocrine: Decreased metabolism and diabetes complications like HHNS.

Integumentary and Musculoskeletal Systems

• Skin: Thinner, bruises easily, and pressure ulcers.
• Muscles and Bones: Decreased bone mass, osteoporosis, osteoarthritis.

Toxicology and Behavioral Emergencies

• Polypharmacy: Risks of overdosing and drug interactions.
• Depression/Suicide: High risk in older adults, especially males.

GEMS Triangle

• Geriatric: Understand aging changes.
• Environmental: Assess living environment for clues.
• Medical: Comprehensive health history important.
• Social: Assess social networks and support systems.

Assessment and Management

General Assessment

• Scene Safety: Note environmental risks and patient access issues.
• Primary Assessment: Focus on ABCDs, considering age-related changes.
• History Taking: Comprehensive medication and medical history.
• Secondary Assessment: Consider modesty and warmth. Vital signs may be atypical.

Trauma and Environmental Injuries

• Increased injury severity and complications in older adults.
• Common Trauma Types: Falls, burns, head injuries.
• Environmental: Greater risk of hypothermia and hyperthermia.

Specific Conditions

• Response to nursing/skilled facilities requires understanding of elder care and infection control protocols.

Elder Abuse and Legal Considerations

• Abuse Signs: Suspicious injuries, neglect, and behavioral signs.
• Legal Directives: DNR, power of attorney, and advance directives.

Conclusion

• Understanding the complexities and nuances of geriatric emergencies is critical for effective care.

Review included questions on key concepts such as causes of death, cataracts, and polypharmacy.