Paramedic Test #8 - Chapter 44 - Geriatric Emergencies

Assessment and treatment of disease in some 65yo+. 

Buildup of fatty plaque on the arteries.  

Stiffening of the vessel walls.  Contributes to systemic hypertension.  Widening of pulse pressure, decreased coronary perfusion, changes in cardiac ejection fraction.  

Increase in intraocular pressure severe enough to damage the optic nerve, potentially losing peripheral and central vision.  

Progressive hearing loss, especially in high frequencies.  

Sense of body position becomes impaired with age.  Increases risk of falling. 

Reduction in functioning nephron units, changes in size and weight of the kidney.  Renal blood flow decreases up to 50% as a person ages.  

26.9 65yo+ have diabetes and 50% are prediabetic.  Metabolism of carbs becomes more difficult.  Other medications may affect glucose metabolism.  

Elderly can't temperature regulate as well, os a fever may not be present if they have an infection. 

General impression - 

• G Geriatric Patient
• Present atypically
• Deserve respect
• Experience normal changes with age

• E Environmental Assessment
• Condition of the home
• Hazardous conditions - poor wiring, rotted floors, unventilated gas heaters, broken window, clutter
• Smoke detectors
• Too hot or too cold
• Odor of feces/urine
• Liquor bottles
• Telephone access
• Adequate care facility

• M Medical Assessment
• Complex issues - trauma and medical
• Medical history important
• Out of date medications
• Primary assessment
• Reassessment

• S Social Assessment
• Assess daily activities
• Delays in obtaining medication, help?
• Able to feed themselves?
• Social network

Consider it if the systolic is below 120. 

Deep vein thrombosis.  Common cause of pulmonary embolus in which an embolus may become displaced from a larger vein (usually in the leg).  

Occurs when the inside wall of the artery becomes torn and allows blood to collect between the arterial wall layers.  AAA - abdominal aortic aneurysm.  Do a blood pressure reading on both arms with patients with chest pain.  If there is a 15+mmHg difference, then might be a thoracic dissection. 

Symptom, not a disease.  Temporary state.  Hallucinations, disorientation, bizarre behavior.

Produces irreversible brain failure. Short term memory loss, jargon aphasia, confusion.  Alzheimer is a type of dementia, along with multi-intact or vascular dementia.  Two or more brain functions are impaired.  

• Two or more - 
• Resting tremor
• Bradykinesia - slow moving 
• rigidity or stiffness of the trunk
• poor balance

Dyskinesia - involuntary movements or tremors affecting one or both sides of the body.  

Caused by the reactivation of the varicella virus on the nerve roots.  Cluster of tiny blisters on the affected area.  

Acute inflammation in the skin caused by bacterial infection.   

Occurr when pressure is applied to body tissue resulting in lack of perfusion and ultimately necrosis.  

Decrease in bone mass leading to reduction in bone strength and greater susceptibility of fracture.  

Progressive disease of the joints that destroys the cartilage, promotes the formation of bone spurs in joints, and leads to joint stiffness.  

Long term auto-immune disorder that is classified by inflammation of the joints and surrounding tissue.  

When the aortic valve does not open fully, decreasing blood flow from the heart.  

Degenerative condition resulting in decreased mobility of vertebral joint and compression of neural elements.  

Inner ear disorder endolymphatic rupture creates pressure on the cochlear duct, damage to organ of Corti and semicircular canal.  Vertigo, tinnitus, sensor-neuronal hearing loss.