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Special Considerations

Special Considerations. The pediatric and geriatric patients. Nationwide over 30% of all patients transported are over age 65. Heart disease Cancer Stroke Fractures Pneumonia. Misuse of drugs Fall (leading cause of trauma related injuries) Mva's (2nd leading cause).

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Special Considerations

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  1. Special Considerations The pediatric and geriatric patients

  2. Nationwide over 30% of all patients transported are over age 65

  3. Heart disease Cancer Stroke Fractures Pneumonia Misuse of drugs Fall (leading cause of trauma related injuries) Mva's (2nd leading cause) Leading Causes of Death or Disability:

  4. Who Is Elderly ? • Society normally thinks of those who are over 65 • Patient considered elderly: • Patient physically appears elderly • Patient is middle aged with significant medical problems associated with elderly • Patient is 65 years or older

  5. Things To Consider • After age 35 the effects of aging start affecting the body's ability to function • Here are some of the things to consider when treating the elderly

  6. Things To Consider • The GEMS Diamond • Remember the following when caring for older people: • Geriatric patients • Environmental assessment • Medical assessment • Social assessment

  7. Aging Statistics • 13% of people in the US are over age 65. • “Baby Boomers” will increase this number. • Expect to see an increase in emergency calls involving older patients.

  8. Case Study • Dispatched to a residence for an 84-year-old woman who has fallen • Patient, Mrs. Reed, cannot get up. Mrs. Reed

  9. Case Study(continued) • Mrs. Reed is on the kitchen floor. • She is alert but weak. • States she fell last night • Has pain in left hip • Vital signs are normal. Mrs. Reed

  10. Living Arrangements • Most live at home. • Women are more likely to live alone. • Less than 5% are institutionalized.

  11. Case Study (continued) • You conduct a GEMS exam: • Small amounts of food, home is warm and clean • No significant medical history, no medications • Son reports that mother lives alone, no regular contact with friends Mrs. Reed

  12. Access to Essential Services • Transportation • Meal preparation • Health care • Social activities

  13. Case Study Conclusion • Mrs. Reed is transported to ED. • Report to Social Services for potential follow up. Mrs. Reed

  14. Aging • Number of people over age 65 is rising • Older people have many social and environmental concerns. • We must understand and accept aging. • Family remains the most common residence for the older population.

  15. Leading Causes of Death in Older People • Disease of the heart • Cancer • CVA/Stroke • COPD • Pneumonia

  16. Case Study • Dispatched for 79-year-old man with difficulty breathing • Says he always gets winded easily and cannot catch his breath today • Environment is clean and warm. Mr. Brophy

  17. Case Study (continued) • History of AMI, CHF, COPD, hypertension, diabetes • Pulse = 112 beats/min • Respirations = 28 breaths/min • Blood pressure = 160/96 mm Hg • ECG = A-fib • Pulse Ox = 92% on oxygen Mr. Brophy

  18. Case Study (continued) What factors influence how well Mr. Brophy can compensate for his illness? How will aging affect these factors? Mr. Brophy

  19. The Aging Body:Integumentary System • Wrinkles • Thinner skin • Decreased fat • Gray hair

  20. The Aging Body: Respiratory System • Changes in airway • Decreasing muscles of ventilation • Increased residual volume • Decreased sensitivity of chemoreceptors

  21. Respiratory • Dental prosthesis • Pulmonary function can be reduced as much as 50 % by age 75 • Reduction in gas exchange through the pulmonary capillaries • Increased respiratory rate • Overall decrease in effectiveness

  22. The Aging Body: Cardiovascular System • Development of atherosclerosis • Decreasing cardiac output • Development of arrhythmias • Changes in blood pressure

  23. Cardiovascular • Increase in PVR • Between 30 and 80, resting cardiac output decreases about 30% • Significant drop in organ perfusion • Reduction of cardiac output by as much as 50 %

  24. Cardiovascular • Diminished ability to raise the heart rate • Decrease in compliance of the ventricle • Decrease response to hormone stimulation

  25. Even without specific heart disease advanced aging produces varying degrees of congestive heart failure

  26. The Aging Body:Nervous System • Brain shrinkage • Slowing of peripheral nerves • Slowed reflexes • Decreasing pain sensation

  27. Neurological and Sensory • Brain requires a continuous supply of oxygen to function • As much as a 45% loss of brain cells • Also affected are the senses • Response to stimuli is diminished • Slowed reaction time • Decreased response to pain

  28. Renal System Changes • Renal blood flow falls an average of 50% between the ages of 30 and 80 • Decline of renal function places the older patient at greater risk of renal failure

  29. The Aging Body:Renal, Hepatic, and GI Systems • Kidneys become smaller. • Hepatic blood flow decreases. • Production of enzymes declines. • Salivation decreases. • Gastric motility slows.

  30. Case Study (continued) • Mr. Brophy appears to have a hard time hearing your questions. • Does not respond to all of your requests What are the sensory changes found in older patients? Mr. Brophy

  31. The Aging Body:Sensory Changes • Vision distorts and eye movement slows. • Hearing loss is more common. • Taste decreases.

  32. Case Study (continued) • Mr. Brophy reports feeling “down” lately. • Lives alone and has few friends still around Is this patient at risk for depression? Mr. Brophy

  33. The Aging Body:Psychological Changes • Depression • Anxiety • Adjustment disorders

  34. Case Study (continued) • When asked about medications, Mr. Brophy directs your attention to a shoebox. How does the body react to medications with aging? Mr. Brophy

  35. The Aging Body:Musculoskeletal System • Decreased muscle mass • Changes in posture • Arthritic changes • Decrease in bone mass

  36. The Aging Body:Immune System • Less effective immune response • Pneumonia and UTI are common. • Increase in abnormal immune system substances

  37. Immune System • Pre-existing nutritional problems • An increased susceptibility to infection

  38. Case Study Conclusion • Mr. Brophy is treated for exacerbation of COPD. • Admitted to hospital, found to be on interacting medications • On discharge, Mr. Brophy was given follow-up visits with a home care service. Mr. Brophy

  39. Thermoregulatory • Diminished ability to maintain normal body temperature • More susceptible to heat and cold related injuries

  40. Chronic Medical Problems • As the effects of illness and injury cumulate they result in a progressive reduction in the bodies ability to function • As this progresses the body’s ability to withstand the introduction of disease, serious or even minor trauma is reduced

  41. Assessing The Elderly Patient • Difficult to separate the effects of aging / consequences of disease or injury • The patient may fail to report significant symptoms • Pain may be diminished or absent • Chronic illness make assessment acute problems difficult

  42. Assessing The Elderly • Aging may change the individual's response to illness or injury • There may be minimal or absent fever even in the presence of severe infection • Decreased vision or hearing may diminish the patient's ability to hear or comprehend

  43. Assessing The Elderly • Vital signs may be altered by chronic medical problems, resulting in abnormal findings which are normal • Social and emotional factors may have greater impact then in other age groups

  44. Assessing The Elderly Orientation should be evaluated using factors that are relative to that patient. An elderly patient who does not work or keep a schedule may not have reason to keep up with the day of the week

  45. Assessing The Elderly Be careful not to assume that the patient who has fallen simply tripped. Take into consideration the possible underlying conditions that may be manifested

  46. Assessing The Elderly Knowledge of the medications the patient is taking will also aid in understanding the condition of the patient and possible underlying causes of the incident at hand

  47. Assessing The Elderly Elderly trauma victim’s die as a result of the same causes as trauma victims of any age, but often due to their pre-existing physical condition, can die from less severe injuries and more rapidly than younger patients

  48. Physical Exam Considerations • General • Patient may fatigue easily • Patients commonly multi-layer clothing • Explain actions clearly • Patient may minimize or deny symptoms • Peripheral pulses may be difficult to evaluate

  49. Respiratory Distress: Causes • Pulmonary embolism • In silent MI dyspnea may be only initial symptom • Pulmonary edema • Asthma/copd • Respiratory infections • Cancer

  50. Cardiovascular Conditions

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