TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
46
Geriatrics
Objectives
• Discuss statistics relating to the
geriatric imperative.
• Discuss pathophysiologic changes that
occur to the body due to aging.
• Integrate assessment findings with
related pathophysiology.
• Review current treatment strategies for
geriatric patients.
Introduction
• People over the age of 65 make up the
fastest-growing segment of the
population.
• Changes in physiology due to aging
have an effect on pathophysiology as
compared to younger adults.
Introduction (cont’d)
• Geriatric patients typically have more
than one disease and take more than
one medication.
Epidemiology
• Almost 40 million in 2008, or 12.8 of
the population.
• Cardiovascular disease is the leading
cause of death, followed by cancer,
strokes, and COPD.
• They use ⅓ of all prescriptions.
• The average geriatric patient takes 4.5
medications per day.
Pathophysiology
• Human body changes with age:
cellular, organ, and system functions.
• Changes in normal physiology start
around age 30.
• Process can be slowed with diet and
exercise, but it cannot be stopped
entirely.
Pathophysiology (cont’d)
• Cardiovascular system
– Degenerative process to the
myocardium
– Damage to valves
– Thickening of the walls
– Loss of artery elasticity
– Decrease in baroreceptor activity
Pathophysiology (cont’d)
• Respiratory system
– Size and strength of respiratory muscles
decrease.
– Alveolar surfaces degrade, impairing
gas exchange.
– Chemoreceptors begin to fail.
– More turbulent airflow through the
bronchioles.
Pathophysiology (cont’d)
• Nervous system
– Nerve cells degenerate and die as early
as in the mid-20s.
– Reflexes slow, proprioception falters.
– Brain atrophies with a resultant increase
in CSF.
– Regulation of basal bodily functions
becomes less sensitive.
Pathophysiology (cont’d)
• Gastrointestinal system
– Sense of taste and smell is diminished.
– Cardiac sphincter becomes weaker.
– Hepatic function decreases.
– Lining of GI system degenerates,
resulting in lesser absorption of
nutrients.
Pathophysiology (cont’d)
• Endocrine system
– Hormones that elevate blood pressure
and those that regulate fluid balance
become deranged.
– Stimulation of adrenergic sites
diminishes due to failure of sensitivity of
receptor cells.
Pathophysiology (cont’d)
• Musculoskeletal system
– Loss of minerals from the bones.
– Vertebral disks narrow.
– Joints lose flexibility.
– Synovial fluid thickens.
Pathophysiology (cont’d)
• Renal system
– Decrease in nephrons, kidneys shrink
– Diminished ability to filter blood
– Fluid and electrolyte disturbances
Pathophysiology (cont’d)
• Integumentary system
– Skin becomes thinner from a loss of
subcutaneous layer.
– Replacement cells generate more
slowly.
– Sense of touch is dulled, less
perspiration.
– Less effectiveness as an external
barrier.
Changes in the body systems of the elderly.
Clues to Illness Found in the Scene Size-Up
Special Considerations in the Primary Assessment of the Geriatric Patient
Special Considerations in the Primary Assessment of the Geriatric Patient
Special Considerations in the Primary Assessment of the Geriatric Patient
Potential Differential Diagnoses Based on Clinical Findings in Geriatric Patients
Potential Differential Diagnoses Based on Clinical Findings in Geriatric Patients
Potential Differential Diagnoses Based on Clinical Findings in Geriatric Patients
Potential Differential Diagnoses Based on Clinical Findings in Geriatric Patients
Emergency Medical Care
• Manual cervical spine considerations
• Assess and maintain the airway.
• Determine breathing adequacy.
– High-flow via NRB with adequate
breathing.
– High-flow via PPV @ 10-12/min if
inadequate.
– Maintain saturation >95%.
Emergency Medical Care (cont’d)
• Assess circulatory components.
– Check pulse, skin characteristics.
– Control major bleeds.
Emergency Medical Care (cont’d)
• Initiate transport with Paramedic
intercept.
• Position the patient:
– Sitting up if able to maintain own
airway.
– Lateral recumbent with altered
mentation.
– Supine if immobilized.
Emergency Medical Care (cont’d)
• Constantly monitor airway, breathing,
and circulation.
• Mental status changes are key to
determining improvement or
deterioration.
Case Study
• Your EMS unit is dispatched for a
“possible cardiac arrest” in the lowincome housing district. Upon arrival,
police escort you into a single-bedroom
dwelling where an unresponsive elderly
male is found in bed. The report is that
the neighbor hasn't seen him in a few
days so he asked the building manager
to gain access.
Case Study (cont’d)
• Scene Size-Up
– Standard precautions taken.
– Scene is safe, no entry or egress
problems.
– 70–75-year-old male, about 200
pounds.
Case Study (cont’d)
• Scene Size-Up
– Patient dressed in pajamas, time is
1430 hrs.
– NOI is unknown/unresponsive, possible
arrest.
– Friend is on scene, but is not much help
regarding history.
Case Study (cont’d)
• Describe possible ways to learn of the
patient's medical history.
• For each body system, name at least
one differential that could cause
unresponsiveness.
– Nervous
– Respiratory
– Cardiac
– Endocrine
Case Study (cont’d)
• Primary Assessment Findings
– Patient unresponsive.
– Pupils reactive, membranes dry, tongue
furrowed.
– Some vomitus in airway, gurgling with
breathing.
Case Study (cont’d)
• Primary Assessment Findings
(continued)
– Respirations rapid and deep.
– Carotid pulse 120/min, peripheral pulse
absent.
– Peripheral skin warm and dry.
Case Study (cont’d)
• How would you prioritize this patient?
• What are the patient's life threats, if
any?
• What care should be administered
immediately?
Case Study (cont’d)
• Medical History
– Unknown
• Medications
– Glucophage found in bathroom
• Allergies
– Unknown
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Pupils reactive to light, membranes dry.
– Airway patent, patient breathing fast
and deep.
– Central pulse present, peripheral
absent.
– Skin is dry, delayed capillary refill.
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings (continued)
– No bruising, guarding or rigidity to
abdomen.
– BGL 710mg/dL, SpO2 96% on high flow.
– B/P 82/62, HR 112, RR 28 and deep.
– No other findings contributory to this
report.
Case Study (cont’d)
• Is this a structural or metabolic cause
of unresponsiveness?
• What is the likely underlying cause for
the emergency?
• Explain the pathology for the following:
– Unresponsiveness
– Rapid heart rate, dehydration findings
Case Study (cont’d)
• Care provided:
– Patient immobilized as a precaution.
– High-flow oxygen via NRB mask.
– Patient loaded on wheeled cot and taken
to ambulance.
– Initiated intravenous access.
– Emergent transport to the hospital.
Summary
• Geriatric patients, like pediatric
patients, have an altered physiology
that needs to be considered given
illness and injuries.
• The normal decline in the body systems
renders them susceptible to a multitude
of emergencies.
Summary (cont’d)
• Carefully manage and closely watch
elderly patients, as they may
deteriorate suddenly.