GERIATRICS
GENERAL GERIATRICS
PromptAge related changes
From PHRM exam (also run by ACEM) but totally reasonable to be in a FACEM exam
From PHRM exam (also run by ACEM) but totally reasonable to be in a FACEM exam
ResponseAirway
- Denture use - Leave in for BVM, remove for intubation
- Reduced cervical mobility - More challenging intubation
- Reduced bone density - Increased chance of c-spine injury
- Friable nasal mucosa - Need more gentle NPA insertion
- Reduced respiratory muscle mass - Fatigue rapidly
- Reduced chest wall compliance - Rib fractures common
- Anticoagulant / antiplatelet use common - Need reversal of coagulopathy
- Reduced vascular compliance - Reduced ability to compensate for haemorrhage
- Reduced cardiac contractility - Reduced ability to compensate for haemorrhage
- Higher resting blood pressures - “Normal” BP may actually represent significant hypotension
- CCF is common - May need smaller fluid boluses
- Atrophied brain is more mobile - Subdural more common
- Cervical canal stenosis - Central cord syndrome common
- Thin skin - Prone to pressure area on spinal board / cervical collars
- Reduced muscle mass / fat - Active warming as hypothermia is common
- Reduced bone density - Fractures more common
PromptDefine delirium vs dementia
ResponseDelirium is defined as “a transient mental disorder, characterised by impaired cognitive function and reduced ability to focus, sustain or shift attention”. The symptoms include confusion; disorientation; disturbance of the sleep/wake cycle; agitation and aggression or quiet withdrawal or sleepiness; emotional disturbances including seeing, hearing or feeling things that are not there. Delirium occurs abruptly/acutely, and symptoms can fluctuate during the day.
Dementia develops over time, with a slow progression of cognitive decline. The hallmark separating delirium from underlying dementia is inattention.
Dementia develops over time, with a slow progression of cognitive decline. The hallmark separating delirium from underlying dementia is inattention.
PromptDetail components of Mini Mental State examination
Response
PromptAllied health to involve in geriatric patient
ResponseSocial Work – to explore options re: emergency respite, supports for family and carers
Community Interface Nurse – home services, offer support groups, aged-care assessment referrals etc
Occupational Therapy – organize in-home assessment for mobility aids, high-risk areas etc
Pharmacy – medication rationalization, assistance with aids ie webster pack
Community Interface Nurse – home services, offer support groups, aged-care assessment referrals etc
Occupational Therapy – organize in-home assessment for mobility aids, high-risk areas etc
Pharmacy – medication rationalization, assistance with aids ie webster pack
PromptLONG LIE
ResponseHas to go somewhere
PromptExamination components for patient with long lie
ResponseVital signs for shock, dehydration
Evidence of Head Injury – may indicate sign of trauma consequent to fall, or primary cause
Chest for signs of aspiration
Skin for pressure sores
Dependent areas for compartment concerns
Mucous membranes for hydration status
Evidence of Head Injury – may indicate sign of trauma consequent to fall, or primary cause
Chest for signs of aspiration
Skin for pressure sores
Dependent areas for compartment concerns
Mucous membranes for hydration status