Lecture 12: Geriatric Emergencies, Team Approach to Healthcare, and Terrorism Response and Disaster Management

Geriatrics refers to the assessment and treatment of disease in patients _____.

65 and older

An increased number of elderly people in the U.S. creates increased demands for _____, _____, and _____.

Healthcare; in-home care; assisted living

Geriatric patients have the highest rate of _____, greatest per capita use of _____, and commonly take _____, but _____ is often difficult.

Inpatient hospital stays; emergency rooms; prescription drugs; continuity of care

_____ of geriatric patients take at least one prescription drug, while _____ take at least 5 or more.

88%; 36%

Aging refers to the _____. Aging begins in the _____. As organs age, organs are more likely to malfunction under stressors, the patient is less able to handle stressors, and side effects from drugs are more likely. How fast we age is a function of _____, _____, and _____.

Gradual decline of body systems; late 20s; genetics; lifestyle; attitude

Some communication techniques to gain trust from geriatric patients include _____, _____, and _____.

Identifying yourself and your level of training; addressing the patient using “sir” or “ma’am”; being patient

Elderly patients are at increased risk for _____ (leading to _____) and _____ following surgeries.

Blood clots; pulmonary embolisms; sepsis

Common complains in elderly patients include respiratory illness and rib fractures, the latter of which is commonly caused by _____ and _____. Rib fractures often result in a difficulty _____, breathing to become _____, _____ to repress _____, and may cause _____. Additionally, their _____ lifestyle may increase the risk of _____ and _____.

Falls; MVAs; clearing secretions; shallower; pain; coughing; pneumonia; sedentary; pneumonia; blood clots

The GEMS diamond should be used when assessing a geriatric patient. It includes the assumption that geriatric patients typically have _____, an assessment of the _____ for _____ and _____, an assessment of _____ (including if the complaint is _____ vs. _____ and the patient’s _____) and _____, and an assessment of the _____, including _____, _____, and _____ (recognizing that _____ and _____ are not normal parts of aging).

Atypical presentations; environment; safety; neglect; medical history; new vs. chronic; baseline; medications; social environment; basic needs; social network; ability to complete ADLs; depression; suicide

_____ have the highest rate of suicide in the U.S.

White males 85 and older

Risk factors for depression include a history of depression, _____ (related to social health), taking _____, and _____ conditions.

Isolation; prescription medications; chronic

In addition to using the GEMS diamond, when assessing a geriatric patient, you should ask them _____, understand that _____ and that they may _____, and remember that their presentation may be atypical.

What bothers them the most; their sensation of pain may be diminished; understate the severity of their condition out of fear

_____ medications are common among the elderly; these include beta blockers that prevent heart rate and blood pressure from rising by blocking the effects of epinephrine.

Compensatory

Respiratory changes in the elderly body include the weakening of the _____, leading to decreased _____; the _____ lose elasticity, causing _____ to become more difficult; and _____ respond more slowly to _____. Other contributing factors include _____, a compromised _____, and a history of _____, _____, or other chronic diseases.

Airway muscles; breathing capacity; alveoli; exhaling; chemoreceptors; hypoxia; institutionalized; immune system; COPD; cancer

Cardiovascular changes in the elderly body include the _____ of the heart, leading to decreased _____, and an increased risk for _____.

Hypertrophy; cardiac output; aneurysm

Heart failure/congestive heart failure refers to when _____ is not able to meet the needs of the body. Risk factors include _____ (related to blood pressure), history of _____, _____ (type of heart rhythm), and _____ (type of mechanical problem).

Cardiac output; hypertension; coronary artery disease; atrial fibrillation; valve insufficiency

Altered mental status in the elderly may be chronic (such as in cases of _____) or acute (as in cases of syncope, insulin shock, stroke, rising ICP, etc).

Dementia

During left-sided heart failure, fluid backs up into the _____. Signs and symptoms include _____, which produces _____ and _____, and _____ (PND), which involves _____, usually at _____; _____ and/or feeling _____; and _____, _____, and _____ skin.

Lungs; pulmonary edema; shortness of breath; rales; paroxysmal nocturnal dyspnea; sudden shortness of breath; night; coughing; suffocated; pale; cool; diaphoretic

During right-sided heart failure, fluid backs up into the _____. Signs and symptoms include _____, _____, and _____. Note that _____, so _____.

Body; jugular vein distention; ascites; peripheral edema; right-sided failure is often caused by left-sided failure; signs and symptoms of both may exist at the same time

During a heart attack in a geriatric patient, classic signs and symptoms are often not present. Silent heart attacks are particularly common in _____ and _____. Signs and symptoms include difficulty _____, feelings of _____, _____ (digestive symptom), _____ and _____ (related to level of consciousness), excessive _____, and _____ and _____ pain (instead of the typical chest pain).

Elderly women; diabetics; breathing; weakness; indigestion; syncope; altered mental status; sweating; arm; back

Dementia is a chronic and irreversible disease that results in a progressive loss of _____ abilities, _____ skills, and _____ skills. It is a result of multiple neurological diseases, including _____, _____, and genetic factors. Signs and symptoms include confusion and anger, impaired judgement, an inability to vocalize _____, short- and long-term _____, decreased _____, inability to stick to a daily routine, and a decreased ability to communicate.

Cognitive; psychomotor; social; Alzheimer’s; stroke; pain; memory; attention span

Delirium refers to a sudden change in mental status, consciousness, or cognitive processes. It is usually a result of a _____ and _____ ailment, such as _____, _____, or _____ causes. Make sure to assess any patients presenting with delirium for _____ or _____, _____, and _____. Signs and symptoms include an inability to focus, think logically, and maintain attention, as well as acute _____. Potential consequences include _____, _____, and _____.

Reversible; physical; tumors; fever; metabolic; alcohol or sedative withdrawal; UTIs; dehydration; anxiety; hypoxia; hypovolemia; hypoglycemia

Skin changes like _____/_____/_____ are common in the elderly. These changes come about when pressure from the weight of the body cuts off blood flow to that area. Stage I involves non-blanching redness with damage under the skin. Stage II involves blisters or ulcers that can affect the dermis and epidermis. Stage III involves the invasion of the fat layer through the fascia. Stage IV involves the invasion of the muscle or bone.

Decubitus ulcers/pressure sores/bedsores

Osteoporosis refers to a _____. The extent of this condition depends on genetics, hormones, weight, level of activity, and lifestyle factors like smoking, diet, and alcohol. These are contributing factor to _____ injuries, making it especially important to _____ when transporting these patients.

Decrease in bone mass; spinal; pad any voids and spaces

_____ can have many possible reasons in the elderly, including straining during a bowel movement, vagus nerve stimulation, myocardial infarction, insulin shock, hypotension, and TIAs/CVAs.

Syncope

The _____ onset of altered mental status is not normal for any patient, even if they are elderly. Make sure you evaluate and treat for hypoxia, hypovolemia, and hypoglycemia.

Acute

Common MOIs for trauma in the elderly include falls, MVAs, pedestrian accidents, and burns. Confounding factors include _____, _____ (leading to possible _____), and decreased ability to _____.

Existing medical conditions; dentures; foreign body airway obstructions; compensate

Because the _____ shrinks as we get older, there is more room for _____ injury and _____, meaning _____. Assume significant injury in elderly patients with signs or symptoms of a head injury. You should also assume _____ injury in patients who take _____.

Brain; contra coup; intracranial bleeding; symptoms of rising ICP may not appear for days or weeks; brain; blood thinners

_____ are the leading cause of injury-related death in the elderly. The most common cause of death following such injuries include _____, _____/_____, and _____.

Falls; respiratory infections; stroke/AMI; complications from heart failure

Disruptions of the pelvic ring can lead to _____ or _____. This may present as _____.

Hemorrhage; internal organ injury; hip or butt pain

When obtaining report from a staff member at a skilled care facility, make sure you receive information on the patient’s _____, the reason for their _____, their overall condition (including normal _____), and any _____.

Chief complaint; original admission; LOC; DNRs

Signs of elder abuse and neglect include poor _____, poor _____ regulation, and lack of _____ in the home. A verbal report must be submitted _____, and a written report must be submitted _____.

Hygiene; temperature; reasonable amenities; ASAP; within 24 hours

Terrorism refers to the unlawful use of force or violence against persons or property to _____ or _____ a government or population in the furtherance of political or social objectives. Domestic terrorism refers to terrorist acts originating in the United States with no foreign direction, while international terrorism refers to terrorist acts outside U.S. territory.

Intimidate; coerce

Types of terrorist groups include religious extremist groups, doomsday cults, extremist political groups, cyber-terrorists, single-issue groups (including animal rights, anarchists, racists, and ecoterrorists), and technology terrorists.

Good

Unlike criminal acts, terrorism has no traditional _____, no _____ for attack, widespread _____ impacts, the possibility for _____, the potential goal of _____, attacks and violence potentially being brought to the _____, and the complication of _____ through _____, _____ considerations, and _____ materials.

Criminal gains; obvious reason; psychological; multiple simultaneous attacks; doing harm to rescuers; hospital; medical response; mass casualties; crime scene; hazardous

Weapons of mass destruction (WMDs) and weapons of mass casualty (WMCs) refer to agents designed to bring about mass death, casualties, and damage to property and infrastructure. The different types of WMDs can be remembered with the mnemonic B-NICER: _____, _____, _____, _____, _____, and _____.

Biologic; nuclear; incendiary; chemical; explosive; radiologic

Biological WMDs are usually found in nature, cultivated, synthesized, and then mutated into a weapon, then spread by _____, such as poisoning the water supply and aerosolizing the agent into the air. The primary types of biological agents are _____, _____, and _____.

Dissemination; viruses; bacteria; toxins

Viruses require _____. Viruses that may be used as biological WMDs include _____ (which begins with fever and body aches and eventually progresses into blisters and lesions) and _____ (which begins with flu-like symptoms before progressing into ebola, rift valley, and yellow fever, causing _____).

A living host to replicate themselves within healthy cells; smallpox; viral hemorrhagic fever; blood to seep from the tissues

Toxins that may be used as biological WMDs include the neurotoxin ricin, which causes _____ and eventual _____ and _____ failure.

Pulmonary edema; respiratory; circulatory

Nuclear/radiologic WMDs can include _____ or _____. Dirty bombs refers to _____.

Radioactive materials; radioactive waste; radioactive waste dispersed using dynamite

Chemical WMDs can come in _____, _____, and _____ forms. Specific agents include blister agents/vesicants, which cause _____, _____, and _____; respiratory agents, which cause _____, _____, and _____ and include _____ and _____; metabolic agents, such as cyanide, which prevents the body from _____; and nerve agents, which are related to _____ (including _____ and _____) and often cause _____ nervous system stimulation and therefore impending _____ and the mnemonic _____. These may remain on surfaces for long periods of time.

Liquid; powder; vapor; skin irritation; eye injuries; respiratory damage; choking; damage to lung tissue; pulmonary edema; chlorine; phosgene; using oxygen; insecticides; cholinergics; organophosphates; parasympathetic; cardiac arrest; SLUDGEM

Radiologic WMDs include _____, _____, _____, and _____ agents (from least harmful to most harmful). Common devices include radiological dispersal devices (such as _____), and _____ weapons (including specific bombs and special atomic demolition munitions). Signs and symptoms depend on the _____ and _____. Low exposure is generally characterized by nausea, vomiting, and diarrhea. Moderate exposure is generally characterized by first-degree burns, hair loss, compromise of the immune system, and cancer. Severe exposure is generally characterized by second- to third-degree burns, cancer, and death.

Alpha; beta; gamma; neutron; dirty bombs; nuclear; amount of radiation; route of exposure

Suicide bombers have _____ incidence but _____ fatality because _____.

Low; high; gases expand outwards in all directions at high speeds

_____ occur in over 50% of people exposed to a blast when pressure exceeds 10 psi.

Eardrum ruptures

Package bombs consist of _____ and _____ in a _____.

Explosive material; shrapnel; common package

Factors that may predict a terrorist attack include _____ areas, areas with easy _____ and/or little _____, _____ or _____ events, recent _____, and locations that have been _____.

Crowded; public access; security; politically sensitive; symbolic; threats; attacked previously

Notification procedures for a terrorist act include _____ with information about the nature of the event, additional resources required, the estimated number of patients, and the optimal approach; _____, which involves setting up a staging area and only allowing people equipped to handle any WMDs to enter the area; and continually _____.

Notifying dispatch; establishing command; re-assessing scene safety

Preparing to respond to a terrorist act involves knowing the _____ issued by the DHS under the _____ in addition to the type of location, the type of call, the number of patients, victim statements, and pre-incident indicators.

Current threat level; National Terrorism Advisory System

Responding to a terrorist act involves being constantly _____, staging your _____ a safe distance from the incident, remaining _____ and _____, being aware of secondary devices (devices intended to _____ and get more media attention), and not _____ (either directly or indirectly).

Aware of your surroundings; vehicle; upwind; uphill; harm rescuers; coming into contact with harmful agents

Managing a patient who has been exposed to a vesicant involves _____, supporting the _____, and transporting to a _____.

Decontamination; airway; burn center

Managing a patient who has been exposed to a pulmonary agent involves _____, supporting the _____, and providing _____.

Decontamination; airway; high-flow oxygen

Managing a patient who has been exposed to a nerve agent involves avoiding _____, supporting the _____, and using a _____ if available, which consists of _____ and _____.

Exposure; airway; Mark I Kit and Duodote; atropine; 2-pam chloride

Managing a patient who has been exposed to a biological agent involves using _____ and supporting the _____.

BSI; ABCs

Managing a patient who has been exposed to a radiologic agent involves _____, supporting the _____, and treating associated _____ and trauma.

Decontamination; ABCs; burns

The role of the EMT during biological events include _____ surveillance, identification of _____, strategic _____, and participation at _____.

Syndromic; outbreaks; national stockpile; distribution sites

As a BLS provider, you can assist ALS providers with _____ for the procedure, setting up _____, performing certain procedures, and continuing care.

Preparing the patient; equipment

IVs typically come in _____, _____, and _____ solutions, with micro-drip tubing set for _____ (typically used when you want better _____ over the fluid) and macro-drip tubing set for _____ (typically used when you need _____ of fluid). The rate of flow for an IV is typically measured in _____ or _____. Once an IV is used from protective packaging, it must be used within _____.

250 ml; 500 ml; 1000 ml; 60 drops/ml; control; 10-15 drops/ml; large volumes; cc’s/hr; drops/min; 24 hours

EMTs can transport patients with IVs that are _____, _____, and have _____, as well as maintain IVs with a _____.

Clean; clear; no medications added; pre-established flow rate

ALS may ask you to help establish an IV by _____ the bag, filling the drip chamber about _____, _____ the tubing, and then _____.

Spiking; ½ to 2/3 full; flushing; adjusting the flow rate

IVs must be kept _____ than the injection site to keep them flowing, other _____.

Higher; blood will back up into the tubing

Approved IV solutions include _____, _____, _____, and _____.

0.9% sodium chloride; Ringer’s lactate; D (dextrose) 5/W; D (dextrose) 5/0.45 normal saline

Potential complications resulting from IV use include infiltration, which refers to when the _____, causing _____. Potential consequences include _____, _____, and _____. Another potential complication is catheter shear, which refers to when _____, creating the potential for a _____.

Catheter is placed outside the vein; fluid to pour into the interstitial space; hematoma; phlebitis; inflammation; a small piece of the catheter becomes an emboli; pulmonary embolism

Patient operated pumps/patient controlled analgesia (PCA) refer to _____.

Prescribed medications with an automated or patient-operated pump

EMTs can transport patients with an NG tube, G-tube, saline/heparin lock, foley catheter, tracheostomy device, ventricular assist device, surgical drains, and medication patches, but cannot transport patients with a _____.

Chest/thoracotomy tube

Common devices that patients you transport may have include a nasogastric (NG) tube, which is inserted through the _____ to _____ and _____. Another common device is a gastrotomy (G) tube, which is inserted through the _____ to _____. Another common device is a _____, which helps the heart pump.

Nose; relieve gastric distention; give certain medications; abdomen; provide hydration, food, and medication; left ventricular assist device

You may be asked to help monitor and maintain the _____ of intravenous devices like pre-existing vascular access devices and peripheral inserted central catheter (PICC) lines, except in cases of _____, _____, _____, and _____, which you cannot transport.

Preset rate; arterial lines; central venous catheter (CVP) monitoring devices; Swan Ganz catheters; triple lumen lines

A common advanced airway used by ALS is an endotracheal (ET) tube, which refers to a _____. Orotracheal airways are inserted through the mouth, while nasotracheal airways are inserted through the nose. Intubations can either be done _____ (using a _____) or _____ (through the _____).

Insertion of a tube into the trachea to maintain an airway; visually; laryngoscope; blind; nose

During an ET tube insertion, you can assist with assembling the equipment, which involves grabbing a _____, the _____ with handle (which helps sweep the tongue out of the way and align the airway), a _____ or _____ (which helps to add rigidity to the tube but should not extend past the end of the ET tube), a _____ (to test for _____), and a _____ attached to _____. You can also assist with _____ prior to ventilation. You can also perform the _____ by visualizing and palpating the _____, then _____ until intubated.

Correctly-sized tube; laryngoscope; stylet or light stylet; 10-ml syringe; air leaks; BMV; oxygen; pre-oxygenation; Sellick maneuver; cricoid cartilage; applying pressure to the cricoid ring

Potential complications that may result from an endotracheal intubation include accidentally intubating the _____ or _____ (which would result in _____), aggravating _____ injuries, the patient not tolerating the ET tube and/or vomiting, _____ trauma, mechanical failure, decreased _____, and taking too long.

Esophagus; right main-stem bronchus; unilateral chest rise and fall; spinal; soft-tissue; heart rate

After endotracheal intubation, you will perform _____.

Asynchronous CPR

Esophageal-tracheal airway devices/multi-lumen airways include _____ (ETCs) and _____ (PtLs). These generally contain _____ tubes. The benefit of such airways is that _____, but use now is subject to local protocol.

Esophageal tracheal combitube; pharyngeotracheal lumen airway; two; you can ventilate the patient whether it goes in the esophagus or the trachea

A perilaryngeal airway device (King LTS-D) is a _____ airway. Contraindications include asthma, COPD, leaking mask, active vomiting, and esophageal diseases. These are often used when _____.

Laryngeal mask; an endotracheal tube cannot be inserted

In patients receiving a breathing treatment (i.e. a handheld nebulizer), oxygen flow rate should be set to _____.

4-6 L/min

In patients with tracheostomy tubes and stomas, EMTs can help with _____ using _____ and _____.

Suction; sterile gloves; aseptic technique

When placing EKG electrodes on a patient, place the white electrode on the _____, place the black electrode on the _____, place the red electrode on the _____, and the green electrode on the _____.

Right shoulder; left shoulder; left leg; right leg

12-lead EKGs actually only have _____ leads.

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