Week 6: Geriatric patients (part 2)

What are some differential diagnoses for falls?

Accident?

Syncope/dizziness/vertigo

Orthostatic hypotension

Hypovolaemia

Drugs/medications

Acute illness of any kind

Arrhythmias

Stroke/Seizure

What is Osteoporosis?

progressive loss of bone mass.

Common.

Managed with a combination of pharma and non pharma.

Increased exercise, decrease smoking/alcohol.

Vitamin D and Calcium supplements.

What is FRAT?

Falls risk assessment tool.

How to assess a patient that has fallen under the AV CPGS?

Consider sensory impairment, medications, mobility issue, altered cognitive state, history of falls, depression.

Do they have full recollection of the fall?

Was there a mechanical/environment issue?

How do you manage a fallen patient?

Decide whether to transport. Consider referral.

GP, community nursing, pharmacist, allied health, psychologist, community groups.

Why are geriatric patients at an increased risk of trauma?

- Unsteady gait, slowed reaction times, cognitive impairments, skeletal abnormalities.

- Osteoporisis, osteoarthirits, scoliosis.

- CNS changes, aging brain is more susceptible. Decreased elasticity, decreased neurons, decreased brain mass.

- Skin changes, become more fragile, delayed wound healing.

What considerations should be made for geriatric trauma patients regarding cardiac changes?

Many have hypertension and heart disease.

If CHF + beta blockers + anti-coagulants, worse traumatic events.

Increased bleeding risk.

What considerations should be made for geriatric trauma patients regarding neurological changes?

Their usual mental status might make it difficult to assess changes.

May already have altered pupillary response, confusion, cognitive changes.

What are some common injuries for geriatric patients?

Neck of femur fracture (NOF)

Rib fracture

Colles fracture

Skin trauma

Burns

Head injuries

Spinal injuries

What is a neck of femur fracture?

Fracture in the upper portion of the femur just below the ball of the hip joint.

Very common

Surgical intervention is the best form of analgesia.

What is a rib fracture?

Usually from falls from standing.

Seatbelts in MVA

Could be caused by coughing

Can cause pneumonia and resp failure.

What is a colles fracture?

Distal radius fracture

Second most common fracture.

Low energy falls.

What is skin trauma?

Even minor break in skin integrity may lead to significant complications.

Dress, maintain moisture, normal saline, antiseptics.

What considerations should be made regarding burn injuries for geriatrics?

Burns are usually more likely to be deeper and wider.

What considerations should be made regarding head injuries for geriatrics?

Usually caused by falls,

Focus on preventing secondary injury.

Physical examination might have a low sensitivity for detecting intracranial injury.

Cushing triad is a late sign.

What considerations should be made regarding spinal injuries for geriatrics?

Geriatrics are more liekly to suststain injuries that are rare.

Central cord syndrome: more likely, disproportionately greater motor impairment in upper extremities.

ELDERLY DO NOT TOLERATE C-COLLARS WELL.

What is advanced care planning and why is it done?

Death is often preceded by disability. Best to know patients wishes before this occurs.

Patients with ACD visit hospital much more.

How does advanced care planning apply to paramedics?

Paramedics must take the time to listen to patient needs, and ensure they are aware of the ACD and follow its wishes.

But also, may be in a position where ACD is not created yet.

What is capacity and how does it relate to advanced care planning?

Adult presumed to have decision making capacity:

- Comprehend an retain information needed to make the decision

AND

- Use and weigh that information as part of their decision making process.

What is a substitute decision maker and how does it relate to advanced care planning?

A person who is lawfully able to make healthcare/treatment decisions on behalf of someone with impaired decision making

May have more than one.

What is a medical treatment decision maker and how does it relate to advanced care planning?

A person nominated to manage their health if they are no longer able to make decisions.

Can consent or refuse treatment on their behalf.

What is an advanced care directive?

An instruction that a person with capacity gives about their future medical treatment and care.

Treatments they would accept or refuse, only used if they do not have capacity to make decisions.

Requires witnesses, does not require legal input.

What is an instructional directive (ACD)?

Legally binding instructions about future medical treatment. For specific medical treatments.

What is a value directive (ACD)?

Documents a persons values and preferences for their medical treatment decision maker to consider when making decisions.

What is voluntary assisted dying?

The assistance provided to a person by a healthcare provider to end their life.

Self-administration were a medical practitioner perscribes VAD medication or administered by themself or compentent person.