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Geriatric Emergencies: an EMT Teaching Manual

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Geriatric Emergencies: an EMT Teaching Manual Geriatric Emergencies: An EMT Teaching Manual Geriatric Emergencies An EMT Teaching Manual Editor and Primary Author: Teresita M. Hogan, MD, FACEP Associate Professor of Emergency Medicine University of Illinois, Chicago Program Director Emergency Medicine Residency Program Resurrection Medical Center Chicago, Illinois MedicAlert developed this teaching manual to address the unique care needs of the geriatric patient. Written by leading authorities on geriatric emergencies, this manual will help instructors teach their students how to correctly assess and care for elderly patients during emergencies. MedicAlert, a nonprofit membership organization founded in 1956 by a physician and his wife, is the nation's leading 24-hour emergency medical information service. The MedicAlert emblem, worn as a bracelet or necklace, alerts emergency responders to the medical conditions, medications, and allergies of the wearer. It is also engraved with a phone number to call for further information at the MedicAlert 24 Hour Emergency Response Center. There, nurses and trained medical personnel are available to provide the patient's key medical facts from their MedicAlert Electronic Health Record and relay it to the emergency care provider by phone or FAX. Medical conditions, medications taken (including dosages) physician contact, and medical device information are some of the types of information provided. MedicAlert also provides a family notification service that imparts peace of mind to family members knowing that they will be contacted and united in case of an emergency. MedicAlert® 24-Hour Emergency Information Service A nonprofit membership organization established in 1956 This manual is funded in part by a grant from the Retirement Research Foundation. CONTRIBUTING AUTHORS Michelle Blanda, MD, FACEP David C. Lee, MD, FAAEM, FACEP Professor of Emergency Medicine Director of Research Northeastern Ohio Universities Col/ege of Medicine Department of Emergency Medicine Chair, Department of Emergency Medicine Norlh Shore University Hospital Summa Health System Manhasset, New York Akron, Ohio Chapter 3: Pain Management and Palliative Care Chapter 2: Advance Directives and the PreHospital Provider Scott W. Marlin, M.Ed, NREMT-P Program Director Andrew K. Chang, MD Paramedic Education Program Assistant Professor Akron General Medical Center Department of Emergency Medicine Akron, Ohio Albert Einstein Col/ege 01 Medicine Chapter 9: The Nursing Home Patient Montetiore Medical Genter Bronx, New York Mary Jo McMullen, MD, FACEP Chapter 6: Falls in the Elderly Associate Professor of Emergency Medicine Akron General Medical Center Scott C. French, MD, FACEP Department of Emergency Medicine Clinical Assistant Professor Akron, Ohio Department of Emergency Medicine Chapter 9: The Nursing Home Patient SI. Francis Hospital Evanston, Illinois David J. Peter, MD, FACEP Chapter 5: Myocardiallschemiallnfardion, Research Director, Associate Professor of Shortness of Breath Clinical Emergency Medicine Chapter 7: Abdominal Emergencies Akron General Medical Center Department of Emergency Medicine Teresita M. Hogan, MD, FACEP Akron, Ohio Associate Professor of Emergency Medicine Chapter 9: The Nursing Home Patient University of //Iinois, Chicago Program Director Barbara K. Richardson, MD, FACEP Emergency Medicine Residency Program Clinical Associate Professor of Emergency Medicine Resurrection Medical Center Mount Sinai Medical Center Chicago, Illinois New York, New York Chapter 2: Advance DireC/ives and the Chapter 1: Approach to the Elderly Patient PreHospital Provider Chapter 3: Pain Management and Palliative Care Rob.rl A. Schwaner, MD Chapter 4: Stroke in the Elderly Mending Staff Chapter 5: Myocardiallschemiallnfan;tion, Department of Emergency Medicine Shortness of Breath Norlh Shore University Hospital Chapter 7: Abdominal Emergencies Manhasset, New York Chapter 3: Pain Management and Palliative Care Norman D. Kalbfleisch, MD Associate Professor of Emergency Medicine Marc R. Spiller, MD, FACEP Oregon Health and SCience University EMS Coordinator Department of Emergency Medicine Emergency Medicine Residency Program Portland, Oregon Resurrection Medical Center Chapter 8: Mental Status Change and Alzheimer's Disease Chicago, Illinois Chapter 5: Myocardial Ischemia/Infarction, Christ G. Kyriakedes, DO, FACOEP, FACEP Shortness of Breath Residency Director, Assistant Professor Chapter 8: Mental Status Change and Alzheimer's Disease of Clinical Emergency Medicine Akron General Medical Center John V. Wiegand, MD, FACEp, EMT-B Department of Emergency Medicine Clinical Professor of Emergency Medicine Akron, Ohio Northeastern Ohio Universities College of Medicine Chapter 9: The Nursing Home Patient Summa Health System Akron, Ohio Chapter 2: Advance Directives and the PreHospital Provider The views expressed in this manual are strictly those of the author and do not necessarily represent official positions of MedicAlert or the Retirement Research Foundation (RRF). Third edition, 2004 Second edition, 1996 © 1994 MedicAlert All rights reserved. The reproduction or use of this manual, in whole or in part, in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system now known or hereafter invented, is strictly forbidden without the express written permission of MedicAlert. Such permission to make copies of this text for non-commercial classroom use by students is extended to educators and instructors in emergency medical services and emergency nursing. Printed in the United States of America. MedicAlert is a federally registered trademark and service mark. MedicAlert wishes to thank the Retirement Research Foundation (RRF) for their generous support that made publication of Geriatric Emergencies: an EMT Teaching Manual possible. RRF has funded this project since the first edition was published in 1994, and is to be commended for its commitment to the advancement of issues involving the elderly. MedicAlert also gratefully acknowledges and thanks Teresita M. Hogan, MD, FACEP, for her untiring dedication in her roles as Editor and Primary Author. Her expertise in the field of geriatric emergency medicine is invaluable. MedicAlert would also like to thank the contributing authors for the important contributions their involvement made to this project; American Medical Response (AMR) Northern California Training Institute for their research and data compilation assistance; Denise Toriani, Administrative Coordinator, Department of Emergency Medicine at Resurrection Medical Center, Chicago, Illinois, for her assistance in compiling the manual and Shu Chan, MD, Research Director, Department of Emergency Medicine at Resurrection Medical Center for his assistance with statistics. In addition, MedicAlert wishes to take this opportunity to acknowledge Cindy Malekos, Project Manager, for the key role she played in coordinating this project from beginning to end, and Noel Rocha, Graphic Designer, for her contribution to the visual appeal of the manual. Contents Geriatric Emergencies: An EMT Teaching Manual Introduction ............................................. v 1 Approach to the Elderly Patient ............................ 2 Barbara K. Richardson, MD, FA CEP 2 Advance Directives and the PreHospital Provider ............ 18 Michelle Blanda, MD, FACEP John V. Wiegand, MD, FACEP, EMT-B Teresita M. Hogan, MD, FACEP 3 Pain Management and Palliative Care ...................... 38 Robert A. Schwaner, MD David C. Lee, MD, FAAEM, FACEP Teresita M. Hogan, MD, FACEP 4 Stroke in the Elderly ..................................... 50 Teresita M. Hogan, MD, FACEP 5 Myocardial lschemia/lnfarction, Shortness of Breath .......... 66 Teresita M. Hogan, MD, FACEP Scott C. French, MD, FACEP Marc R. Spiller, MD, FACEP 6 Falls in the Elderly ...................................... 94 Andrew K. Chang, MD 7Abdominal Emergencies ................................ 106 Teresita M. Hogan, MD, FACEP Scott C. French, MD, FACEP 8 Mental Status Change and Alzheimer's Disease ............. 134 Norman D. Kalbfleisch, MD Marc R. Spiller, MD, FACEP 9 The Nursing Home Patient ............................... 154 David J. Peter, MD, FACEP Christ G. Kyriakedes, DO, FACOEP, FACEP Scott W. Martin, M.Ed, NREMT-P Mary Jo McMullen, MD, FACEP About MedicAlert ...................................... 174 Glossary ............................................. 177 About the Primary Author ............................... 185 INTRODUCTION Geriatric Emergencies: An EMT Teaching Manual Geriatric Emergencies: An EMT Teaching Manual was developed for practicing pre-hospital care providers to address the unique emergency care needs of elderly patients. The elderly, defined in this text as persons above the age of 65, are the most frequent users of emergency medical care. They have a higher severity of illness, and greater morbidity and mortality than younger persons. They are also the fastest growing segment of the U.S. population, comprising one of every eight individuals in the nation today, according to the Administration on Aging. This age group continues to increase daily due to the aging of the baby boomer generation, the 75 million people born between 1946 and 1964. How does this affect the pre hospital care provider? As these 'boomers' grow older and their incidences of medical conditions increase, the occurrence of emergency medical events rises as well. Therefore EMS providers will spend a majority of their time caring for elderly patients. It is clearly
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