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Geriatrics Final > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

***When treating trauma in the elderly, equating normal blood pressure with normovolemia is dangerous. Why?

A

A normal change that occurs with aging is increased blood pressure (d/t stiff arteries).
Normal blood pressure in an old person could mean active bleeding!

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2
Q

***Geriatric pts may be taking lots of medications (beta blockers, anticoagulants). How does this fact complicate treating trauma?

A

Psychotropic medications, commonly prescribed for elderly, may mask injuries or become problematic if discontinued abruptly.

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3
Q

***If an elderly pt exhibits altered level of consciousness, what should you never miss?

A

Hypoglycemia – 1st step! Get blood sugar finger stick

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4
Q

What are some other causes of altered LOC?

A
  • Dementia – gradual decrease in intellectual ability or cognition; non-reversible
  • Delirium – waxing and waning LOC; often reversible
  • Depression
  • Hard of hearing
  • Drugs
  • W/d
  • Sepsis
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5
Q

What is Delirium Tremens? Define Delirium.

A

Stage IV of alcohol withdrawal.

Delirium=waxing and waning level of consciousness.

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6
Q

How do you diagnose Delirium Tremens?

A

Diagnosis—
• Symptoms (Confusion, tremor, agitation, delusions, diaphoresis, hallucinations, anxiety, GI distress, vomiting leading to dehydration) onset 2-5 days (sometimes up to 14 days) after last drink and last 1-5 days.
• Physical Exam–Autonomic lability (severe hypertension, severe tachycardia and tachypnea, hyperthermia)
• Testing—Chem panel, Mg, Coags, urine tox screen

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7
Q

How do you treat Delirium Tremens?

A

ABCs, IV(most pts are dehydrated), O2, monitor, **benzodiazepines (lorazepam…may require extremely large doses), propofol is another option. **Use Normosaline, consider K, Mg, Thiamine, MVI, folate (banana bag).
If seizure send to ICU.

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8
Q

Pt w/ abd pain, suspecting bladder tumor, what do you do?

A

Use ultrasound to look at the tumor. Looking for fluid in the bladder. Use a catheter to drain bladder.

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9
Q

What do you not want to miss w/ abd pain in the elderly?

A

Appendicitis, **Abdominal aortic aneurysm (AAA) (often confused w/ renal stone) (risk factors = smoking, fmhx), ruptured viscous, GI bleed (get rectal exam), **mesenteric vein thrombosis or arterial embolus (pain out of proportion to PE findings), diverticulitis with perforation.

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10
Q

***What is the first step w/ elderly pt presenting w/ chest pain?

A

EKG!

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11
Q

What else should you do w/ chest pain?

A
  • Cardiac enzymes (blood work) (***troponin takes 6 hours to rise)
  • Elevated troponin can also be seen in renal failure (not being excreted)
  • CXR
  • CBC, chemistry panel
  • O2 if < 95% saturation
  • If MI → catheter lab!
  • If in rural area → tPA
  • For pulse-less V-Tach or Torsades → defibrillate (not cardiovert which requires synchronization)
  • Torsades – also give Mg Sulfate
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12
Q

What do you not want to miss in pts w/ chest pain?

A
  • Unstable Angina
  • MI
  • PE
  • Aortic dissection
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13
Q

What is “cogwheel rigidity”? What is it associated with? What should you do w/ this pt?

A

Cogwheel rigidity=hand/wrist exhibits hangups w/ passive articulation.
Assoc. w/ Parkinson’s Disease:
• 1% of population over 60, men > women
• Resting tremor, pill-rolling
• Rigidity of the limbs (cogwheeling)
• Bradykinesia (unable or slow to initiate movement)
• Decreased facial expression (masked facies)
• Shuffling gait
• Depression and or dementia
• Avoid phenothiazines, haloperidol, metoclopramide, and Compazine
• Refer to neurologist for treatment with dopamine receptor agonist or other meds

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14
Q

Exercise and the elderly: what is the disadvantage?

A

break a bone

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15
Q

How do you prevent a decubitus ulcer of the sacrum?

A

constant motion

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16
Q

What is dehisced bowel? What do you do to tx it? What can happen if it is not promptly treated?

A

Small bowel leaking out thru a surgical incision.
Tx: Call surgeon, Keep it moist and covered until surgery.
Complication: Bowel becomes incarcerated and/or strangulated = intestines is out of body and can’t get back in and is strangulated (losing blood supply)

17
Q

Diabetic complications: What is the cause of this purple toe? What is the treatment?

A

– blood supply cut off

– cut off toe and change lifestyle

18
Q

***Dialysis tularemia Medication Toxicity: What are the drugs that potentially cause renal injury in the elderly?

A
  1. Trimethoprim sulfamethoxazole
  2. Nitrofurantoin
  3. Ibuprofen and NSAIDs
  4. Aminoglycosides (Gentamycin)
  5. ACE inhibitors (Lisinopril)
  6. Contrast media used in medical imaging
19
Q

What is narrow angle glaucoma?

A
  • Ocular emergency—one pupil dilates, narrows angle of lens/iris junction and results in inability of aqueous fluid to flow from posterior to anterior chamber then out of trabecular network resulting in pressure build up.
  • Sudden onset severe eye pain, may have blurred vision or see “halos”, headache, N/V and photophobia……
  • Physical exam decreased visual acuity, “steamy” cloudy cornea, fixed mid-position pupil, increase intraocular pressure >30
  • Tests—Shiotz tonometer, Goldman applanation tonometry (gold standard—need slit lamp), Tono-Pen
  • Treat—call ophthalmologist, block aqueous humor production(beta blockers), reduce vitreous vol (mannitol), facilitate outflow of aqueous humor (pilocarpine)
20
Q

When should you consider geriatric abuse (ex. hematoma)?

A

Consider elder maltreatment and patterns of injuries (Physical, Sexual, Psychological, Neglect, Financial)
Physical findings suggesting elder maltreatment include:
• Contusions affecting the inner arms, inner thighs, palms, soles, scalp, ear(pinna), mastoid area, buttocks, or multiple and clustered contusions
• Abrasions to the axillary area (from restraints)
• Nasal bridge and temple injury (eyeglasses)
• Periorbital ecchymoses
• Oral injury
• Unusual alopecia pattern
• Untreated pressure ulcers or ulcers in non-lumbar/sacral areas
• Untreated fractures
• Fractures not involving the hip, humerus, or vertebra
• Injuries in various stages of evolution
• Injuries to the eyes or nose
• Contact burns and scalds
• Scalp hemorrhage or hematoma
• The presence of these findings should prompt a detailed history that may be at variance with the physical findings and may uncover an intentional delay in treatment. These findings should prompt further investigation by reporting to appropriate authorities.

21
Q

***Why is it important to know SAD PERSONS?

A

More likely to commit suicide. (The S’s are most important).
S Sex (male)
A Age (teenager or elderly)
D Depression
P Previous Attempt
E Ethanol or drug use
R Loss of rational thinking
S Sickness (medical illness, 3 or more prescription meds)
O Organized plan
N No spouse (divorced, widowed, or single, especially if childless)
S Social support lacking

22
Q

What should you suspect and do for a pt w/ a rash?

A

Shingles (get vaccinated!) – watch out for dendritic ulcerations in the eye

23
Q

What do you do for a pt w/ a pronator drift stroke?

A
  • Get CT scan (STAT) if occurred recently

- ***tPA has a window of effectiveness of 2-4 hours.

24
Q

***If a pt presents complaining of symptoms “like a shade being pulled down in front of eye”, what is this called and what causes it?

A

Amaurosis fugax.

TIA (transient ischemic attack).

25
Q

***What MUST you do if you suspect a stroke?

A

Speech, drift, eyes, watch the patient walk if able.

Must document findings.

26
Q

***What do you do for a pt w/ a headache you suspect to be caused by trigeminal neuralgia?

A

-Pain causing tic or twitch, affects the trigeminal or 5th cranial nerve. Electric shock like, usually unilateral, begins and ends abruptly. Predominently in patients over 50. Female > male. Pain is intolerable at times.
-May be due to compression of nerve root.
-Labs—no specific lab tests
-Imaging—MRI may show compression of nerve
-Treat—Carbamazepine, sometimes surgery, refer neurology.
(This can cause people to be suicidal b/c it never goes away and gets worse over time.)

27
Q

What is the most common tremor in the elderly?

A

Essential (senile) tremor (familial). Benign.

Geriatrics Final (10 decks)

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