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3 results

  • 10 - Thoracic trauma

  • from Section 2 - Trauma
  • Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    05 November 2013
    Print publication:
    24 October 2013, pp 71-81

  • Summary

    This chapter discusses the diagnosis, evaluation and management of shock. It presents special circumstances which make diagnosis and management of shock difficult in pediatric and pregnant patients. Shock should be suspected when patients present with a constellation of signs including ill-appearance, tachycardia, tachypnea, hypotension, and oliguria. The principles of shock management include specific therapy for treating the underlying cause, and general therapy to manage the shock syndrome. Recognition of shock is difficult due to variations in age-dependent vital signs, difficulty in assessing mental status, and the non-specificity of early manifestations of shock such as irritability and poor feeding. Elderly patients experience significantly more morbidity and mortality from all causes of shock due to their limited ability to augment cardiac output and maintain vascular tone. Elderly patients often have multiple comorbidities or use multiple medications that distort the diagnosis and management of shock.

  • Frequent Use of Emergency Medical Services by the Elderly: A Case-Control Study Using Paramedic Records

  • Niels Tangherlini, Mark J. Pletcher, Mark A. Covec, John F. Brown
  • Journal:
    Prehospital and Disaster Medicine / Volume 25 / Issue 3 / June 2010
    Published online by Cambridge University Press:
    28 June 2012, pp. 258-264
    Print publication:
    June 2010
  • Introduction:

    The objective of this study was to identify the factors that lead to increased use of emergency medical services (EMS) by patients ≥65 years of age in an urban EMS system.

    Methods:

    Retrospective, case-control study of frequent EMS use among elderly patients transported during one year in an urban EMS system. Three distinct groups were examined for transports that took place in 1999: (1) 1–3 transports per year (low use); (2) 4–9 times per year (high use); and (3) those transported 10+ times (very high use). This frequency-use indicator variable is the primary outcome measurement. Predictors included age, gender, preexisting medical diseases, ethnicity, number of medications, number of medical problems, primary physician, psychiatric diagnosis, and homelessness. Analysis of predictors was done using ordinal logistic regression model, and a global test of interaction terms.

    Results:

    Male gender, black ethnicity, homelessness, and a variety of types of medical problems were associated with increased use of EMS resources. The strongest single predictor of case status remained homelessness, which was nearly eight times as commonly associated with frequent EMS use than for the controls. The number of medical problems and medications also were significantly associated with EMS use in this patient population. There was a lack of association of alcohol, substance abuse, and psychiatric disorders with EMS use. Patients with asthma who did not have a primary care physician were more likely to use EMS services than were those who had a physician.

    Conclusions:

    This analysis highlights homelessness as being strongly associated with frequent EMS use among the elderly and downplays other associated factors, such as psychiatric disease and substance use. Medical illness severity, particularly asthma when no primary care physician is available, also appears to drive frequent EMS use. Both findings have implications in terms of targeting of public resources; providing housing to medically ill elderly and primary care to asthmatics in particular, may provide dividends not only in terms of social welfare and medical care, but in preventing frequent EMS use by the elderly.

  • 11 - Plain Radiography in the Elderly

  • from PART I - PLAIN RADIOGRAPHY
  • Edited by J. Christian Fox, University of California, Irvine
  • Book:
    Clinical Emergency Radiology
    Published online:
    07 December 2009
    Print publication:
    29 September 2008, pp 180-200

  • Summary

    The elderly have some indications for plain film radiography that are specifically determined by their age group. Imaging of the pelvis is most commonly prompted by pain and/or trauma. In addition to identification of fractures, emergency physicians should look for neoplastic lesions and degenerative changes of the hip joints or sacroiliac joints. Rheumatologic conditions are increasingly common with age. Plain radiology in the evaluation of non bony abdominal pathology has the same limitations in the elderly as it does for other adults, with the consequence that CT is often the imaging modality of choice. Most of the limitations of plain radiography in the elderly are the same as those for adults. Radiographs are limited by the patient's ability to cooperate with the exam. This chapter presents clinical images depicting radiographic findings and pathology that clinicians should be familiar with in the elderly patient.