approach to the elderly patient


Elderly patients are at higher risk for many emergencies, and it can be helpful to take a systems-based approach


  • higher risk of c-spine fracture
  • can be more difficult airways for mask and tube


  • Sick pneumonia higher risk, including aspiration, can present less typically (confusion, GI complaints, can be afebrile)


  • RV strain: PE higher risk
  • Dysfunction LV: higher risk of ACS, and present more atypically (sob, fatigue, confusion, abdo pain)
  • Incompetent valve: higher risk of valvular disease
  • Outflow dissection: higher risk
  • Volume depletion can develop more easily, especially if mobility issues or dementia prevent access to liquids
  • S: higher risk for AAA, GI bleed, soft tissue bleed if anticoagulated
  • L: higher risk of sepsis


  • RBC bleed/clot: higher risk stroke and bleed, including insidious and spontaneous subdural bleed


  • Normothermia: less likely to mount fever in response to infection


  • multiple reasons to get renal failure: pre-renal, renal and post-renal


  • Biliary disease can present less obviously
  • Mesenteric ischemia higher risk
  • No motion from dehydration, medications, obstruction
  • Appy/diverticulitis higher risk delayed diagnosis and rupture



  • more sensitive to medications and polypharmacy, underdiagnosed substance use


  • more likely to fracture and develop soft tissue infections (including sacral ulcers)


Putting this together to approach the elderly patient

  • A: lower threshold for C-spine Xray +/- CT; expect more difficult airway
  • B: high suspicion for pneumonia
  • C: high suspicion for ACS, consider causes of pump failure, volume resuscitate and consider bleed/sepsis
  • D: low threshold CT head
  • E: don’t assume afebrile means no infection
  • F: correct fluids
  • G: beware abdo pain, POCUS of gallbladder/aorta, check lactate, low threshold for /CT
  • H
  • I: check meds for iatrogenic reason for visit, ask about substances, check doses
  • J: complete exam for sources of infection or fractures


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