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

A

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

B: CHEST

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

C: CARDIOVASCULAR

• 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

D: NEUROLOGIC

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

E

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

F

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

G: ABDOMINAL

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

H

I: INTOX

• more sensitive to medications and polypharmacy, underdiagnosed substance use

J

• 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