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