This document summarizes a chapter from the sixth edition of the textbook "International Trauma Life Support for Prehospital Care Providers" about trauma in the elderly. It outlines how the aging process impacts the body's response to trauma, with decreased function of organs like the heart, lungs, and bones. Injuries can be more serious in elderly patients even if relatively minor. The assessment and management of geriatric trauma requires special consideration of preexisting medical conditions and the effects of medications.
I picked that presentation from the internet and edited it, all rights reserved to the original owner. Anyhow this presentation might be helpful for med students doing their emergency rotation/elective and especially those who don't have an instructor or any kind of mentor in their emergency elective, like me.
I picked that presentation from the internet and edited it, all rights reserved to the original owner. Anyhow this presentation might be helpful for med students doing their emergency rotation/elective and especially those who don't have an instructor or any kind of mentor in their emergency elective, like me.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
history taking in pain medicine is most imp part,in this covered all the imp aspects refrence:The art of history taking in patient with pain:An ignored but very important component
in making diagnosis;Indian Journal of Pain | May-August 2013 | Vol 27 | Issue 2
CPR – or Cardiopulmonary Resuscitation – is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest.
Management of-unconscious-patient
Definition of unconsciousness
Common causes
Diagnosis and treatment of unconscious patient
Unconsciousness is a state in which a patient is totally unaware of both self and external surroundings, and unable to respond meaningfully to external stimuli.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Calm Computing 2016: La rencontre de l'internet industriel et des objets av...calmr.io
Dans le cadre de la 6e Édition de ECOM MTL.
Réalité virtuelle et objets connectés - Application concrète
Au cours de la dernière annnée, de nouvelles technologies et de nouveaux produits prendre de plus en plus de place sur le marché. Conséquence : un intérêt de plus en plus grandissant pour pour des technolgies comme l'augmented reality et le virtual reality. Qu'ont ils en commun? Ils font partie d'un système intégré où le monde réèl devient plus connecté que jamais :
Le wearable tech a rejoint le maché de masse.
Les possibilités de mesure ont atteint de nouveaux sommets (sensor tech).
Les applications sont plus concrète et utiles que jamais.
Do Not Resuscitate Orders : What They Mean ?SMSRAZA
Most doctors working in Acute areas know when and how to do CPR. However, most get stuck when it comes to ' When not to do CPR' due to cultural, social, ethical and legal issues attached.
history taking in pain medicine is most imp part,in this covered all the imp aspects refrence:The art of history taking in patient with pain:An ignored but very important component
in making diagnosis;Indian Journal of Pain | May-August 2013 | Vol 27 | Issue 2
CPR – or Cardiopulmonary Resuscitation – is an emergency lifesaving procedure performed when the heart stops beating. Immediate CPR can double or triple chances of survival after cardiac arrest.
Management of-unconscious-patient
Definition of unconsciousness
Common causes
Diagnosis and treatment of unconscious patient
Unconsciousness is a state in which a patient is totally unaware of both self and external surroundings, and unable to respond meaningfully to external stimuli.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
Calm Computing 2016: La rencontre de l'internet industriel et des objets av...calmr.io
Dans le cadre de la 6e Édition de ECOM MTL.
Réalité virtuelle et objets connectés - Application concrète
Au cours de la dernière annnée, de nouvelles technologies et de nouveaux produits prendre de plus en plus de place sur le marché. Conséquence : un intérêt de plus en plus grandissant pour pour des technolgies comme l'augmented reality et le virtual reality. Qu'ont ils en commun? Ils font partie d'un système intégré où le monde réèl devient plus connecté que jamais :
Le wearable tech a rejoint le maché de masse.
Les possibilités de mesure ont atteint de nouveaux sommets (sensor tech).
Les applications sont plus concrète et utiles que jamais.
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
Learn why heart disease is a major issue and what you can do to prevent and reverse the number one killer of American's today. Review extensive science and studies demonstrating the effect of nutrient dense foods, exercise and mental health on heart health. Establish your own personal heart health program today.
Problem faced by Adult with Cerebral Palsy & their emediesjitendra jain
As with any other normal individual, function of Cerebral Palsy affected individual also declines significantly as result of aging but proportion of problems can be more. Shorter life span in these group of population not because of cerebral palsy but commonly due to existing co-morbidities so it is better to understand their co-morbidity and try to resolve them .
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Key Lecture Points
Review pathophysiology of aging by systems.
Stress that when doing field triage, geriatric patients have more injuries and worse outcomes than younger patients who are subjected to the same mechanisms.
Review patient assessment, and relate how aging affects assessment and interventions.
Discuss potential problems with spinal motion restriction in elderly patients.
NOTE: In U.S., www.census.gov has wealth of information. QuickFacts (quickfacts.census.gov) and American FactFinder (factfinder.census.gov) allow you to get detailed demographic information for states, counties, and cities.
NOTE: Check national census data.
“Elderly”
Often understood as being 65 years or older, but chronological age is not most reliable definition of “elderly.”
More appropriate to consider biological processes that change with time, such as fewer number of neurons, decreased functioning of kidneys, and decreased elasticity of skin and tissues.
Discuss aging population in your area.
United States:
U.S. 2005 Census: 12% of population aged 65 years and older—expected to double in next 25–30 years.
Age group 85 and older now fastest-growing segment of population.
More than 30% of all patients transported by ambulance are older than age 65.
Physiologic and anatomic changes of aging increase risks for trauma as well as increase complications and mortality.
NOTE: Data based on U.S. population by U.S. National Safety Council.
Geriatric patients tend to respond to injury less favorably than younger adult population.
Little research on poor response of geriatric patient to trauma.
Existing literature is retrospective in nature and offers little explanation for more adverse outcomes experienced by elderly.
A number of aging processes contribute to increased risk of injury to geriatric patient.
Increase in falls has been linked to physiological changes of aging process—decrease in function of special senses, syncope, transient impairment of cerebrovascular perfusion, alcohol ingestion, or medication usage.
Alterations in perception and delayed response to stressors may also contribute to injury.
NOTE: Closer look at image on next slide. Included here to emphasize that respiratory system changes do not just occur in lungs.
Aging is gradual process whereby changes in bodily functions occur.
Changes are in part responsible for greater risk of injury in geriatric population.
Airway
Potential obstructions due to caps, bridges, dentures, and fillings. Gums shrink with age, causing dentures to become loose.
Respiratory system
Decreased alveolar exchange means decreased carbon dioxide and oxygen exchange.
Decreased inhalation time leads to rapid breathing.
From previous slide: Airway potential obstruction also due to decreased airway clearance, decreased laryngeal reflexes, decline in mucolary clearance, and decreased ciliary action (which also increases chance of infection).
From previous slide: Decreased pulmonary circulation combined with loss of elastic recoil leads to ventilation/perfusion mismatch.
From previous slide: Decreased alveolar exchange means decreased carbon dioxide and oxygen exchange. This is due to decreased numbers of alveoli.
From previous slide: Decreased chest wall movement is due to stiffening of chest wall with declining strength of chest muscles.
From previous slide: Decreased pulmonary circulation, rapid breathing, and decreased alveolar exchange lead to hypercapnia due to resulting altered chemoreceptor response.
From previous slide: Decreased pulmonary circulation, rapid breathing, and decreased alveolar exchange lead to arterial hypoxemia with reduced PO2 levels.
Increased work of breathing leads to increased anterior-posterior diameter.
Circulation reduced due to changes in heart and blood vessels.
Cardiac output and stroke volume may decrease.
Conduction system may degenerate.
Ability of valves of heart to operate efficiently may decline.
These changes may predispose patient to congestive heart failure and pulmonary edema.
Arteriosclerosis occurs with increasing frequency in course of aging process.
Blood pressure may normally be higher in elderly.
Significant change may occur in a patient when normal blood pressure of 160 mmHg drops to 120 mmHg as a result of trauma.
Changes occur in brain with age.
Increased risk of subdural hematoma due to space or an increased distance between brain and skull.
Instead of protecting brain during impact, space allows an increased incidence of following trauma.
Decreased pain tolerance can result in failure to identify areas of injury.
Other signs of decreased cerebral circulation due to aging process may include confusion, irritability, forgetfulness, altered sleep patterns, and mental dysfunctions such as loss of memory and regressive behavior.
May be decrease in ability, or even an absence of ability, to compensate for shock.
Mechanisms to maintain normal body temperature may not function properly.
May not respond to infection with a fever, or may not maintain normal temperature with injury.
Patient with broken hip lying on floor in room with temperature 64o Fahrenheit/18o Celsius can experience hypothermia.
Decrease in number of functioning nephrons in kidneys of geriatric patient can result in a decrease in filtration and a reduced ability to excrete urine and drugs.
May be less able to fight off infection.
A poor nutritional state will be more susceptible to infection from open wounds, IV access sites, and lung and kidney infections.
Geriatric trauma patient who is not otherwise severely injured may die from sepsis from an impaired immune system.
NOTE: Emphasize importance of neutral alignment/positioning specific for that patient (pediatrics, adults, and geriatrics).
Exhibit changes in posture.
Decrease in total height due to narrowing of vertebral discs, slight flexion of knees and hips, and decreased muscle strength.
Result in kyphosis or kyphotic deformity of spine (“S” curvature of spine often seen in stooped elderly).
NOTE: Need to pad SMP accordingly.
More susceptible to fractures.
Advanced osteoporosis—a thinning of bone resulting in a decrease in bone density.
Diminished subcutaneous tissue.
Decreases protection from falls and blunt trauma.
Decrease ability to respond to temperature changes.
Weakening in strength of muscle and bone from decrease in physical activity.
More susceptible to fractures with only a slight fall.
Gastrointestinal system
Decrease ability to absorb nutrients due to decreased saliva production, esophageal motility, and gastric secretion.
Constipation and fecal impactions common.
Decreased ability to metabolize medications due to liver enlargement from disease processes.
Prolonged illness and recovery time.
Decreased total body water and total number of body cells.
Increase in proportion of body weight as fat.
Loss in capacity of systems to adjust to illness or injury.
Many geriatrics take several medications that can interfere with their ability to compensate after sustaining trauma.
General organ systems may not function as effectively as in a younger adult.
Especially cardiovascular, pulmonary, renal.
Chronic illness complicates trauma care.
Difficult to distinguish.
Bones fracture more easily.
Major bone fractures can be life-threatening.
The ability for elderly to compensate is hindered by many of the things discussed in previous slides.
Geriatric patient assessment, as any assessment, must take into account priorities, interventions, and life-threatening conditions.
You must search for important signs or symptoms. The patient may minimize or even deny symptoms out of fear of becoming dependent, bedridden, institutionalized, or even of losing a sense of self-sufficiency.
You may have difficulty communicating with patient. This could result from patient’s diminished senses, hearing or sight impairment, or depression. The geriatric patient nonetheless should not be approached in a condescending manner. Do not allow others to take over reporting of events from patient who is able and willing to communicate reliable information.
Explain any actions, including removing any clothing, before initiating physical assessment.
Use same ITLS Patient Assessment approach for elderly, but anticipate possible complicating factors.
Loss of skin elasticity and presence of mouth breathing may not necessarily represent dehydration.
Dependent edema may be secondary to venous insufficiency with varicose veins or inactivity rather than congestive heart failure.
Pay attention to deviation from expected ranges in vital signs and other physical assessment findings in geriatric patient.
An injury that is isolated and uncomplicated in young adult may be debilitating in older adult due to overall condition, lowered defenses, or inability to keep effects of an injury localized.
Better to verify history in area where patient unable to overhear—otherwise, implying that patient is incompetent.
Abuse and neglect of elderly are common.
Initial level of consciousness has more significance with elderly patients than with younger patients, because subsequent health-care providers may attribute a decreased level of consciousness to a preexisting condition rather than to trauma.
This is less likely to occur if you clearly indicate that:
Family and bystanders report this is an abnormal presentation, or
Patient was clear, lucid, and cooperative at scene.
Airway is likely to be partially obstructed.
Be alert to possible teeth fragments due to decay and gum disease and dental devices such as caps, bridges, dentures, and fillings.
Chest injuries more likely to cause serious problems in older people with poor pulmonary reserve.
Be especially alert to problems with chronic lung disease.
Usually have borderline hypoxia even when not injured.
Briefly notice heart sounds so you will have a baseline for changes such as development of muffled heart sounds.
Take extra care when performing SMR on geriatric trauma patient including padding void areas that may be exaggerated due to aging process.
Kyphosis will require padding under shoulders and head to maintain neck in usual alignment.
Do not force neck into neutral position if it is painful to do so, or if neck is obviously fused in a forward position.
Remember: SMR needs to be in an anatomically neutral position specific to each patient to be neutral for spinal cord and airway. Although texts often recommend age ranges (including ITLS), SMR is principle-driven. Appropriate padding should be used for all age groups and situations (elderly, American football shoulder pads, infants, obesity, etc.).
Same indications for immediate transport apply for elderly as well as for younger patients, but remember that you may not have as dramatic a response to injury in elderly, so you should have a low threshold for early transport.
If one of the critical conditions is present, immediately transfer patient to a long backboard (vacuum backboard is recommended) with appropriate padding, apply oxygen, load patient into ambulance, and transport rapidly to nearest appropriate trauma facility.
Volume infusion may precipitate congestive heart failure in patients with underlying cardiovascular disease.
Frequently assess patient’s pulmonary status, including lung sounds and cardiac rhythm.
All elderly patients should have cardiac monitoring, pulse oximetry, and capnography, if available.
If altered mental status, it is always helpful if there are family members or friends who can give you pertinent history.
If not abusing alcohol or drugs, most common cause of altered mental status is hypoglycemia.
Report suspicion of elderly abuse.
Although mechanisms of injury may be different from those of younger adults, prioritized evaluation and treatment is same.
As a general rule, elderly patients have more serious injuries and more complications than younger patients.