Geriatric Patient Care
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1
What percentage of Canada's population was over 65 in 2003?
13%\
2
What percentage of Canada's population is expected to be over 65 by 2030?
22%\
3
Why must the public become better educated about the needs of elderly people?
Caregiving often falls to family and friends.\
4
What are three important legal considerations in geriatric care?
Advance directives, durable power of attorney, and do-not-resuscitate orders.\
5
What psychosocial factors can influence successful aging?
Bereavement, loneliness, isolation, and feeling unproductive.\
6
At what age does the aging process generally begin?
After growth peaks in the late 20s and early 30s.\
7
At what rate do age-related physiological changes begin occurring after age 30?
Approximately 5–10% per decade.\
8
What body systems are particularly affected by aging?
Respiratory, cardiovascular, renal, nervous, and musculoskeletal systems.\
9
Do most geriatric patients reside in nursing homes?
No, most maintain independent lives.\
10
How does respiratory function change with aging?
It generally declines as lung tissue ages.\
11
Why does pulmonary capacity decrease with aging?
Changes in lung and chest wall compliance.\
12
How does the chest wall change with aging?
It becomes stiffer as the bony thorax becomes more rigid.\
13
How does lung elastic recoil change with aging?
It decreases.\
14
How does alveolar diameter change with aging?
It increases.\
15
What happens to distal airways during expiration in older adults?
They tend to collapse.\
16
How does aging affect residual lung volume?
It increases.\
17
How does aging affect vital capacity?
It decreases.\
18
By how much may vital capacity decrease by age 75?
Up to 50%.\
19
By how much may maximum breathing capacity decrease by age 75?
Up to 60%.\
20
How does arterial oxygen pressure (PaO2) change with aging?
It slowly decreases.\
21
How does arterial carbon dioxide pressure (PaCO2) change with aging?
It generally stays the same.\
22
How does aging affect airway cilia?
There is a loss of cilia.\
23
How does the cough reflex change with aging?
It becomes diminished.\
24
How does the gag reflex change with aging?
It becomes impaired.\
25
How do reduced cilia, cough, and gag reflexes affect older adults?
They impair defenses against inhaled bacteria and particulate matter.\
26
Why are pulmonary infections more common in geriatric patients?
Their respiratory defense mechanisms decline.\
27
Why are pulmonary infections harder to resolve in geriatric patients?
Reduced respiratory defense mechanisms impair clearance of infection.\
28
What happens to cardiac function with aging?
It declines.\
29
What contributes to declining cardiac function in older adults?
Nonischemic physiological changes and a high incidence of atherosclerotic coronary artery disease.\
30
How does the ability to increase heart rate change with aging?
It diminishes.\
31
What types of situations may older adults struggle to increase their heart rate in response to?
Stress, exercise, and catecholamines.\
32
How does ventricular compliance change with aging?
It decreases.\
33
How does the duration of cardiac contraction change with aging?
It becomes prolonged.\
34
How much does resting cardiac output decrease between ages 30 and 80?
Approximately 30%.\
35
What cardiovascular changes predispose geriatric patients to dysrhythmias?
Myocardial hypertrophy, coronary artery disease, and hemodynamic changes.\
36
What cardiovascular changes predispose geriatric patients to heart failure?
Myocardial hypertrophy, coronary artery disease, and hemodynamic changes.\
37
What can unexpected cardiovascular stress cause in geriatric patients?
Sudden cardiac arrest.\
38
What happens to the heart muscle with aging?
It hypertrophies.\
39
What happens to cardiac output with aging?
It declines.\
40
What is arteriosclerosis?
Hardening of the arteries.\
41
What happens to the heart's electrical conduction system with aging?
Cells in the SA node, AV node, and other conduction pathways lose function.\
42
What can age-related changes in cardiac conduction pathways cause?
Dysrhythmias.\
43
What is the most common dysrhythmia associated with aging?
Atrial fibrillation.\
44
What other conduction abnormalities can occur with aging?
Sick sinus syndrome, bradycardias, and heart blocks.\
45
How can age-related conduction abnormalities affect the body?
They can contribute to decreased cardiac output.\
46
What happens to peripheral vascular resistance after age 40?
It progressively increases.\
47
What is the combined effect of decreased cardiac output and increased peripheral vascular resistance?
Significant reduction in organ perfusion.\
48
What lifestyle choices can slow age-related physiological changes?
Regular exercise, healthy diet, avoiding smoking, and managing health conditions.\
49
What health conditions should be managed to slow cardiovascular changes?
Diabetes, high cholesterol, and hypertension.\
50
What lifestyle factors can contribute to cardiovascular decline?
Smoking, drinking, poor diet, and sedentary lifestyle.\
51
How does a sedentary lifestyle affect the cardiovascular system?
It causes deconditioning.\
52
What can cause older adults to have limited physical activity?
Disabilities and psychological factors.\
53
How much does renal blood flow decrease between ages 30 and 80?
An average of 50%.\
54
What happens to functioning nephron units with aging?
Their number decreases.\
55
How does renal blood flow change with aging?
It decreases.\
56
How do aging kidneys respond to electrolyte imbalances?
They respond sluggishly.\
57
What fluid imbalances are particularly concerning in older adults?
Severe dehydration and overhydration.\
58
Is urinary incontinence a normal part of aging?
No.\
59
What is stress incontinence?
Urinary leakage associated with physical stress or pressure.\
60
What is urge incontinence?
Urinary leakage associated with a sudden urge to urinate.\
61
What can urinary incontinence cause in older adults?
Significant social and emotional effects.\
62
What is urinary retention?
Inability to empty the bladder adequately.\
63
What prostate condition can contribute to urinary retention?
Benign prostatic hyperplasia (BPH).\
64
How common is BPH in men aged 31–40?
Approximately 1 in 12.\
65
How common is BPH in men aged 51–60?
Approximately 1 in 2.\
66
How common is BPH in men over age 80?
More than 8 in 10.\
67
What does ADE stand for?
Adverse drug event.\
68
What are adverse drug events?
Harmful reactions or interactions involving medications.\
69
Why are ADEs important in geriatric patients?
They are a common cause of hospital admission, morbidity, and death.\
70
What percentage of adverse drug events are estimated to be dose-related?
More than 80%.\
71
Are many adverse drug events predictable?
Yes, many are predictable and potentially avoidable.\
72
Which medication categories are associated with preventable ADEs?
Cardiovascular medications, diuretics, nonopioid analgesics, and hypoglycemics.\
73
Why are older adults particularly susceptible to neurological toxicity from anticholinergic drugs?
Increased blood-brain barrier permeability and reduced acetylcholine levels.\
74
What two factors contribute to age-related CNS changes?
Decreased cerebral blood flow and changes in neurotransmitter locations and amounts.\
75
What neurological functions may change with aging?
Thinking speed, memory, and postural stability.\
76
How may age-related changes affect responses to questions?
Responses may be slower, and questions may need repeating.\
77
How much can brain weight decrease by age 70?
Up to 10%.\
78
How does brain volume change with aging?
It decreases.\
79
Does a smaller, lighter brain necessarily impair mental capabilities?
No, the brain has enormous reserve capacity.\
80
How do taste and smell change with aging?
Both become diminished.\
81
What are three common age-related visual conditions or changes?
Cataracts, glaucoma, and decreased visual acuity.\
82
How can visual impairment affect older adults?
It can impair independence, reading, and driving.\
83
What is presbycusis?
Age-related hearing loss.\
84
How can hearing loss affect geriatric patients?
It decreases their ability to communicate.\
85
What can cause speech impairment in older adults?
Weakness, paralysis, poor hearing, and brain damage.\
86
What is proprioception?
The body's ability to sense position and maintain postural stability through receptors.\
87
How does proprioception change with aging?
It may decline, making patients less steady on their feet.\
88
What is the effect of reduced postural stability?
An increased tendency to fall.\
89
How does peripheral nerve conduction velocity change with aging?
It decreases.\
90
What can decreased peripheral nerve conduction cause?
Changes in motor or position sense.\
91
How does aging affect reaction time?
It becomes slower.\
92
What other gradual nervous system changes occur with aging?
Decreased visual acuity, reduced auditory keenness, and sleep changes.\
93
Which organ failures can cause toxic or metabolic changes in mental functioning?
Liver, kidney, and lung failure.\
94
Which medical conditions can cause toxic or metabolic changes in mental functioning?
Pneumonia, CHF, dysrhythmias, infections, and tumors.\
95
How do muscles change with aging?
They shrink.\
96
What happens to muscles and ligaments with aging?
They may calcify.\
97
How do intervertebral disks change with aging?
They become thinner.\
98
Which bone condition is common in geriatric patients, especially women?
Osteoporosis.\
99
What percentage of geriatric patients show some degree of kyphosis?
Approximately 68%.\
100
What is kyphosis?
An exaggerated forward curvature of the upper spine, producing a humpback posture.\
101
What adjustment may be needed when immobilizing a patient with significant kyphosis?
Extra padding under the head to allow the patient to lie flat.\
102
What is osteoarthritis?
Wear-and-tear damage to joint cartilage.\
103
What happens when osteoarthritis severely damages joint cartilage?
Bones grind directly against each other, causing pain and restricted movement.\
104
What is rheumatoid arthritis?
An autoimmune disease in which the immune system attacks the synovial membrane.\
105
What happens to the synovial membrane in rheumatoid arthritis?
It becomes inflamed and swollen.\
106
What can rheumatoid arthritis eventually destroy?
Joint cartilage and bone.\
107
What happens to total muscle mass with aging?
It decreases.\
108
How much height can an older adult lose with aging?
Approximately 2–3 inches.\
109
How do certain bones change with aging?
They become widened and weakened.\
110
How does age-related posture change affect mobility?
It can impair mobility and alter balance.\
111
What assistive devices can help prevent fall injuries?
Walkers and canes.\
112
How can flooring modifications prevent falls?
Remove throw rugs and secure loose carpeting.\
113
What should be removed from walking areas to prevent falls?
Items that may cause tripping and general clutter.\
114
How can handrails reduce fall risk?
They provide support during movement.\
115
Why is adequate lighting important for fall prevention?
It improves visibility and helps prevent tripping.\
116
How should furniture be arranged to reduce falls?
To allow easy and unobstructed walking.\
117
What can be placed in bathtubs and showers to prevent falls?
Nonslip decals.\
118
Where should handrails be installed to reduce fall risk?
Bathtubs, showers, and commodes.\
119
What should patients discuss with their physician if medications increase fall risk?
Whether medication changes are appropriate.\
120
How much can lean body mass decrease as a person approaches age 65?
Up to 25%.\
121
How much can fat tissue increase as a person approaches age 65?
Up to 35%.\
122
How can changes in body composition affect fat-soluble medications?
They can change the required dosage and administration frequency.\
123
Why can fat-soluble drugs accumulate more in older adults?
There is a larger fat reservoir for drug accumulation.\
124
Why can water-soluble drug concentrations increase in older adults?
Total body water decreases.\
125
How does thermoregulation change with aging?
The body's ability to maintain normal temperature declines.\
126
At approximately what age do thermoregulatory changes begin?
Around age 30.\
127
Which temperature-related emergencies are older adults at increased risk for?
Hypothermia, heat exhaustion, and hyperthermia.\
128
Why are geriatric patients vulnerable to malnutrition?
They can easily become malnourished.\
129
What complications can result from malnutrition in older adults?
Dehydration, hypoglycemia, and other complications.\
130
What are the two main learning objectives concerning geriatric psychosocial emergencies?
Depression and suicide assessment and management.\
131
What special characteristics can complicate geriatric patient assessment?
Multiple illnesses, chronic conditions, and altered responses to illness or injury.\
132
Why can chronic conditions complicate assessment of acute problems?
Chronic symptoms may be confused with acute symptoms.\
133
How can aging affect a patient's response to illness or injury?
It can alter or diminish typical responses.\
134
How may pain present in geriatric patients?
It may be diminished or absent.\
135
What danger does diminished pain perception create?
The patient or paramedic may underestimate condition severity.\
136
Which social and emotional factors may influence geriatric health?
Fear of losing autonomy, fear of hospitals, and financial concerns.\
137
Why may geriatric patients fear hospital admission?
They may fear losing independence or autonomy.\
138
Why may geriatric patients worry about healthcare?
Financial concerns.\
139
Why does obtaining a history from an older adult usually take longer?
Age, chronic illness, medication use, sensory impairments, fatigue, and distractibility.\
140
What physical impairments may complicate a geriatric patient interview?
Hearing loss and visual impairment.\
141
What should a paramedic always do when first communicating with an older patient?
Identify themselves.\
142
Why should a paramedic speak at eye level with an older patient?
So the patient can see them while communicating.\
143
Which personal aids should a paramedic locate if needed?
Hearing aids, eyeglasses, and dentures.\
144
Why should lights be turned on during communication?
To help patients with visual impairment.\
145
How should paramedics speak to geriatric patients?
Slowly, distinctly, and respectfully.\
146
How should paramedics address geriatric patients?
By surname unless the patient requests otherwise.\
147
What communication behaviours help preserve geriatric patient dignity?
Listening closely, being patient, and using gentleness.\
148
Why should geriatric patients bring all medications to the hospital?
To verify their medication list, compliance, and number of prescribing physicians.\
149
Why might a geriatric patient tire during a physical examination?
Older adults may fatigue easily.\
150
How can clothing complicate a geriatric physical examination?
Multiple layers worn for warmth may hamper examination.\
151
What should paramedics respect during a geriatric examination?
The patient's modesty and need for privacy, unless care is affected.\
152
Why should paramedics explain actions before examining an older patient?
It is especially important for patients with diminished sight.\
153
Why might an older patient minimize or deny symptoms?
Fear of becoming bedridden, institutionalized, or losing independence.\
154
What should paramedics distinguish during a geriatric physical examination?
Symptoms of chronic disease versus acute problems.\
155
What environmental factors should be assessed if time allows?
Alcohol or medication use, food availability, housing condition, and personal hygiene.\
156
What can a geriatric patient's surroundings reveal?
General health and ability to care for themselves after hospital release.\
157
Whom should paramedics question about a patient's normal appearance and responsiveness?
Friends or family members.\
158
Why is comparing a patient's current condition with their baseline important?
It helps identify acute changes.\
159
What should paramedics discreetly ask about during geriatric assessment?
Advance directives and initiation of care.\
160
What should paramedics do with available advance directives?
Obtain them and communicate the information to medical direction.\
161
How should geriatric patients be handled during transport?
Gently, with appropriate padding for comfort.\
162
Which three pulmonary illnesses are common in geriatric patients?
Bacterial pneumonia, COPD, and pulmonary embolism.\
163
What is a leading cause of death in the geriatric age group?
Bacterial pneumonia.\
164
Why is bacterial pneumonia particularly dangerous in frail older adults?
It is often fatal.\
165
What serious complication are geriatric pneumonia patients more likely to develop?
Bacteremia.\
166
Which respiratory germs are older adults particularly susceptible to?
Gram-negative bacilli.\
167
Why does chronic disease increase pneumonia susceptibility?
It impairs respiratory tract clearance.\
168
How can respiratory germs reach the lungs in older adults?
They can travel from the throat or be aspirated.\
169
Why can bacterial pneumonia cause respiratory failure in geriatric patients?
Decreased lung function.\
170
What are four risk factors for bacterial pneumonia in older adults?
Institutional environments, feeding tubes, chronic diseases, and compromised immunity.\
171
Why can bacterial pneumonia be difficult to diagnose in geriatric patients?
Its presentation may be atypical.\
172
Which common signs of pulmonary congestion may be absent in geriatric pneumonia patients?
Typical congestion findings may be absent.\
173
What are possible signs of bacterial pneumonia in older adults?
Fever, productive cough, and pleurisy.\
174
What atypical symptom may indicate bacterial pneumonia in an older adult?
Altered mental status.\
175
What are possible symptoms of bacterial pneumonia?
Altered mental status, cough, variable fever, shortness of breath, tachycardia, and tachypnea.\
176
Why might geriatric pneumonia patients not produce sputum?
They may be too weak to cough.\
177
Why might geriatric pneumonia patients be unable to breathe deeply?
Weakness and decreased respiratory function.\
178
Why can breath sounds be misleading in geriatric pneumonia patients?
Preexisting emphysema or chronic CHF.\
179
What are the most reliable prehospital indicators of bacterial pneumonia in older adults?
Tachycardia and tachypnea.\
180
What are the main prehospital treatment priorities for bacterial pneumonia?
Manage life threats, maintain oxygenation, and transport for physician evaluation.\
181
How is bacterial pneumonia generally treated in hospital?
Antibiotics.\
182
Why are geriatric pneumonia patients frequently admitted to hospital?
They have a high rate of serious complications.\
183
What is COPD commonly associated with?
A history of smoking.\
184
What characterizes COPD?
Diseases that result in reduced expiratory airflow.\
185
What commonly triggers a COPD exacerbation?
An acute respiratory infection.\
186
What three airway changes can occur during a COPD exacerbation?
Airway edema, bronchial smooth muscle irritability, and increased mucus secretion.\
187
What can airway abnormalities cause during acute COPD decompensation?
Limited airflow and increased work of breathing.\
188
What respiratory symptoms can result from COPD decompensation?
Dyspnea, ventilation-perfusion mismatch, and hypoxemia.\
189
What acid-base disturbance can occur during COPD decompensation?
Respiratory acidosis.\
190
What cardiovascular complication can occur during COPD decompensation?
Hemodynamic compromise.\
191
What are common signs and symptoms of COPD exacerbation?
Anxiety, cyanosis, wheezing, diminished breath sounds, dyspnea, and accessory muscle use.\
192
What abnormal breathing pattern may occur in severe COPD?
Paradoxical breathing.\
193
What cardiovascular findings may occur during COPD exacerbation?
Dysrhythmias and jugular vein distention.\
194
What happens to oxygen saturation during COPD exacerbation?
It may decrease.\
195
What historical information is important when assessing COPD?
Previous intubation and steroid therapy.\
196
What should paramedics be prepared for when managing severe COPD?
Aggressive airway management.\
197
What are the main goals of COPD emergency care?
Correct life-threatening hypoxemia and improve airflow.\
198
What supportive treatments may be used for COPD exacerbation?
Airway and ventilatory support with supplemental oxygen.\
199
What medications may be indicated for COPD exacerbation?
Inhaled or injected bronchodilators.\
200
What can failure to aggressively treat COPD-related hypoxia and acidosis cause?
Progressive patient deterioration.\
201
What should paramedics consider regarding nebulized salbutamol under the cited COVID-19 treatment considerations?
Withholding nebulized salbutamol in all cases.\
202
When should salbutamol MDI with spacer be withheld under the cited considerations?
In mild-to-moderate respiratory distress unless distress becomes severe with no cough.\
203
How should salbutamol MDI be administered using a spacer under the cited considerations?
Using tidal breathing with five normal breaths.\
204
How many normal breaths should a patient take through a spacer?
Five.\
205
When may IM epinephrine be administered under the cited considerations?
Severe respiratory distress with cough in a known asthma patient, per directive.\
206
What is the maximum number of IM epinephrine doses under the cited considerations?
Two doses.\
207
What is the minimum interval between IM epinephrine doses under the cited considerations?
Five minutes.\
208
What is a pulmonary embolism?
A life-threatening cause of dyspnea caused by a pulmonary blood vessel obstruction.\
209
What conditions are associated with pulmonary embolism risk?
Venous stasis, heart failure, COPD, malignancy, and immobilization.\
210
Where do most pulmonary emboli originate?
The veins of the legs.\
211
How does a leg thrombus travel to the lungs?
Through the femoral veins, inferior vena cava, and heart.\
212
Why is pulmonary embolism frequently misdiagnosed in geriatric patients?
Its clinical presentation is often misleading.\
213
What is the hallmark sign of pulmonary embolism?
Unexplained tachycardia.\
214
What cardiac presentation can occur with pulmonary embolism?
Left ventricular failure with sudden tachypnea or atrial fibrillation.\
215
What calf symptom may indicate underlying venous thrombosis?
Calf discomfort without tenderness.\
216
What swelling may indicate underlying venous thrombosis?
Mild calf or ankle edema.\
217
What temperature change may indicate underlying venous thrombosis?
Increased warmth.\
218
What vascular change may indicate underlying venous thrombosis?
Dilation of superficial veins in one foot or leg.\
219
What cardiac condition can pulmonary embolism precipitate?
Congestive heart failure.\
220
What condition can pulmonary embolism be mistaken for in geriatric patients?
Bacterial pneumonia.\
221
What are the prehospital priorities for pulmonary embolism?
Airway, ventilatory, and circulatory support.\
222
Which ECG investigation is identified for pulmonary embolism?
12-lead ECG.\
223
What is the transport priority for suspected pulmonary embolism?
Rapid transport for physician evaluation.\
224
What happens to typical chest pain as an MI symptom by age 70?
It becomes less frequent.\
225
What percentage of MI patients over age 85 report chest pain?
Approximately 45%.\
226
Why can MI go unrecognized in geriatric patients?
They may not experience typical chest pain.\
227
What are major risk factors for MI in geriatric patients?
Previous MI, angina, diabetes, hypertension, high cholesterol, and smoking.\
228
What is the most common sign of MI in patients over age 85?
Dyspnea.\
229
What vague symptoms may indicate MI in older adults?
Dyspnea, abdominal or epigastric distress, and fatigue.\
230
What is a silent MI?
An MI occurring without typical symptoms such as chest pain.\
231
Why may geriatric patients experience silent MI?
Decreased visceral sensory function or mental deterioration.\
232
What atypical symptoms may indicate a silent MI?
Fatigue, breathlessness, nausea, and abdominal pain.\
233
What should paramedics maintain when assessing unusual symptoms in older adults?
A high index of suspicion for MI.\
234
What investigation should be considered for unusual possible MI symptoms?
A 12-lead ECG.\
235
What medication-related question must be asked before administering nitroglycerin?
Whether the patient has used a PDE5 inhibitor.\
236
What does PDE5 stand for?
Phosphodiesterase type 5.\
237
What is an important consideration when assessing MI in older adults?
Typical chest pain may be absent.\
238
What hospital treatments may be used for MI?
Analgesics, bed rest, IV fluids, vasopressors, thrombolytics, and anticoagulants.\
239
Why may IV fluids and vasopressors be used during MI hospital care?
To support blood pressure and stabilize hemodynamics.\
240
Why are thrombolytics sometimes administered during MI care?
To lyse the thrombus.\
241
Why are anticoagulants administered during MI care?
To prevent further emboli.\
242
Approximately what percentage of people over age 80 experience heart failure?
10%.\
243
What is the most common reason for acute care hospital admission in patients aged 65 and older?
Heart failure.\
244
What is heart failure?
A condition in which ventricular output cannot meet the body's metabolic demands.\
245
Can heart failure have noncardiac causes?
Yes, it has a significant incidence of noncardiac causes.\
246
What are common causes of heart failure?
Ischemic heart disease, valvular disease, cardiomyopathy, dysrhythmias, hyperthyroidism, and anemia.\
247
What is a common respiratory symptom of heart failure?
Dyspnea.\
248
What is often the first symptom of left-sided heart failure?
Fatigue.\
249
What is orthopnea?
Shortness of breath when lying flat.\
250
How may a cough progress in heart failure?
From dry, hacking cough to productive cough with frothy sputum.\
251
What causes dependent edema in heart failure?
Right-sided heart failure.\
252
What is nocturia?
Excessive urination at night.\
253
What gastrointestinal or abdominal findings may occur in heart failure?
Anorexia, hepatomegaly, and ascites.\
254
What are the goals of emergency care for heart failure?
Reverse the condition quickly and help prevent cardiac damage.\
255
What monitoring and supportive treatments may be used for heart failure?
Oxygen, ECG monitoring, intubation, IV therapy, and medications.\
256
Which medications may be used in heart failure?
Nitroglycerin, morphine, and furosemide.\
257
How do nitroglycerin, morphine, and furosemide help relieve heart failure symptoms according to the presentation?
They cause venodilation, decreasing preload.\
258
How does furosemide additionally help heart failure?
Its diuretic action removes excess water.\
259
What is a common cause of dysrhythmias in older adults?
Hypertensive heart disease.\
260
What can cause cardiac rhythm irregularities?
Any condition that decreases blood flow to the heart.\
261
How common are premature ventricular contractions in adults over 80?
They are common.\
262
What is the most common dysrhythmia in geriatric patients?
Atrial fibrillation.\
263
What electrolyte-related problem can cause dysrhythmias?
Electrolyte imbalances.\
264
What complications can result from dysrhythmias in older adults?
Falls from cerebral hypoperfusion, transient ischemic attacks, and heart failure.\
265
What are the prehospital priorities for dysrhythmias?
Airway, ventilatory, and circulatory support.\
266
When should oxygen be administered for dysrhythmias?
As needed.\
267
What is the transport priority for geriatric dysrhythmia patients?
Transport for evaluation.\
268
What percentage of U.S. men over 50 are affected by abdominal aortic aneurysm?
Approximately 2–4%.\
269
What is an acute dissecting aortic aneurysm associated with?
A high mortality rate.\
270
How do signs and symptoms of an aortic aneurysm vary?
According to rupture location or extent of dissection.\
271
What are the main prehospital goals for abdominal and thoracic aneurysms?
Pain relief and immediate transport.\
272
What supportive care may be required if an aneurysm patient deteriorates?
Airway, ventilatory, and circulatory support.\
273
How should paramedics handle patients with suspected aneurysms?
Gently and with reassurance to reduce anxiety.\
274
When should oxygen be administered for suspected aneurysm?
As needed.\
275
Should IV fluids be routinely administered for suspected aneurysm?
No, restrict fluids unless severe hypotension is present.\
276
What is the fluid management consideration for suspected aortic aneurysm?
Obtain IV access but restrict fluids unless severe hypotension occurs.\
277
How is pain medication administered for suspected aneurysm?
According to medical direction.\
278
What is considered an active bleed?
Occult bleeding, including hematuria or gastrointestinal bleeding.\
279
Is controlled external bleeding considered active bleeding?
No, if trauma has been dressed and controlled.\
280
Is trace blood in urine with suspected renal colic considered active bleeding?
No.\
281
What is a stroke?
Neurological impairment caused by ischemic or hemorrhagic interruption of blood supply to the brain.\
282
What is stroke's position as a cause of death according to the presentation?
Third leading cause of death in most countries.\
283
What is stroke a leading cause of in adults?
Brain injury.\
284
What are the two main types of stroke?
Ischemic and hemorrhagic.\
285
What are risk factors for cerebrovascular disease?
Smoking, hypertension, diabetes, atherosclerosis, hyperlipidemia, polycythemia, and heart disease.\
286
What is the most important incident-history detail when assessing suspected stroke?
Exact time of symptom onset.\
287
Why is it important to establish whether stroke symptoms were witnessed?
To establish the reliability and timing of symptom onset.\
288
Where should a suspected stroke patient be transported?
A stroke centre.\
289
Which consultation may be needed for a suspected stroke patient?
Neurology consultation.\
290
Why should paramedics minimize scene time for suspected stroke?
There is limited time to initiate treatment.\
291
What treatment window for fibrinolytic therapy is identified in the presentation?
Often less than six hours from symptom onset.\
292
What are the immediate clinical priorities for a suspected stroke patient?
Airway, breathing, circulation, and vital sign monitoring.\
293
What is the most important element of prehospital stroke care beyond supporting vital functions?
Identifying the patient as having a stroke.\
294
How quickly should a stroke patient be transported to a stroke centre?
As rapidly as possible.\
295
What treatment capability should the receiving emergency department provide within one hour of arrival?
Stroke treatment.\
296
What factors can delay an emergency call for stroke symptoms?
Poor stroke awareness, failure to recognize an emergency, waiting for symptoms to improve, and impaired thinking.\
297
Why might a stroke patient who is alone delay calling for help?
Stroke-related cognitive impairment may affect their ability to seek help.\
298
What is delirium?
Abrupt disorientation to time and place.\
299
What types of perceptual disturbances commonly occur with delirium?
Illusions and hallucinations.\
300
How may speech present in delirium?
It may be incoherent.\
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