Geriatric Considerations

Troubleshooting

Troubleshooting geriatric considerations in the field:

• King airway: If supraglottic blind-insertion airway device fails, verify connections, check battery, try alternate equipment. Available sizes: Size 3 (4-5 ft), Size 4 (5-6 ft), Size 5 (over 6 ft)
• IO drill: If intraosseous access device for emergent vascular access fails, verify connections, check battery, try alternate equipment. Available sizes: EZ-IO: 15mm (peds), 25mm (adult), 45mm (obese)
• Pulse oximeter: If measures spo2 via infrared absorption through capillary bed fails, verify connections, check battery, try alternate equipment. Available sizes: Finger clip, Earlobe, Pediatric wrap

Patient Communication

Communication about geriatric considerations in the prehospital setting includes: explaining procedures to the patient in simple terms, obtaining informed consent when possible (implied consent for unresponsive patients), providing a calm and reassuring presence, and delivering a structured handoff report (SBAR: Situation, Background, Assessment, Recommendation) to the receiving facility.

Assessment Techniques

Assessment techniques for geriatric considerations:

SAMPLE

Components: Signs/symptoms, Allergies, Medications, Past history, Last intake, Events. Scoring: Mnemonic for patient history gathering

Cincinnati Stroke Scale

Components: Facial droop, Arm drift, Speech abnormality. Scoring: Any 1 positive = 72% probability of stroke

Equipment & Tools

Equipment used in geriatric considerations assessment and treatment:

IO drill

Intraosseous access device for emergent vascular access. Available sizes: EZ-IO: 15mm (peds), 25mm (adult), 45mm (obese)

Waveform capnograph

Measures end-tidal CO2 continuously with waveform display. Available sizes: Mainstream (inline), Sidestream (sampling)

AED

Automated external defibrillator for VF/pVT. Available sizes: Adult pads (over 8yo or 25kg), Pediatric pads (under 8yo or 25kg)

Calculation Methods

Dosage calculations related to geriatric considerations in EMS:

• epinephrine: 1:10,000 1mg IV/IO q3-5min (cardiac arrest), 1:1,000 0.3mg IM (anaphylaxis) (IV/IO, IM, ET)
• amiodarone: 300mg IV/IO first dose, 150mg second dose (IV/IO)
• dextrose: D50W 25g IV (adult), D25W 2-4 mL/kg (peds) (IV/IO)

Pediatric dosing: always calculate by weight (mg/kg). Use Broselow tape if weight is unknown.

Differential Diagnosis

When assessing geriatric considerations, use structured assessment tools to differentiate between possible causes:

APGAR: Components: Appearance, Pulse, Grimace, Activity, Respiration. Scoring: 0-10 at 1 and 5 minutes, under 7 needs intervention.

Glasgow Coma Scale: Components: Eye opening (1-4), Verbal response (1-5), Motor response (1-6). Scoring: 3-15, 8 or less = severe, 9-12 = moderate, 13-15 = mild.