Geriatrics Emergency Medicine

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It is not uncommon for geriatric patients to present to the ED with clinical evidence of vertebral or spinal cord injury in the absence of known trauma. The increased incidence of osteoporosis and cancer in this population substantially raises the risk for pathologic fracture. Degenerative spine disease may lead to canal or neural foraminal stenosis with subsequent motor and sensory findings. Unremitting back pain may be the herald of vertebral fracture, spinal metastasis, epidural hematoma, or abscess.

Falls from a sitting or standing position can lead to surprisingly severe injuries in older people. Sterling and colleagues found that same-level falls resulted in serious injury in 30% of elderly persons compared with only 4% of a younger cohort. Head and neck injuries were particularly common, occurring more than twice as often (47% versus 22%) [26]. Mortality for these low falls in the elderly population approaches 15%, three times that seen in younger cohorts [27]. Paramedics and emergency physicians must be cautious with these patients and maintain a low threshold for cervical spine immobilization, imaging, and admission.

Factors relevant to this decision include the emotional state of the family member(s) and the age and number of family members present. If a family member is present during the resuscitation, a staff member should be assigned to provide support to this person [53]. 270 NARANG & SIKKA Summary In the future, EM physicians can anticipate increasing ED visits from critically ill, elderly patients. These individuals require prompt identification and early, aggressive intervention. Unfortunately, the effects of aging on normal physiology conspire to make the recognition of the critically ill geriatric patient a challenge.

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