Makindo Medical Notes.com Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes.com
Download all this content in the Apps now Android App and Apple iPhone/Pad App

MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd

Geriatric Medicine Emergencies

About

Anaesthetics and Critical Care

Obstetrics Gynaecology

Oncology

Ophthalmology

Oral Medicine and Dentistry

Statistics and Research

Stroke

Surgery

Toxicology

Trauma and Orthopaedics

Twitter

Urology

Geriatric Medicine Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Acute Confusional State (Delirium)	Acute onset of confusion, disorientation, and fluctuating levels of consciousness. Agitation or lethargy, visual or auditory hallucinations, and disturbed sleep-wake cycles. May be triggered by infections, medications, metabolic disturbances, or environmental changes.	Clinical diagnosis based on history and mental status examination (using tools like CAM). Blood tests including electrolytes, glucose, renal function, liver function, and complete blood count. Urinalysis and cultures to rule out infection, particularly urinary tract infection or pneumonia. Review of medications to identify potential culprits (e.g., anticholinergics, sedatives).	Treat underlying cause (e.g., infection, dehydration, medication adjustments). Ensure a safe environment with reorientation techniques, adequate lighting, and minimizing restraints. Use of antipsychotics (e.g., haloperidol) only if the patient is severely agitated and at risk of harm. Close monitoring and supportive care to prevent complications such as falls.
Acute Stroke	Sudden onset of focal neurological deficits, such as weakness, numbness, speech disturbances, or visual changes. Symptoms may be accompanied by headache, dizziness, or altered consciousness. Risk factors include hypertension, atrial fibrillation, diabetes, and previous stroke.	Non-contrast CT scan of the head to differentiate ischaemic stroke from hemorrhagic stroke. MRI of the brain for more detailed imaging in ischaemic stroke. ECG to detect atrial fibrillation, echocardiography to assess for cardiac emboli. Blood tests including glucose, electrolytes, coagulation profile, and cardiac enzymes.	Thrombolytic therapy (e.g., IV tPA) within 3-4.5 hours of symptom onset for eligible ischaemic stroke patients. Aspirin for patients not eligible for thrombolysis or as secondary prevention. Management of blood pressure, blood glucose, and other risk factors. Rehabilitation and secondary prevention strategies, including antiplatelet therapy and statins.
Hip Fracture	Severe pain in the hip, groin, or thigh, often after a fall. Inability to bear weight on the affected leg, with shortening and external rotation of the leg. Common in elderly patients with osteoporosis or frailty.	X-ray of the hip and pelvis to confirm the fracture. MRI or CT scan if the X-ray is inconclusive but clinical suspicion is high. Preoperative blood tests including CBC, electrolytes, renal function, and coagulation profile.	Early surgical intervention (e.g., hemiarthroplasty, total hip replacement, or internal fixation) to reduce morbidity and mortality. Pain management with opioids or regional anesthesia (e.g., nerve block). Preoperative and postoperative assessment and optimization of medical comorbidities. Rehabilitation and fall prevention strategies postoperatively.
Acute Coronary Syndrome (ACS)	Chest pain or discomfort, often described as pressure or tightness, radiating to the arm, neck, or jaw. Shortness of breath, diaphoresis, nausea, and lightheadedness. Symptoms may be atypical in elderly patients, such as fatigue, weakness, or syncope.	ECG showing ST-segment changes, T-wave inversion, or new left bundle branch block. Serum cardiac biomarkers (troponin, CK-MB) elevated in myocardial infarction. Chest X-ray to rule out other causes of chest pain. Echocardiography to assess cardiac function and identify complications.	Immediate administration of aspirin, nitrates, and oxygen if hypoxic. Reperfusion therapy: Primary percutaneous coronary intervention (PCI) or thrombolytic therapy for STEMI. Beta-blockers, ACE inhibitors, and statins as part of long-term management. Anticoagulation with heparin or enoxaparin during acute management.
Sepsis	Fever or hypothermia, tachycardia, hypotension, and altered mental status. Signs of infection, such as pneumonia, urinary tract infection, or skin infection. Elderly patients may present with nonspecific symptoms such as confusion, weakness, or decreased appetite.	Blood cultures, urine culture, and other relevant cultures before starting antibiotics. Complete blood count (CBC) showing leukocytosis or leukopenia. Serum lactate level elevated, indicating tissue hypoperfusion. Imaging studies (e.g., chest X-ray, CT scan) to identify the source of infection.	Early goal-directed therapy with IV fluids, broad-spectrum antibiotics, and vasopressors if needed. Monitor and correct electrolyte imbalances and provide supportive care. Source control (e.g., drainage of abscess, removal of infected devices) as necessary. Close monitoring in an ICU setting for severe sepsis or septic shock.
Dehydration and Electrolyte Imbalances	Dry mucous membranes, decreased skin turgor, tachycardia, and hypotension. Confusion, dizziness, and decreased urine output. May be caused by inadequate fluid intake, excessive losses (e.g., vomiting, diarrhea), or medications (e.g., diuretics).	Serum electrolytes to assess for hypernatremia, hyponatremia, hypokalemia, or hyperkalemia. Blood urea nitrogen (BUN) and creatinine levels to evaluate renal function. Urinalysis to assess urine concentration and exclude urinary tract infection.	IV fluid replacement with normal saline or balanced electrolyte solutions. Correction of electrolyte imbalances based on laboratory findings. Monitoring of fluid status, electrolytes, and renal function during treatment. Address underlying causes, such as adjusting diuretic doses or treating infections.
Acute Urinary Retention	Severe lower abdominal pain and inability to void. Distended bladder palpable on physical examination. Often associated with benign prostatic hyperplasia (BPH), medications (e.g., anticholinergics), or constipation.	Bladder ultrasound showing significant post-void residual volume. Urinalysis to rule out infection or hematuria. Serum creatinine to assess renal function if prolonged obstruction.	Immediate catheterization to decompress the bladder. Treatment of underlying cause (e.g., alpha-blockers for BPH, discontinuation of offending medications). Pain management and monitor for post-obstructive diuresis. Referral to urology for further evaluation and management.
Falls and Fractures	Injury, pain, and functional impairment following a fall. Risk factors include muscle weakness, balance problems, polypharmacy, and environmental hazards. Complications may include fractures (especially hip fractures), head injury, and prolonged immobilization.	X-rays or CT scans of the affected area to identify fractures or head injuries. Blood tests to assess for contributing factors (e.g., anaemia, electrolyte imbalances, hypoglycemia). Assessment of gait and balance, and review of medications.	Immediate management of injuries (e.g., immobilization, pain relief, surgical intervention for fractures). Address underlying causes of the fall (e.g., medication review, physical therapy for strength and balance). Implement fall prevention strategies, including home safety modifications and exercise programs. Monitoring and rehabilitation to regain mobility and prevent further falls.
Hyperglycemic Hyperosmolar State (HHS)	Severe hyperglycemia, dehydration, altered mental status, and weakness. Absent or mild ketosis and no significant acidosis. Commonly occurs in elderly patients with type 2 diabetes, often triggered by infection, stroke, or other acute illnesses.	Extremely high blood glucose levels (>600 mg/dL) and high serum osmolality (>320 mOsm/kg). Serum electrolytes showing hypernatremia, and mild or absent ketonemia. Blood gas analysis typically showing normal or near-normal pH.	IV fluids (initially normal saline, then switch to hypotonic saline once stabilized) for rehydration. IV insulin to gradually lower blood glucose. Electrolyte management, particularly potassium and sodium. Monitoring and treatment of underlying precipitating factors (e.g., infection).

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

Makindo