Geriatric Dementia

  1. Polypharmacy
    1. Multiple chronic diseases mean multiple medications
    2. Drug dosages may not have been adjusted for multiple meds
    3. Drug interactions may cause problems
    4. Consider polypharmacy as a reason for problems
  2. Psychosocial and economic aspects
    1. Demographics and “graying of America”
    2. Psychosocial issues
      1. Living environments
      2. Financial issues
      3. Social services
    3. Alzheimer’s Disease
      1. Definition
        1. Stages
        2. Diagnosis
        3. Prognosis
      2. Epidemiology
        1. Population
        2. early onset
      3. Pathophysiology
        1. Plaques
        2. Tangles
      4. Signs and Symptoms
        1. Memory
        2. Learning
        3. Judgment
        4. Language
        5. Tasks
      5. Personality changes
        1. Apathy
        2. Irritability
        3. Depression
        4. Agitation
        5. Psychosis
      6. Normal day-to day living
        1. Problems associated with management
        2. Patient violence
        3. Patient verbal abuse
        4. Fearful patient
      7. Management
        1. Communication
        2. Slow clear instructions
        3. Distraction from agitation
        4. Other
        5. Treat symptomatically
        6. Consider co-illnesses
        7. Consider medication reactions
      8. Alzheimer’s treatment
        1. Cholinesterase inhibitors
        2. Antipsychotics
        3. Antidepressants
    4. Dementia
      1. Definition
      2. Causes of dementia
        1. Alzheimer’s disease
        2. Multi-infarct dementia
        3. Drug toxicity
        4. Emotional disorders
        5. Metabolic and endocrine disorders
        6. Brain tumor
        7. Brain trauma
        8. Infections
        9. Major depression Parkinson’s disease
        10. Huntington’s chorea
        11. Alzheimer’s Disease—most common form of dementia
          1. Pathophysiology
          2. Stages
          3. Paramedic assessment and interactions
      3. Associated signs and symptoms
        1. Progressive loss of cognitive function; short and long-term memory problems
        2. Loss of attention span
        3. Loss of communication skills
        4. Inability to perform daily routines
        5. Easily lost
        6. Angers easily
      4. Problems associated with management of patient with dementia
        1. Poor historian; impaired judgment
        2. Inability to vocalize areas of pain and current symptoms
        3. Unable to follow commands
        4. Anxiety over movement out of home or current establishment
        5. Anxiety and fear of treatment of current medical problems
    5. Delirium- a sudden change in behavior, consciousness, or cognitive processes generally due to a reversible physical ailment.
      1. Mortality rates
      2. Evaluation of pathophysiology through history, possible risk factors, and current medications
        1. Intoxication or withdrawal from alcohol
        2. Withdrawal from sedatives
        3. Vitamin deficiencies
        4. Urinary tract infections/ bowel obstructions
        5. Cardiovascular disease
        6. Hyper/hypoglycemia
        7. Psychiatric disorders
        8. Malnutrition
        9. Dehydration
        10. Environmental emergencies
        11. Depression
        12. Fever
        13. Current medications:  anticholinergic medications
      3. Associated signs and symptoms
        1. Onset of minutes, hours, days
        2. Disorganized thoughts: inattention, memory loss, disorientation
        3. Hallucinations
        4. Delusions
        5. Reduced level of consciousness
      4. Possible changes in physical assessment
        1. Changes in peripheral, core and neurovascular perfusion
        2. Changes in response of pupils
        3. Changes in response to motor tests
        4. Dysrhythmias
        5. Adventitious breath sounds
      5. Assessment tools
        1. Neurological examination of cranial nerves, motor and sensory function
        2. Blood pressures
        3. Evaluation of limb lead ECG
        4. Interpretation of 12 lead ECG for signs of ischemia, injury or anomalies
        5. Auscultation of heart to detect irregular, muffled, or extra heart tones
        6. Auscultation of breath sounds to detect adventitious noises
        7. Capnography
        8. Evaluation of glucose
      6. Treatment
        1. Airway, ventilatory and circulatory support
        2. Oxygen with adjuncts appropriate to patient condition
        3. Venous access
        4. ECG monitoring
        5. Treatment to correct reversible causes: Hypoglycemia D50 IV or glucagons, or possible drug overdose with Narcan
        6. Evaluation of patient treatment through reassessment

Content Creator: Madison Browning

CAPCE Course Number: 18-EMTP-F3-1311

Total CE Hours: 1

Level: Basic

EMT-CE uses the NEMSES guidelines as the foundation for every course outline.