Saturday, February 24, 2024

How to Handle Senior Emergencies

On 27 Jan, 2024, Seniors Today hosted the weekly Health Live Webinar with Dr Roohi Pirzada, a Senior Physician who spoke on and answered questions about Recognising na dReacting to Senior Citizen Emergencies.

Dr Roohi Pirzada a specialist in Critical Care Medicine is a Senior Physician practising in Mumbai. She has around two decades of experience as an intensivist and  She also consults with Apollo 247 and Tata 1MG.

Geriatric emergencies, with better knowledge, can be managed with more ease and we can be more equipped to handle these emergencies. If you know the medical management and advance directives of managing an emergency, you can help and empower our loved ones to navigate emergencies with a lot of confidence and ease.

Some geriatric emergencies, if identified in time can help minimise mortality, especially in case of preventable deaths such as cardiac events, cerebrovascular events, electrolyte imbalance and metabolic conditions such as hypoglycaemia, reparatory emergencies, pulmonary thromboembolism, aspiration pnenomia, etc.

  1. Heart attack

These days the incidences of heart attacks have increased.

Heart attack is a cardiac emergency where the coronary artery (the artery which supplies blood to the cardiac tissues) is blocked suddenly by a thrombus or an atherosclerotic plaque (a cholesterol plaque/ deposit). A thrombus is a clot.

When the coronary artery which is supplying blood to the heart muscles is blocked suddenly, the territory that it is supplying will die. This is what is called a heart attack or a myocardial infarction.

The dead tissue becomes non functional, resulting in the presenting symptoms.

The cause for the blockage is not always a clot, sometimes it can also be because of :

  • Coronary artery spasm leading to narrowing of the blood vessel
  • Coronary artery dissection (rupture of an artery)
  • Viral infections- leading to viral myocarditis which can trigger a cardiac event

Signs and symptoms of a heart attack include:

  • Persistent chest pain- this may sometimes radiate to the neck, jaw, back, upper abdominal pain or left arm. So, if you have an unusual pain at an unusual time, it is better to go to a hospital and get an ECG, just to be on the safer end.
  • Acute shortness of breath
  • Cold sweats
  • Syncope/ fainting

These symptoms/ pain does not relieve on/ after rest

Risk factors:

  • Age; men over 40 years of age, women over 55 years of age
  • Smoking and tobacco chewing habits
  • Long standing history of hypertension- leading to damage to the lining of the coronary vessels
  • Dyslipidemia
  • Obesity
  • Diabetes
  • Unhealthy lifestyle and dietary habits
  • Prothrombotic states such as- malignancy, pregnancy

What should you do:

  • Rush the individual to the hospital, there may be needfor an angioplasty. In the meanwhile you can give the patient a vasodilator to prevent the cardiac tissue from further damage. Sorbitrate is given sub lingually.
  • Aspirn/ disprin- to prevent thrombus formation. Not more than 300mg. These medications have to be given only if there is no absolute contraindication. You need to consult with a doctor before administering any of these medications
  • Statins- cholesterol and lipid lowering drug
  • While you’re taking these measures take the patient to the hospital emergency
  1. Hypoglycaemia

This is more commonly seen in diabetic patients.

When the blood sugar levels fall below 70 mg/dL. It in not severe hypoglycaemia but it is still hypoglycaemia

When the blood sugar levels fall below 55 mg/dL, it is classified as severe hypoglycaemia, which can be fatal

Common causes:

  • Excessive or inappropriate insulin dosages in reference to your carbohydrate consumption
  • Inconsistent timing of taking your insulin doses. You need to keep your food and insulin dose timing consistent
  • Change/ alteration in physical activity levels
  • High altitude
  • Alcohol consumption

Signs and symptoms:

  • Giddiness
  • Blackout
  • Sweating
  • Cold extremities
  • Tachycardia
  • Confused state/ disoriented talk
  • Seizure
  • Diabetic coma

What should you do:

– You need to be aware of the 15-15, this is applicable for a moderate hypoglycaemia, and does not give instant results.

Take 15gms of carbohydrates and check your blood sugar levels again after 15 mins.

If the blood sugar levels are still not in the desirable limits, repeat the same till the desired levels are achieved.

For the 15 gms you can take 1 tsp of sugar/ honey/ sugar syrup/ half a cup of juice/ soda, 3-4 hard sugar candies

Ensure that you don’t take a high fat/ fibre diet with carbohydrates, since it slows down the absorption of carbohydrates.

  • In case of severe hypoglycaemia, Inj Glucagon is the mainstay for treatment
  • Take the patient to the emergency for regular sugar monitoring and further course of management
  1. Electrolyte imbalance:

Though there are a lot of imbalances in the electrolytes which can be seen, but the most common ones which are seen in the elderly are

  • Low sodium levels (Hyponatremia)
  • High potassium levels
  1. Hyponatremia

Can occur due to :

– Low salt intake

– Cardiac/ renal diseases for which the individual is on medications

– Drugs such as diuretics, antidepressants, anti epileptics

– Individuals with a compromised liver or kidney functions

– Pulmonary lung cancer

  • Urinary tract infections

 Signs and symptoms:

These individuals, contrary to patients with hypoglycaemia, will have a normal blood sugar level

  • Nausea, vomiting
  • Disorientation
  • Confused state
  1. B) Hyperkalemia

Normal potassium levels are between 45.- 5.5 mEq/ dL

Potassium levels exceeding 5.5 mEq/ dL is a serious and possibly fatal medical emergency.

This is seen in:

  • Patients with chronic kidney disease

Signs and symptoms include:

  • Diarrhoea
  • Nausea
  • Muscle weakness and pain
  • Arrhythmias
  • Sometime the patient may collapse

The diagnosis can be confirmed with the help of an ECG and AGB, blood sample

The treatment has to be started immediately.

Mainstay modalities include IV Calcium gkuconate, IV Soda Bicarb- these are some of the antihyperkalemic measures that need to be taken

GI drip is a very important treatment modality. It is a glucose insulin drip. You use insulin to push the potassium from the blood levels to the cells. But, if the individual is not diabetic, the individual may become hypoglycaemic, so to counter the hypoglycaemia, we give it with glucose/ dextrose solution.

  1. Cerebrovascular Accidents/ Stroke

It is due to the acute compromise of the blood supply to the brain tissue.

Cerebrovasular perfusion compromise leads to stroke.

There are 2 types of stroke:

  1. Ischaemic– more common
  2. Hemorrhagic– less common

We will be discussing ischaemic strokes wince they are more common adn respond better to treatment if diagnosed quickly and brought to the hospital for treatment within the 1 hour, golden hour period. 100% reversal can be tried

Signs and symptoms/ how to identify:

  • Weakness of the limbs, lower extremities, one sided, face only, etc.
  • Heaviness in the limbs
  • Inability to fit your limbs
  • Imbalances gait= ataxia
  • Dysphagia- difficulty in swallowing
  • Difficulty in talking/ inability to speak
  1. Respiratory Emergencies

a) Aspiration pneumonia:

These are very common in the elderly, since anthem food can end up in the trachea. This can trigger and cough reflex, however in the elderly, the cough reflex is weak and can lead to he foreign food particle entering the lungs, causing inflammation of the lung tissues, pneumonia

b) Pulmonary thromboembolism:

It is a blood clot dislodged in the pulmonary artery blocking the blood supply to the lung.

This clot is usually formed in another part of the body, especially the calf/ veins in the legs (Deep Vein Thrombosis), the clot detaches- forming an embolus and travels to the lung, reaching the pulmonary arteries.

Presenting symptoms include:

  • Acute shortness of breath
  • Chest pain
  • Cough
  • Hemoptysis
  • Low blood pressure

This is a medical emergency and should not be taken lightly.

Dr Noor Gill
Dr Noor Gill, MBBS, deciphers the space between heartbeats, figuratively and literally. Powered by frequent long naps and caffeine, she believes that “knowledge without giving back to society is meaningless” and works to make caring cool again.

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