NOTARZT 2012; 28(04): 171-180
DOI: 10.1055/s-0032-1305168
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Geriatrische Notfälle

Geriatric Emergency Medicine
K. Delport
1   Notfallstation, Universitätsspital Basel
,
M. Lüthy
2   Departement Anästhesie, Universitätsspital Basel
,
R. Bingisser
1   Notfallstation, Universitätsspital Basel
,
M. Jakob
3   Klinik für Traumatologie, Universitätsspital Basel
,
C. H. Nickel
1   Notfallstation, Universitätsspital Basel
› Author Affiliations
Further Information

Publication History

Publication Date:
14 August 2012 (online)

Zusammenfassung

Trotz höherer Morbidität und Mortalität ist eine initial aggressive Therapie bei geriatrischen Notfallpatienten gerechtfertigt. Dieser Beitrag beschäftigt sich mit den wichtigsten Problemen geriatrischer Notfallmedizin und gibt hierfür praktische Tipps. Außerdem werden physiologische Besonderheiten des Alterns, besondere Verletzungsmuster und Krankheitspräsentation, Untertriage, Polypharmazie und Komorbiditäten abgehandelt.

Abstract

An initial aggressive management strategy is appropriate in geriatric emergencies, despite higher morbidity and mortality. This review presents some of the problems and pitfalls and offers practical management tips for geriatric emergency care. Physiological changes of ageing, unique patterns of injury and disease presentation, as well as undertriage, polypharmacy and comorbidities are discussed.

 
  • Literatur

  • 1 Aminzadeh F, Dalziel WB. Older adults in the emergency department: A systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med 2002; 39: 238-247
  • 2 Salvi F, Morichi V, Grilli A et al. The elderly in the emergency department: a critical review of problems and solutions. Intern Emerg Med 2007; 2: 292-301
  • 3 Downing A, Wilson R. Older people’s use of Accident and Emergency services. Age Ageing 2005; 34: 24-30
  • 4 Statistisches Bundesamt. Destatis Bevölkerungspyramide (2009). Im Internet: https://www.destatis.de/bevoelkerungspyramide (Stand: Mai 2012)
  • 5 Battistella FD, Din AM, Perez L. Trauma patients 75 years and older: long-term follow-up results justify aggressive management. J Trauma 1998; 44: 618-623 discussion 623
  • 6 Nickel CH, Nemec M, Bingisser R. Weakness as presenting symptom in the emergency department. Swiss Med Wkly 2009; 139: 271-272
  • 7 Nemec M, Koller MT, Nickel CH et al. Patients presenting to the emergency department with non-specific complaints: the Basel Non-specific Complaints (BANC) study. Acad Emerg Med 2010; 17: 284-292
  • 8 Bergeron E, Clement J, Lavoie A et al. A simple fall in the elderly: not so simple. J Trauma 2006; 60: 268-273
  • 9 Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma 2001; 50: 116-119
  • 10 Hohl CM, Dankoff J, Colacone A et al. Polypharmacy, adverse drug-related events, and potential adverse drug interactions in elderly patients presenting to an emergency department. Ann Emerg Med 2001; 38: 666-671
  • 11 Budnitz DS, Shehab N, Kegler SR et al. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007; 147: 755-765
  • 12 Ruedinger JM, Nickel CH, Maile S et al. Diuretic use, RAAS Blockade and morbidity in elderly patients presenting to the Emergency Department with non-specific complaints. Swiss Med Wkly 2012; [im Druck]
  • 13 Morris JA, MacKenzie EJ, Edelstein SL. The Effect of Preexisting Conditions on Mortality in Trauma Patients. JAMA 1990; 263: 1942-1946
  • 14 Meldon SW, Reilly M, Drew BL et al. Trauma in the Very Elderly: A Community-Based Study of Outcomes at Trauma and Nontrauma Centers. J Trauma Acute Care Surg 2002; 52: 79-84
  • 15 Mann NC, Cahn RM, Mullins R et al. Survival among injured geriatric patients during construction of a statewide trauma system. J Trauma 2001; 50: 1111-1116
  • 16 Demetriades D, Karaiskakis M, Velmahos G et al. Effect on outcome of early intensive management of geriatric trauma patients. Br J Surg 2002; 89: 1319-1322
  • 17 Chang DC, Bass RR, Cornwell EE et al. Undertriage of elderly trauma patients to state-designated trauma centers. Arch Surg 2008; 143: 776-781 discussion 782
  • 18 Grossmann FF, Zumbrunn T, Frauchiger A et al. At Risk of Undertriage? Testing the Performance and Accuracy of the Emergency Severity Index in Older Emergency Department Patients. Ann Emerg Med 2012; http://dx.doi.org/10.1016/j.annemergmed.2011.12.013 [Epub ahead of print]
  • 19 Lehmann R, Beekley A, Casey L et al. The impact of advanced age on trauma triage decisions and outcomes: a statewide analysis. Am J Surg 2009; 197: 571-574 discussion 574-575
  • 20 Hsia RY, Wang E, Saynina O et al. Factors associated with trauma center use for elderly patients with trauma: a statewide analysis, 1999–2008. Arch Surg 2011; 146: 585-592
  • 21 Bulger EM, Arneson MA, Mock CN et al. Rib fractures in the elderly. J Trauma 2000; 48: 1040-1046 discussion 1046–1047
  • 22 Henry SM, Pollak AN, Jones AL et al. Pelvic fracture in geriatric patients: a distinct clinical entity. J Trauma 2002; 53: 15-20
  • 23 Kimbrell BJ, Velmahos GC, Chan LS et al. Angiographic embolization for pelvic fractures in older patients. Arch Surg 2004; 139: 728-732 discussion 732–733
  • 24 Franko J, Kish KJ, O’Connell BG et al. Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. J Trauma 2006; 61: 107-110