Packaged set of six exam review books. Single copy previously listed in approval week 2002-09. CD includes a mock exam. Softcover.
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Addressing a significant deficiency in prehospital educational materials for EMS providers, this unique text focuses solely on the prehospital care of the elder patient with illness or injury. Geriatric patients are one of the most rapidly growing segments serviced by Prehospital Providers, and this comprehensive resource is an ideal tool to aid in the training and education of how to best treat these patients. Based on real-world cases, it provides material relevant to the work of all EMS personnel, and contains special sections on elder abuse, medical ethics, and living wills.
This book was written to address a glaring deficit in the prehospital literature. In reviewing the many books available for teaching emergency medical technicians and paramedics for our own courses, we found none that focused on prehospital care of the elder patient. Elder patients represent a considerable proportion of all patients treated and transported by prehospital emergency medicine personnel. Yet not only are no texts devoted to this important subject, but a review of current standard prehospital textbooks also reveals almost no information at all that specifically addresses older patients.
We undertook this project to educate prehospital emergency medicine personnel about the assessment, stabilization, and management of this important and expanding patient group. It focuses specifically on issues affecting older patients and on how prehospital management of these patients differs from that of other cohorts. This book is intended for all emergency medical technicians at the basic level, with additional advanced material in each chapter geared toward the paramedic level. Each chapter also includes a question set for self-assessment and review. Prehospital providers at all levels can benefit from the information in this text and easily apply this knowledge to their specific situations.
Section One of this book is intended to provide a general introduction to the management of the prehospital patient. It focuses on the differences between elder patients and other adult patients whom the emergency medical technicians or paramedics encounter in the course of their practice. Key topics include the changing anatomy, physiology, and pathophysiology of the elder patient, and how these changes affect the work of the prehospital provider.
Section One also focuses on the assessment of the elder patient. It is divided into two subsections: 1) assessment of the elder patient with medical illness, and 2) assessment of the elder patient who has suffered trauma. As in other patients, assessment is grounded in the ABCs (airway, breathing, circulation), but it must be adapted to the particular presentation of the elder patient, who very often provides a confusing picture to prehospital emergency personnel, as well as to the medical staff at the emergency department. Problems that are easily diagnosable in other patients, such as shock, myocardial infarction, and acute abdominal emergency, are often masked and present in an occult fashion in the elder patient. It is essential for the prehospital provider to be cognizant of these differences in presentation and take them into account in deciding on initial stabilization and approach to these patients. The elder trauma patient also can be very difficult to assess. Baseline changes in cognition, multiple cardiac and other medications, and long-standing chronic disease may interfere with the normally adequate trauma evaluation.
The management of medical emergencies is the focus of Section Two, which reviews medical considerations specific to elder patients, including cardiovascular, pulmonary, gastrointestinal, genitourinary, neurological, endocrine, toxicological, environmental, and behavioral pathology and pathophysiology. This hands-on review is very symptoms and systems based, stressing basic strategies for assessment, stabilization, and transport. The paramedic section goes into greater depth in each of the medical subsections in order to broaden and deepen the paramedics' understanding of these problems in the elder patient.
Section Three examines trauma in the elder patient, with a focus on assessment of the cardiovascular system, shock, bony, and neurological injuries. Perception of pain, ability to communicate, and lowered baseline level of functioning can interfere with appropriate assessment and intervention in elder trauma patients. It is quite common to underestimate the degree of injury. For an elder patient, even a minor fall can result in a fracture or contusion of the liver or spleen, with extensive intraperitoneal hemorrhage. This section offers specific guidance for avoiding pitfalls in evaluating these patients.
In Section Four the pharmacological management of the elder patient is reviewed. The first part of this section delineates differences in the absorption and metabolism of medication in the normally functioning elder person, and then addresses specific organ system dysfunction as it affects medications. The second part of the section reviews specific medications and considerations for their use in elder patients.
Section Five focuses on the medicolegal aspects of care of the elder patients. Very often, prehospital providers find themselves on difficult legal and ethical ground when trying to decide whether to initiate full or critical care in the acutely ill or dying elderly patient. Often, relatives disagree about the wishes of the patient, the presence or absence of living wills or other documents, and the contents of those documents. This section also addresses neglect and abuse, a growing problem in the United States. The prehospital provider has both a medical and a legal obligation to report any suspicions of neglect and abuse, but the signs are often very subtle. Often, clues picked up by the prehospital emergency medicine practitioner from the patient's home environment provide some of the only information the physician or nursing staff can use to begin an investigation of neglect or abuse.
It is our sincere hope that this text on prehospital care of elder patients will be an important addition to the growing body of knowledge for prehospital care providers. The ultimate goal of this project is to enhance the ability of prehospital providers to care for elder persons.
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