Acute Geriatric Medicine by J. R. Playfer (auth.), M. Lye (eds.)

By J. R. Playfer (auth.), M. Lye (eds.)

Most sufferers in built international locations with scientific difficulties requiring health center care are aged. more and more the dividing line among normal inner medi­ cine and acute geriatric medication is turning into extra blurred. it truly is, however, obvious that a few aged sufferers on clinical or sub-specialty medical institution wards turn into 'bed blockers'. Why? additionally, why are 'bed blockers' much less of an issue on an acute geriatric ward? Many clinicians think this can be on the topic of a swifter entry to the long-stay beds of the geriatric unit. Even a quick learn of clinic working facts will express this isn't and can't be the case. while geria­ tricians are requested to determine aged 'bed blockers' on colleagues' wards they procedure with anxiousness simply because those sufferers usually need to be put on a protracted ready record for those scarce and extremely dear carrying on with care beds. Do geria­ tricians see varied acute scientific difficulties in comparison with their colleagues? the answer's now not instantly noticeable, even though geriatricians are inclined to obtain extra capability 'bed blockers' than their basic scientific colleagues. How is it then, that geriatricians appear to cope greater than their colleagues? All geriatricians have adventure of normal inner drugs however the contrary regrettably doesn't carry. This ebook is written within the wish of redressing the imbalance.

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Where death is directly due to the cerebral lesion, the cause is usually due to brain stem failure. In a supratentorial lesion, the most important prognostic sign is impairment of consciousness. Most patients deeply comatose on admission die, usually within 24 hours. Semi-comatose patients also do badly whereas most alert patients survive the acute phase. Pupillary changes, abnormal respiratory patterns and the progression of a unilateral to a bilateral lesion are also ominous. Mortality will increase with concurrent cardio-pulmonary and renal problems and hence with age.

Cardiac emboli may originate from the left atrium (thrombotic or myxomatous), from rheumatic, infected or prosthetic aortic or mitral valves, or from the left ventricle following myocardial infarction. The significance of mitral leaf prolapse in the elderly is still uncertain. For cerebral infarction, age and cerebral atheroma are the most important risk factors. Others are listed in Table 6. ACUTE STROKE ILLNESS IN THE ELDERLY 43 INVESTIGATIONS In the light of what has been said so far, how should an elderly stroke patient be investigated?

In the elderly cardiac failure patient the prescriber should not be surprised how low the clearance is. Because digoxin is quite heavily protein bound in the blood hypoalbuminaemia should be sought. At the same time hypokalaemia and hypercalcaemia should be excluded as both potentiate digoxin toxicity. Any abnormalities in serum electrolytes require investigation (Chapter 4) and correction, preferably before commencing digoxin. Finally, the patients' potential compliance should be assessed - if they live alone and are confused, digoxin therapy should be strongly reconsidered (Chapter 7).

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