By Thomas T. Yoshikawa, Dean C. Norman
This incisive reference systematically reports the analysis and therapy of universal surgical and clinical emergencies in aged patients-thoroughly analyzing surgical interventions, drug treatments and drug prescribing protocols, life-threatening drug reactions, moral matters, and techniques of profiling sufferers for nursing care. Evaluates disorder states and gauges optimum responses to every, helping suggestions with beneficial case reports. Written via over forty individual health workers, Acute Emergencies and demanding Care of the Geriatric sufferer ·describes perfect patient-physician relationships in severe care settings ·highlights emergency administration of myocardial infarction and cardiogenic pulmonary edema ·illuminates moral questions surrounding confidentiality, trained consent, surrogate selection making, and sufferer convenience ·assesses designated pharmacokinetic and pharmacodynamic stipulations in geriatric sufferers ·provides very important details on stroke, seizures, and spinal wire compression ·investigates serious issues as a result of pneumonia, meningitis, and endocarditis ·explores acute lung problems equivalent to emphysema, power bronchitis, pneumonia, relevant apprehensive procedure disorder, and irregular regulate of air flow ·clarifies preoperative strategies for emergency surgical procedure ·reviews anesthesia suggestions for pulmonary, cardiovascular, renal, hepatic, and neurological stipulations within the aged ·and extra! together with over one thousand references, tables, and illustrations, Acute Emergencies and important Care of the Geriatric sufferer is an integral source for geriatricians, basic care physicians, internists, emergency medication physicians, intensivists, hosptialists, surgeons, anesthesiologists, orthopedists, cardiologists, psychiatrists, neurologists, and internists/residents in those disciplines, in addition to nurses, pharmacists, and clinical scholars.
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Extra resources for Acute Emergencies and Critical Care of the Geriatric Patient
Many studies have shown that the volume of distribution is much larger in patients in the critical care unit than those on a general medical ward (20–22). Such pharmacokinetic change necessitates a larger than usual loading dose be given early in therapy (within the ﬁrst 24 hours) to achieve a therapeutic drug concentration. Achieving a high concentration is particularly important in serious systemic infections, such as bacteremia, because of the high mortality rates when treatment is inadequate (23).
PHARMACODYNAMIC CHANGES The interaction of a drug on its receptor organ may produce a desired beneﬁcial therapeutic effect or a negative toxic effect. The elderly appear to be more sensitive to medications. This is due to age-related changes in receptor selectivity and changes in homeostatic control mechanisms (12–13). Drug response with aging may therefore be increased, decreased, or unchanged because of these multifacto- Drug Dosing and Life-Threatening Drug Reactions 37 rial interactions. Among the changes that may occur include impaired sympathetic and parasympathetic response, thermoregulation, and postural stability; glucose intolerance; and reduced immune response and cognitive function (14).
Sulmasy DP. Ethics, outcomes, and end-of-life care. J Clin Outcomes Mgmnt 5:36– 42, 1998. 9. High DM. Surrogate decision making. In: Fein AM, Adelman RD, eds. Clin Geriatr Med Philadelphia: Saunders, 10:445–462, 1994. 10. Tolle SW, Tilden VP, Nelson CA, Dunn PM. A prospective study of the efﬁcacy of the physician order form for life-sustaining treatment. J Am Geriatr Soc 46:1097– 1102, 1998. 11. Sachs GA, Miles SH, Levin RA. Limiting resuscitation: emerging policy in the emergency medical system.
Acute Emergencies and Critical Care of the Geriatric Patient by Thomas T. Yoshikawa, Dean C. Norman