Primary Assessment and Stabilization of Life-Threatening Conditions in Older Patients

2017 ◽  
pp. 23-48
Author(s):  
Mehmet Akif Karamercan ◽  
Abdelouahab Bellou ◽  
Hubert Blain
Keyword(s):  
Older Patients ◽  
Life Threatening ◽  
Primary Assessment

scholarly journals A case of Henoch-Schönlein purpura with cardiopulmonary involvement

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Guang Ming Tan
Keyword(s):  
Older Patients ◽  
Rare Case ◽  
Cardiac Involvement ◽  
Case Reports ◽  
Immunoglobulin A ◽  
Life Threatening

Henoch-Shönlein purpura (HSP) commonly affects the kidney, causing hematuria and Immunoglobulin A type nephropathy. Extra-renal involvements are rare but can be life threatening if missed. Cardiac involvement has been described only in a handful of case reports. Although HSP is predominantly a pediatric disease, it should not be overlooked in older patients presenting with typical triad of symptoms. We report a rare case of HSP with both cardiac of pulmonary systems involvement and his clinical progress

Rescue carotid puncture for ischemic stroke treated by endovascular therapy: a multicentric analysis and systematic review

2020 ◽  
pp. neurintsurg-2020-016725
Author(s):  
Julien Allard ◽  
Sam Ghazanfari ◽  
Mehdi Mahmoudi ◽  
Julien Labreuche ◽  
Simon Escalard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Elderly Patients ◽  
Functional Outcome ◽  
Endovascular Therapy ◽  
Older Patients ◽  
Intravenous Thrombolysis ◽  
Review Of The Literature ◽  
Femoral Access ◽  
Life Threatening

BackgroundEndovascular therapy (EVT) for acute ischemic stroke (AIS) can be challenging in older patients with supra-aortic tortuosity. Rescue carotid puncture (RCP) can be an alternative in case of supra-aortic catheterization failure by femoral access, but data regarding RCP are scarce. We sought to investigate the feasibility, effectiveness and safety of RCP for AIS treated by EVT.MethodsPatients treated by EVT with RCP were included from January 2012 to December 2019 in the Endovascular Treatment in Ischemic Stroke (ETIS) multicentric registry. Main outcomes included reperfusion rates (≥TICI2B), 3 month functional outcome (modified Rankin Scale) and 3 month mortality. We also performed an additional systematic review of the literature according to the PRISMA checklist to summarize previous studies on RCP.Results25 patients treated by EVT with RCP were included from the ETIS registry. RCP mainly concerned elderly patients (median age 85 years, range 73–92) with supra-aortic tortuosity (n=16 (64%)). Intravenous thrombolysis (IVT) was used for nine patients (36%). Successful reperfusion was achieved in 64%, 87.5% of patients were dependent at 3 months, and 3 month mortality was 45.8%. The systematic review yielded comparable results. In pooled individual data, there was a shift toward better functional outcome in patients with successful reperfusion (median (IQR) 4 (2–6) vs 6 (4–6), p=0.011).ConclusionRCP mainly concerned elderly patients admitted for AIS with anterior LVO with supra-aortic tortuosity. The procedure seemed feasible, notably for patients treated with IVT, and led to significant reperfusion rates at the end of procedure, but with pronounced unfavorable outcomes at 3 months. RCP should be performed under general anesthesia to avoid life-threatening complications and ensure airways safety. Finally, RCP led to low rates of closure complications, emphasizing that this concern should not withhold RCP, if indicated.

scholarly journals PHYSICIAN’S ATTITUDE TOWARDS TREATMENT OF OLDER PATIENTS AND THE CHOICE OF THERAPY

2013 ◽  
Vol 5 (1) ◽  
pp. e2013025 ◽  
Author(s):  
Felicetto Ferrara
Keyword(s):  
Older Patients ◽  
Myeloid Leukemia ◽  
Daily Practice ◽  
Predictive Score ◽  
Considerable Proportion ◽  
Therapeutic Decision ◽  
Life Threatening ◽  
History Of ◽  
Physician Attitude ◽  
Choice Of Therapy

The treatment of acute myeloid leukemia in older patients is still object of controversies, because of considerable heterogeneity of patients and disease. Reluctance in administering conventional intensive chemotherapy relies on life-threatening complications induced by treatment in an often frail patient population.  Nonetheless, while there is general consensus on the management of frail patients with supportive care only, a wide area of uncertainty remains for a considerable proportion of patients in whom treatment beyond support is feasible, with the aim of altering the natural history of the disease. Several predictive score have been proposed in order to prevent toxicity in absence of survival advantage, however in the daily practice patients’ and physician attitude do still have a major role in the final therapeutic decision.

scholarly journals Analysis of the Interventions of Medical Emergency Teams in Older Patients in Selected Polish Cities with County Status: A Retrospective Cohort Study

2021 ◽  
Vol 18 (14) ◽  
pp. 7664
Author(s):  
Mariusz Celiński ◽  
Mateusz Cybulski ◽  
Joanna Fiłon ◽  
Marta Muszalik ◽  
Mariusz Goniewicz ◽  
...  
Keyword(s):  
Older Patients ◽  
Emergency Service ◽  
Geriatric Patients ◽  
Health Care Facilities ◽  
Medical Emergency ◽  
Ambulance Dispatch ◽  
Medical Emergency Teams ◽  
Threatening Condition ◽  
Emergency Interventions ◽  
Life Threatening

Introduction: Geriatric patients account for a large proportion of interventions of medical emergency teams (METs). The aim of this study was to analyse medical emergency interventions in the Biała Podlaska and Chełm (Poland) between 2016 and 2018 in a group of patients ≥ 65 years of age. Materials and Methods: We analysed medical records of 1200 older patients treated by METs in Biała Podlaska and Chełm (Lublin Province, Poland). The research was conducted from June 2019 to March 2020 at the Emergency Medical Service Station in Biała Podlaska and the Medical Rescue Station in Chełm (Independent Public Complex of Health Care Facilities). Results: A total of 92.5% of medical emergency service interventions took place at the patient’s home. The mean time of stay at the scene was 20 min. The highest number of interventions occurred between 8:00 p.m. and 8:59 p.m. There were no statistically significant differences in the type of ambulance used depending on the patient’s sex, while there was a statistically significant relationship between priority code and sex. Cardiovascular diseases were diagnosed in 40% of patients, and the symptoms were not precisely classified in almost the same percentage of patients. Mortality cases accounted for 3.1% of the 1200 interventions analysed. Ambulance dispatch resulted in the patient being transported to the hospital emergency department in 69.1% of cases. Conclusions: METs were called for a variety of diseases due to the fact that geriatric patients are not able to distinguish a life-threatening condition. Medical procedures performed by METs from Biała Podlaska and Chełm were closely related to the initial diagnoses made by these teams. It was irrelevant whether a specialist or non-specialist medical emergency service was used. Paramedics are very well trained to practice their profession and are able to provide treatment to older patients in a state of sudden life threat.

scholarly journals Study of Side Effects of Patients Receiving Cisplatin in the Treatment of Cervical Cancer by Age Group

2020 ◽  
Vol 43 (4) ◽  
pp. 28-38
Author(s):  
Rachadapan Chaitosa ◽  
Worathida Maskasame
Keyword(s):  
Cervical Cancer ◽  
Side Effects ◽  
Cancer Patients ◽  
Older Patients ◽  
Concurrent Chemoradiotherapy ◽  
Combined Therapy ◽  
Age Groups ◽  
Cervical Cancer Patient ◽  
Younger Patients ◽  
Life Threatening

Background: Cisplatin is one of the options of chemotherapy used to treat cervical cancer. Patient can experience side effects from drugs frequently with many factors as a catalyst including the age of the patient. Objective: To compare the side effects of cervical cancer patients receiving concurrent chemoradiotherapy (Cisplatin) 2 rounds between patients ≤ 60 years and > 60 years. Methods: A retrospective study, 70 cervical cancer patients undergoing concurrent chemoradiotherapy at Ramathibodi Hospital were investigated. Questionnaires about adverse effects were completed by patients at home 7 days after 1st and 2nd courses of combined therapy. The side effects of cervical cancer patients between groups was analyzed. Results: Of 70 patients, there were 47 patients ≤ 60 years and 23 patients > 60 years. After the 1st course, life-threatening side effects occurred in 9 patient’s ≤ 60 years but none occurred in patients > 60 years. Younger patients also had significant more nausea than older patients (P < .05). After the 2nd course, younger patients also had significant more vomiting than older patients (P < .05). The most common side effects for both age groups were fatigue and anorexia respectively. Conclusions: Patients younger than 60 year would experience significantly more symptoms of nausea and vomiting after the 1st and 2nd courses of concurrent chemoradiotherapy.

scholarly journals Preoperative hyponatremia predicts complications in older patients undergoing digestive tract surgery: a propensity score matching analysis

2021 ◽  
Author(s):  
Chun-Qing Li ◽  
Chen Zhang ◽  
Fan Yu ◽  
Hao Kong ◽  
Chun-Mei Deng
Keyword(s):  
Postoperative Complications ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Digestive Tract ◽  
Older Patients ◽  
Infectious Complications ◽  
Increased Risk ◽  
Life Threatening ◽  
Digestive Tract Surgery ◽  
Complications And Mortality

Abstract Purpose Whether preoperative hyponatremia increases the risk of postoperative complications in older patients undergoing digestive tract surgery remains unclear. The purpose of the study was to investigate the association between preoperative hyponatremia and life-threatening postoperative complications (including death) among older patients undergoing digestive tract surgery. Methods This was a propensity score-matched, retrospective cohort study. We recruited older patients (≥ 65 years of age) who underwent digestive tract surgery in our institution. The propensity score matching (PSM; 1:2) was used to balance a range of covariates between patients with preoperative hyponatremia (serum sodium [Na+] levels < 135 mmol/L) and those with normal [Na+] levels (135–145 mmol/L). The primary outcome was the occurrence of life-threatening postoperative complications and mortality (i.e., Clavien–Dindo grade IV and V [CD IV and V] complications) during hospital stay. The relationship between preoperative hyponatremia and the development of CD IV and V complications was identified with logistic regression analysis. Results A total of 1076 patients were analyzed (mean age 73.9 years; 421 female [39.1%]). Preoperative hyponatremia was identified in 122 patients. After matching, 312 patients were included in the analyses (104 patients with preoperative hyponatremia and 208 patients with normal [Na+] levels; mean age, 76.3 years; 130 female [41.7%]). When compared with normal [Na+] levels, preoperative hyponatremia was associated with an increased risk of CD IV and V complications (odds ratio [OR] 2.082, 95% confidential interval [CI] 1.041–4.164, P = 0.038). Preoperative hyponatremia was also significantly associated with a higher risk of postoperative infectious complications (OR 2.158, 95% CI 1.138–4.091, P = 0.018). Conclusion Preoperative hyponatremia can predict an increased risk of life-threatening postoperative complications and mortality in older patients undergoing digestive tract surgery.

scholarly journals Tetanus: The Old Enemy Resurfaces

2021 ◽  
Author(s):  
Hemanth Boppana
Keyword(s):  
Rare Disease ◽  
Tetanus Toxoid ◽  
Diabetic Foot ◽  
Older Patients ◽  
Prevention Strategy ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Life Threatening Illness ◽  
Life Threatening ◽  
To Receive

The widespread use of the tetanus toxoid vaccine has been very effective in the prevention of tetanus. However, older patients who may have failed to receive or complete immunization schedules for this vaccine are prone to the significant risks of this life-threatening illness. We present two cases stemming from diabetic foot ulcers to remind clinicians of the presentation and treatment of this now rare disease and to also draw attention to the need to emphasize immunisation as a prevention strategy.

scholarly journals Polytrauma – Definition & Management Aspects and Trauma Score?

2018 ◽  
Vol 1 (1) ◽  
pp. 9-10
Author(s):  
Agron Dogjani
Keyword(s):  
Trauma System ◽  
Childhood And Adolescence ◽  
Transport Time ◽  
Golden Hour ◽  
Child Deaths ◽  
External Agent ◽  
Life Threatening ◽  
Trauma Teams ◽  
Primary Assessment ◽  
Trauma Score

Introduction: It is defined as "a clinical condition by the action of an external agent causing profound physio-metabolic changes involving several systems simultaneously with life-threatening consequences." In Germany, more than 20 000 people die each year The main cause of M & M & D in childhood and adolescence Responsible for 80% of adolescent deaths Responsible for 60% of child deaths 73% of them caused by AA in the age group of 25-34 years Causes large and social loss -the country's economy Purpose; Discussion about polytrauma, principles, and their assessment at all levels; during the transport, in the Emergency Department, OR, ICU…Identifying the concepts of the Mortal triad, primary assessment, secondary evaluation ... and the primacy of concepts "Scoope and run" as the foundation of the concepts of ATLS... Examination of the pre-hospital management elements related to the time of the accident, the way of transport, transport time, etc ... the value of "Golden Hour" & "Platinum 10 minutes" as a key element in managing trauma.  Recognition of the pre-hospital and hospital trauma system, and their levels in the most appropriate trauma treatment. How are trauma teams structured? Types of vertical vs. horizontal trauma management, which would be most adapt to our conditions... How much do we know ABCDEFGH ... of the trauma, how, and how deeply we know them and is their implementation possible in the practical activity of any individual or institution ... where the traumatized patient gets the greatest benefit...

scholarly journals Pathophysiological Complexity of Amiodarone-Induced Hypothyroidism (AIH) in patient With Congenital Heart Disease- Ebstein Anomaly: a case report

2021 ◽  
Author(s):  
Zvonimir Bosnic ◽  
Domagoj Vucic ◽  
Nikica Marinic ◽  
Blazenka Saric ◽  
Ljiljana Trtica Majnaric
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Systematic Study ◽  
Older Patients ◽  
Congenital Heart ◽  
Amiodarone Therapy ◽  
Class Iii ◽  
Ebstein Anomaly ◽  
Autoimmune Thyroid ◽  
Life Threatening

Abstract Background: Amiodarone is a class III antiarrhythmic drug, used for the threatment of life threatening supraventricular and ventricular tachyarrhythmias and widely used in prevention of life threatening tachyarrhythmia in adults with congenital heart disease. Thyroid dysfunction is a potentially serious complication of amiodarone therapy, especially in older patients with acquired heart disease. Cause there is no published systematic study on amiodarone-associated hypothirodism in patients with congenital heart disease, we report the case of a patient with Ebstein anomaly, a rare congenital heart disorder, who developed hypothyroidism after prolonged amiodrone therapy. We report a possible pathophysiological link of amiodarone-induced hypothyroidism in a patient with rare congenital heart disease, that has not been reported in a significant number in the literature so far.Case presentation: A female, 55-year-old patient with history of Ebstein anomaly (non operated), presented to a family medicine doctor with symptoms of progressive dyspnoea, fatigue and dysfagia for several months. Electrocardiography, echocardiography and chest X- ray confirmed presence of Ebstain anomaly. Laboratory results (including thyroid hormone values) and thyroid ultrasound were performed which confirmed the presence of hypothyroidism.Conclusions: According to available data, there is no published systematic study on amiodarone-associated hypothirodism in patients with congenital heart disease (large cohort studies). Pathophysiological complexity, however, could be due to the agent triggering autoimmune thyroid disease, so it is possible that amiodarone precipitated the onset of preexisting autoimmune disease. The value of regular thyroid function testing and measurement of thyroid antibodies should be considered in patients during amiodarone administration, especially in older patients with rare congenital heart disease.

The impact of frailty on the occurrence of immune-related adverse events in older patients with advanced melanoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24028-e24028
Author(s):  
Cheryl P. Bruijnen ◽  
Josephine J Koldenhof ◽  
Erwin H.J. Tonk ◽  
Rik Jasper Verheijden ◽  
Frederiek van den Bos ◽  
...  
Keyword(s):  
Adverse Events ◽  
Older Patients ◽  
Checkpoint Inhibitors ◽  
Advanced Melanoma ◽  
Frail Patients ◽  
Systemic Corticosteroids ◽  
Life Threatening ◽  
Major Increase ◽  
Grade 3 ◽  
The Impact

e24028 Background: Immune checkpoint inhibitors (ICIs) have changed the melanoma treatment landscape by inducing durable responses and significantly improving survival. ICI can cause immune-related adverse events (irAES) ranging from mild to life threatening. Clinical trials have not shown major increase of irAES in older patients when compared to younger patients. However, older patients have been underrepresented and were relatively fit in these trials. In this study, we assessed the occurrence of irAEs treated with systemic corticosteroids and/or leading to treatment discontinuation (relevant irAEs) in older patients with melanoma and, if relevant irAEs occurred more often in frail patients, as assessed with the Geriatric 8 (G8). Methods: Patients ≥70 years diagnosed with advanced melanoma, about to start with ICI, and screened with a G8, were enrolled in this prospective observational study. Patients were classified according to the G8 score as “fit” (G8 score >14) or “frail” (G8 score ≤14). Toxicity was scored according to CTCAE v4.03. Primary outcome was occurrence of relevant irAEs in “fit” and “frail” patients. Secondary outcomes were the occurrence of irAEs any grade and severe irAE (grade ≥3). Results: In total, 49 patients were included for statistical analyses. Thirty-three patients were classified fit according to the G8 and, 16 patients were frail. Relevant irAEs occurred statically significantly more often in in frail patients: 12 (75%) versus 15 patients (46%) ( p=0.05). In addition, more irAEs grade ≥3 were reported in frail patients, although not significant: 7 (44%) versus 8 patients (25%) ( p= 0.11). Conclusions: Frailty, classified by the G8, is associated with the occurrence of relevant irAEs in the older patient with advanced melanoma. These data need to be confirmed in larger series.

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