By J. R. Playfer (auth.), M. Lye (eds.)
Most sufferers in built international locations with clinical difficulties requiring clinic care are aged. more and more the dividing line among common inner medi cine and acute geriatric drugs is changing into extra blurred. it's, however, obvious that a few aged sufferers on clinical or sub-specialty clinic 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 concerning a quicker entry to the long-stay beds of the geriatric unit. Even a short examine of health center working facts will exhibit this isn't and can't be the case. whilst geria tricians are requested to determine aged 'bed blockers' on colleagues' wards they method with anxiousness simply because those sufferers frequently need to be put on a protracted ready record for those scarce and extremely dear carrying on with care beds. Do geria tricians see assorted acute scientific difficulties in comparison with their colleagues? the answer's now not instantly visible, notwithstanding geriatricians are inclined to obtain extra strength 'bed blockers' than their common scientific colleagues. How is it then, that geriatricians appear to cope higher than their colleagues? All geriatricians have event of common inner drugs however the contrary regrettably doesn't carry. This ebook is written within the desire of redressing the imbalance.
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Additional resources for Acute Geriatric Medicine
Details of the three main agents are given in Table 4. In essence, there is little to choose between the three though experience with frusemide is more extensive. Table 4 Loop diuretics Duration of effect onset-end (h) Dose range (mg/day) Price band* Yz-6 Yz-6 1-5 50-400 20-2000 D Bumetamide Ethacrynic acid Frusemide 1-4 C B * Relative Price Bands (See Table 3) Unfortunately, their very potency leads to significant adverse effects in elderly patients with fluid retention. In the acute situation, administration may cause acute urinary retention as all urological surgeons will confirm.
Nursing and medical support of the acutely ill or severely disabled patient 5. Prevention, diagnosis and treatment of medical complications 6. Early physical and social rehabilitation ACUTE STROKE ILLNESS IN THE ELDERLY 39 are most apparent in wards where the stroke patient is tolerated rather than managed and admission considered as a 'holding operation' while spontaneous recovery or long term placement is awaited. DIAGNOSIS AND ASSESSMENT Is It a Stroke? When a patient is referred to hospital with a 'stroke', it is important to appreciate that this is a presumptive diagnosis.
Person in the absence of meningitis. Post ictal states. 40% of the patients misdiagnosed as strokes in Norris's series were recovering from seizures and a third of these had had a previous stroke, the seizure presumably arising in scar tissue. The correct diagnosis was subsequently made when a history of previous episodes was obtained or when further fits were seen. In a few cases the EEG (see below) was helpful. To summarize, the chances of diagnostic error in the elderly stroke patients who present with sudden onset focal signs are fairly slim but some caution 41 ACUTE STROKE ILLNESS IN THE ELDERLY may be necessary when patients present with a slow onset history, with evidence of preceding illness or neurological symptoms, or with stupor or coma.