Elderly First Aid Handbook Book A by andrew tang

Emergency Medicine Interest Group

Emergency Medicine Unit, The University of Hong Kong

BOOK

Presents

ELDERLY FIRST AID HANDBOOK

Edited by KL Fan LP Leung

CONTENT

Foreword

Disclaimer

Process of Ageing

9 10 13 16 18

Basic Life Support Basic Life Support Compression-only Bystander CPR Conventional Bystander CPR Automated External Defibrillator (AED) Recovery Position

21 23 25 28

Central Nervous System Stroke Seizure Head Injury Depression and Suicide

33 35 38 40

Cardiovascular System Hypertensive Emergency Angina Syncope Shock

43 47

Thorax Acute Asthmatic Attack Choking

51 54 57 59

Abdomen Abdominal Pain Vomiting Constipation Dehydration

Content

63 65

Pelvis and Perineum Acute Urine Retention Urinary Tract Infection

High Fever

71 72

Extreme Temperature - Too Hot Heat Exhaustion Heat Stroke

Extreme Temperature - Too Cold Hypothermia

Ear Nose Throat Nose Bleeding

Acknowledgement

FOREWORD

These two handbooks were written by a group of medical students of the University of Hong Kong (HKU) with the guidance from the academic staff of the Emergency Medicine Unit of the HKU. The students have formed an Emergency Medicine Interest Group with the vision of serving the community of Hong Kong through their knowledge in Emergency Medicine. Ageing population is a worldwide phenomenon. It is expected that the proportion of people aged 65 or above would rise from 13% in 2011 to 30% in 2041 in Hong Kong. With increasing number of seniorcitizens in the community, how to best respond to their healthcare demands should be everyone’s concern. These two handbooks aim at guiding the readers across the vast topic of first aid for an ill or injured elderly. It is primarily written for the caretakers of the elderly in the community. But readers other than the caretakers of the elderly may also find the two handbooks useful if they come across an elderly who is acutely unwell. These two handbooks are neither authoritative nor comprehensive. It is hoped that readers would pursue further study on the topics in which they are interested and help themselves better respond to an ill or injured elderly under their care. The Emergency Medicine interest Group and the Emergency Medicine Unit would like to thank the ‘We Are With You’ Fund for the support in the production of these handbooks. KL Fan, LP Leung June 2016

Disclaimer Every effort has been made to ensure the accuracy of the content of these two handbooks. Nevertheless, the authors, the editors and publishers can make no warranties that the information contained herein is totally error-free. Readers are strongly advised to consult the relevant specialists or literature before following the recommendation in these two handbooks. The authors or any party involved in the production of these two handbooks disclaim any liability, loss, injury or damage resulting from the use of these two handbooks.

Foreword

PROCESS OF AGEING

Muscle - Reduced muscle mass (30-40%) and muscle power - Becoming fatigue earlier and more easily during exertion - Lower regenerative ability - More fat in muscle tissue

Skin - Wrinkling and sagging especially on face, neck and hands - Getting thin and pale - Wounds heal more slowly or may not heal at all - Reduced sensitivity to cold - Reduced sweating - Reduced resistance to UV light damage

General - Decrease in body mass - Decrease in the proportion of body fat

Eyes - Yellowing of lens - Higher prevalence in cataract - Lower light sensitivity - Poorer dark adaptation - Reduced tear production - Minimal decrease of visual acuity at rest but significant decrease of visual acuity with a moving target

Nervous system - Slower central processing and longer reaction time - Reduced sensitivity to vibration especially in feet - Less sensitivity to temperature - Modest loss of neurons - Slight decrease in brain mass

Skeleton - Both men and women lose bone mass during ageing - Women have faster loss in bone mass, which accelerates after menopause - Men have slower bone loss, as they start losing other tissues as well - Higher prevalence of osteoporosis in both genders

Physiology/Anatomy of Ageing Ageing is a term to describe the changes in our body functions when we get older. The changes affect every body system and are affected by environmental and genetic causes. The following are changes that appear in our body during the process of ageing.

PROCESS OF AGEING

Heart and blood vessels - No change in heart rate and contraction force at rest - Less increase in heart rate and contraction force during exercise - Moderate increase in heart size - Stiffer heart and blood vessel tissues - Increased blood pressure

Digestive system - More stomach acid production - More common to have constipation - Reduced absorption of nutrients - Decrease in liver mass

Respiratory system (breathing) - Decrease in diaphragm strength - Decrease in lung volume and air flow rate - Increase in residual air in lungs

Other systems - Impaired shivering - Decrease in sensitivity of smell - Decrease in thirst drive - Deterioration of balance - Loss of hearing in high-frequency tones

Immune system - More prone to infection - Reduced response to vaccination

Kidney, urinary and genital systems - Decrease in kidney filtration function, concentration ability and dilution of urine - Decrease in kidney mass - Incomplete bladder emptying leading to increase in residual urine - Less intense orgasms (both men and women) - Longer resting time between orgasm and next erection for men

BASIC LIFE SUPPORT

Basic Life Support (BLS) Basic Life Support is the combination of emergency procedures needed to ensure a person’s survival, including cardiopulmonary resuscitation (CPR), control of bleeding, treatment of shock and poisoning, stabilization of injuries and/or wounds, and basic first aid. In this chapter, we will cover CPR, recovery position, and automated external defibrillator (AED).

CPR

Recovery Pose

AED

Why Basic Life Support? It is important to learn BLS because emergencies happen! There are a lot of things you can do with little or no equipment to deal with medical emergencies, and you could potentially save a life with these simple skills.

Why learn Bystander CPR? Because Bystander CPR is a simple and effective way to keep a person with sudden cardiac arrest alive. This is a series of actions to support the breathing and circulation of a person whose heart has stopped beating, and help maintain blood perfusion to the vital organs to a certain extent to buy time for more definitive treatment.

Average age

Witnessed

80 40%

30% CPRed

What is sudden cardiac arrest? Sudden cardiac arrest (SCA) is when there is a sudden failure of the heart to contract effectively, so that the delivery of oxygen by blood to the body tissues, including the brain and the heart itself, is disrupted, or even stopped. This situation is very dangerous, and is one of the leading causes of death worldwide, especially in the elderly. The median age of SCA in Hong Kong is 80 years old. Two-thirds of the cases occur at home, and 40% occur witnessed. Yet, only about 30% of the elderly in Hong Kong get immediate CPR from a bystander. This is very low compared to other developed countries, and many more lives could potentially be saved if more people step out to carry out CPR on an elderly with SCA.

Basic Life Support

How does Bystander CPR help?

Compression-only Bystander CPR

The Chain of Survival

CPR is one of the most important first aid techniques, it’s a series of actions to support the circulation of a person whose heart has stopped beating. This helps maintain blood perfusion to the vital organs to a certain extent to buy time for more definitive treatment.

The Chain of Survival is a closely packed series of five steps to keep the chances favorable for a SCA elderly to stay alive. The steps are: 1) Early access to care (e.g. calling 999) 2) Early CPR 3) Early defibrillation (i.e. with an AED) 4) Early advanced care (by professionals) 5) Good post-resuscitation care Each one of these steps must be done well and early, and with the Bystander BLS routine, you will already be covering the first 3 key steps in saving the elderly. Here is how to do it.

1 2 3

CPR

AED

If you have not been trained in CPR, or do not wish to have mouth-tomouth contact with a stranger, you can do compression-only CPR. It is as effective as the conventional bystander CPR. The approach can be remembered with a mnemonic of :

Danger + Check + Call + Chest Compression

1 Danger

Check if the environment is safe for you and the elderly

2 Check

Check the elderly for Responsiveness: call the elderly; shake the elderly’s shoulders

3 Call

IF the elderly is not responsive AND not breathing properly, call for help by - Dialing 999 - Asking a bystander to take the nearby AED for you

Breathing: observe if there are chest movements; listen for any breathing sound

Proceed to CPR (C A B)

4 Chest Compression

Basic Life Support

Compression-only Bystander CPR A. Position Place the heel of a hand on the breastbone at the center of the elderly’s chest.

C. Depth Using your body weight, press the elderly’s chest down hard for 5-6 cm (2 inches - 2.4 inches).

B. Posture Place the other hand on top of the first hand, and make your fingers interlocked. Move your shoulders so that they are directly above your hands, keep your arms vertical and straight throughout. Do not bend them even as you apply pressure.

D. Frequency Press repeatedly and fast with the same posture at a frequency of 100-120 per minute. As a rule of thumb, run the song Staying Alive “Ha, ha, ha, ha, staying alive, staying alive…” in your head. Each beat roughly corresponds to one press. Alternatively, follow the best of the song 急救進行中

x 100 - 120/mins

E. Recoil After each press, make sure you allow the chest of the elderly to recoil.

Repeat the procedure until - the elderly regains consciousness with normal breathing and heart rate - an ambulance has arrived - the AED has arrived - you are exhausted and cannot carry on.

Conventional Bystander CPR This is a series of actions to support the breathing and circulation of a person whose heart has stopped beating. The approach can be remembered with a mnemonic of :

Danger + Check + Call + C A B 1 Danger

Check if the environment is safe for you and the elderly

2 Check

Check the elderly for Responsiveness: call the elderly; shake the elderly’s shoulders

3 Call

IF the elderly is not responsive AND not breathing properly, call for help by - Dialing 999 - Asking a bystander to take the nearby AED for you

Breathing: observe if there are chest movements; listen for any breathing sound

Proceed to CPR (C A B)

4 C AB (CPR )

C - Circulation A - Airway B - Rescue Breaths

Basic Life Support

Conventional Bystander CPR

C for Circulation - Chest Compression (Optional) If you have been trained and confident in doing pulse check, check if there is a neck (carotid) pulse by placing two fingers on the side of the prominence at the front of the neck. Check one side at a time.

A. Position Place the heel of a hand on the breastbone at the center of the elderly’s chest.

C. Depth Using your body weight, press the elderly’s chest down hard for 5-6 cm (2 inches - 2.4 inches).

x 100 - 120/mins

E. Recoil After each press, make sure you allow the chest of the elderly to recoil.

A for Airway If neck injury is not suspected, head-tilt and chin-lift can be performed: Tilt the head back, and lift the chin up.

If neck injury is suspected, jaw thrust can be performed instead.

B for Rescue Breaths After 30 chest compressions, give 2 breaths. Place your mouth on the elderly’s mouth so that it is airtight, and blow steadily into his/her mouth. Each breath must last about 1 second. Observe to see if his/her chest rises. If so, the rescue breath is effective.

In conventional bystander CPR, the cycle between chest compressions and rescue breaths in a 30:2 ratio, in which 30 chest compressions are followed by 2 rescue breaths.

Repeat the procedure until - the elderly regains consciousness with normal breathing and heart rate - an ambulance has arrived - the AED has arrived - you are exhausted and cannot carry on.

Basic Life Support

Automated External Defibrillator (AED) Commonly called AED, the device has a daunting full name Automated External Defibrillator. However, its principles and use are actually not difficult to grasp. Sudden cardiac arrest, in which the heart stops beating suddenly, can cause death within minutes if untreated. The 2 major causes of sudden cardiac arrest, both triggering irregular heartbeats, are ventricular fibrillation and ventricular tachycardia. The commoner cause is ventricular fibrillation, in which the lower chambers (ventricles) of the heart quiver quickly and irregularly. The other cause is ventricular tachycardia, in which the ventricles have regular, fast beats that lasts for a short period of time. The AED can be used in this condition to assess the heart rhythm and restore it to normal by administering electric shocks to the heart. CPR also helps the chance of survival. AED sets usually come with spoken or visual instructions for the untrained user and are easy to use. An important point, though, would be to make sure that no one is touching the elderly when the shock is being administered.

AEDs can be found in many public places, such as shopping malls, airports, hotels and schools. You can find them directly under these signs

AED It’s important for the local EMS system and Community members to know where AEDs are located in the community. In the event of a sudden cardiac arrest emergency, you can find AED quickly.

There are many different brands of AEDs, but the same basic steps apply to all of them.

STEPS in using AED 1. Turn on the AED ON-OFF

ON-OFF

2. Attach defibrillation pads to the chest (Right side upper chest , Left side lower chest, wipe the chest dry if it’s wet) 3. Push the analyze button and the AED analyze heart rhythm 1 ON-OFF

If AED advises you to shock the person: 4. Make sure no one, including you, is touching the person Tell everyone to “STAND CLEAR!” 5. Push the “shock” button

Basic Life Support

Recovery Position If the elderly is unconscious without any suspected neck injuries and breathes spontaneously, he/she should be placed in the recovery position. The recovery position keeps the airway patent, and prevents the elderly from aspiration. 1. Kneel by the right side of the elderly.

2. Place the right arm of the elderly at right angle with his/her palm facing up.

6. Gently tilt the head back, and lift the chin (head-tilt and chin-lift), and perform the airway check of ABC again if you have not done so.

Stay with the person and monitor the elderly’s ABC continuously until an ambulance arrives.If the injuries are not too severe, turn the person to the other side after 30 minutes.

Basic Life Support

3. Hold the left hand of the elderly and place the back of the hand against his/her right cheek.

4. Grasp his/her left leg and bend to a right angle.

90˚

5. Keep his/her left hand on the right cheek. Pull the bent leg towards you to make the elderly roll to your side. His/her left arm should prevent the elderly from rolling too far.

CENTRAL NERVOUS SYSTEM

Stroke

Background

Stroke is a medical emergency. It occurs when the blood supply to the brain is disrupted, causing oxygen depletion and loss of function of the affected area. Strokes could be caused by either a clot in a blood vessel stopping blood passing to the brain or a burst blood vessel bleeds into the brain. Stroke is more common in old age. It is associated with circulatory system disorders, such as high blood pressure. Early recognition and hospital care (within 3 hours) may improve the chance of recovery. In Hong Kong, nearly 3,000 people die of stroke each year. At present, it is the 4th fatal disease in Hong Kong. In general, people who suffer from a stroke are usually over the age of 50.

Symptoms and signs

A characteristic of acute stroke is that the symptoms and signs often come suddenly. - Facial weakness - Limb weakness - Speech problems like slurring or inability to comprehend or express - Difficulty to swallow, maybe associated with drooling and easy choking - Headache, especially new or sudden - Nausea not accountable by other apparent causes - Reduced level of responsiveness - Numbness and tingling in face, arms or legs - Dizziness especially persistent, severe or unrelated to posture change - Loss of balance or inability to walk steadily - Blurred vision especially only one eye is affected - Loss of bladder or bowel control

Central Nervous System

As a first aider

- Recognize the symptoms and signs of stroke and arrange emergency help - Reassure and comfort the elderly to keep him or her calm Do’s The FAST test could be used to recognize stroke. 1. A Chinese mnemonic to remember the test is “微笑殭屍會說話“ a / Face (Facial weakness) - Ask the casualty to smile - If he has a stroke, he may only be able to smile on one side and his face may look uneven b / Arm (Arm weakness) - Ask the casualty to close his eyes and raise both arms - If he has a stroke, he may only be able to move one arm or has weakness on one arm c / Speech (Speech problems) - Find out if the casualty can speak clearly and understand your words - If he has a stroke, he may not be able to speak clearly or respond appropriately d / Time - If any of the signs are present, call 999 for emergency help - If possible, record the time the symptoms first appear 2. Reassure the elderly and keep him or her comfortable 3. Monitor the level of responsiveness, breathing and pulse until help arrives 4. If the patient becomes unconscious, check for pulse and breathing and start CPR if necessary Don’ts Give the elderly anything to eat or drink

Remarks

Transient Ischemic Attack (TIA) is commonly known as a mini stroke by the lay public. The symptoms and signs are similar to those of stroke. However, the symptom and signs are often transient and the elderly may recover within 24 hours. TIA is associated with a high risk of stroke in the subsequent days and weeks. Those elderly with features suggestive of TIA should obtain immediate medical consultation despite the recovery from the initial symptoms and signs.

Seizure

Background

Seizure consists of involuntary muscle contractions due to disturbance in electrical activity of the brain. It presents with sudden loss of consciousness and jerking of the extremities in most cases. In rare cases, consciousness is preserved. In elderly, the most common causes of seizure include epilepsy, Alzheimer’s disease, stroke and medication. Seizure can also be caused by head injury, brain-damaging disease (neurodegenerative diseases, tumor, and infection), and lack of nutrients in brain (hypoglycemia, acute alcohol intoxication or drug withdrawal)

Symptoms and signs

- Sudden loss of consciousness - Arching of back - Breathing difficulty (grey-bluish lips, red and puffy face/neck) - Convulsive movements (clenched jaw with noisy breathing, tonguebiting, drooling or foaming of saliva, facial twitching) - Urine or bowel incontinence - Tiredness and sleepiness after seizure The elderly may have brief warning symptoms (aura) just before seizure, for example, strange dizzy feeling, and special smell/taste. He/she may regain consciousness in a few minutes, and may be unaware of the actions.

Central Nervous System

! Repeated seizures within a short time ! Having the first seizure ! Seizure lasts for > 5mins ! Loss of consciousness for >10mins ! Limb weakness or paralysis after the seizure has stopped

As a first aider

! ! ! ! !

- Look for red flags and manage as medical emergency - Protect the seizing elderly from injury - Maintain a patent airway and smooth breathing during and after the seizure when the elderly is not fully conscious Do’s 1. Seek emergency medical help as soon as possible 2. Protect the elderly - clear away any potentially dangerous objects to prevent injury of the elderly, pad the area with clothing or pillows if the elderly is close to wall or hard objects, ask bystanders to keep clear 3. Protect the head and loosen tight clothing around neck 4. Lie the elderly down in recovery position (if not suspecting a spinal injury) 5. Monitor closely the responsiveness level and breathing; open airway 6. Note the time of onset and duration of seizure 7. Check for any injuries and apply necessary first aid Don’ts 1. Move the elderly unnecessarily 2. ut anything in his mouth or attempt to restrain him or her during a seizure 3. Give food and drinks

Head Injury

Background

Symptoms and signs

Falls account for the majority of head injury cases in elderly. Serious head injuries are often a result of traffic accident. In the elderly, an apparently trivial head trauma may lead to complications not commonly seen in the young. Intracranial bleeding is the most worrisome complication. What’s more important to note is the onset of the intracranial bleeding may be delayed and may go unrecognized for months until the elderly suddenly deteriorates or becomes symptomatic.

It is usually not difficult to recognize the symptoms and signs of an acute head injury. There may be a wound or swelling on the scalp and the elderly may complain of pain. For those elderly who cannot express themselves properly, very often the injury is only incidentally noted. The elderly with acute complication as a result of the head injury almost always appear unwell and may appear different from their usual status. On the other hand, those with delayed complication are difficult to recognize. Sometimes, they may be able to recall that there was a head injury or the injury was so trivial that they forget it. One of the most well-known delayed complication in the elderly is called ‘subdural hematoma’. It means that there is blood collection beneath the dura covering the brain surface. The symptoms and signs are often subtle. For example, the elderly may appear more and more forgetful, with unexplained personality change or non-specific dizziness and headache. A high index of suspicion is needed.

Central Nervous System

One of the objectives of first aid for an elderly with acute head injury is to look for clues suggestive of post-injury complication, in particular, intracranial bleeding. Red flag sign: ! Clear fluid or watery blood ! from nose or ear ! Bruise around eyes ! ! Increasing drowsiness ! ! Confusion ! ! Impaired consciousness ! ! Memory impairment ! ! Weakness ! ! Numbness ! ! Worsening headache ! ! Repeated vomiting ! ! Convulsion !

- Look for the red flag signs - Protect the elderly from further injury

As a first aider

Do’s For those with red flags or you are not sure about the clinical status of the injured elderly: 1. Seek emergency medical help immediately 2. Provide BLS if needed 3. Provide basic wound care if there is a wound 4. Regularly monitor the vital signs including responsiveness, breathing and pulse until medical help is available For those without red flags and you are confident that the injured elderly is stable and well: 1. Observe for at least 24 hours from time of injury for any abnormal symptoms. Seek medical consultation as soon as possibleif there is persistent dizziness, worsening headache, repeated vomiting, twitching or anything that worries you. Common Head Injury Symptoms / Post-Concussion Syndrome (PCS) Physical Symptoms: - Headache, Dizziness - Sensitive to noise & visual disturbance - Fatigue

Cognitive Symptoms: - Memory problems - Poor concentration - Judgement problems

Behavioural Symptoms: - Depression - Anxiety & Stress - Irritability

2. Ensure there is a responsible adult who can observe the elderly Whenever there is doubt, seek medical consultation as soon as possible. Don’ts Give food and drink to the injured elderly with red flags.

Central Nervous System

Depression and Suicide Background

Depression is one of the commonest psychiatric disorders in old age. Yet, it is frequently unrecognized. In Hong Kong, the prevalence of depressive disorders in elderly is 9.7%, compared to 8.4% in adults aged 18-65 years old. Depression is a known risk factor of suicide, and suicide risk increases with age. The suicide rate in the general population of Hong Kong is around 10 to 13 per 100 000, whereas the rate in the age group of 65 and above is around 30 per 100 000, and in the age group of 75 or above is 50 per 100 000. The ratio of the male to the female suicide rate in the elderly is 1.3 to 1. Compared to other countries, the elderly suicide rate in Hong Kong is relatively high.

Symptoms and signs

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) of the American Psychiatric Association, the definition of depression is: Anyone who has 5 or more of the following symptoms, including at least one of the first two symptoms, nearly every day for at least 2 weeks - An usually sad mood - Loss of enjoyment and interest in activities that used to be enjoyable - Lack of energy and tiredness - Feeling worthless or feeling guilty when they are not really at fault - Thinking about death a lot or wishing to be dead - Difficulty concentrating or making decisions - Moving more slowly or sometimes becoming agitated and unable to settle - Having sleeping difficulties or sometimes sleeping too much - Loss of interest in food or sometimes eating too much Risk factors - Family history - Being female - Disability and illness (especially if serious) - Old age home residents - Bereavement - Social isolation - Chronic pain - Sensory impairment (e.g. hearing or sight)

Central Nervous System

The most important red flag in a depressed elderly is suicidal tendency. It is commonly found in those institutionalized, or those with chronic illness or disability. The elderly suffering from depression may think that the future is so hopeless that suicide is the only way out. Following an attempted suicide, further attempts — and successful suicide — are common. Suicidal tendency may be overt or covert. Overt manifestations include: ! Intentional drug overdoses (opiates, antidepressants, ! paracetamol, benzodiazepines; more common in women) ! Self-injury (hanging, shooting, jumping, drowning; ! more common in men) Covert features are especially common in older people, and include: ! Social withdrawal ! ! Severe self-neglect ! ! Refusal of food, fluid, ! or medication

As a first aider

- Approach the depressed elderly and assess whether there is any immediate suicidal risk. Immediate suicidal risk is suggested by strong and frequent suicidal ideation or presence of a suicide plan. However, the absence of which is not equivalent to a lower risk. If the person has an immediate risk of committing suicide or the situation is beyond control, seek medical help immediately, or simply call 999. - Provide emotional support to the person and encourage him or her to get appropriate professional help if there is no immediate risk. - Whatever the situation is, always ensure that support and attention is readily available to the elderly. Do’s 1. Listen non-judgmentally. 2. Express empathy to the elderly. 3. Take every suicidal idea or expression seriously 4. Seek professional help whenever possible Don’ts 1. Leave the elderly with suicidal risk alone. If you cannot stay with them, you must arrange someone else to do so, for example, a family member or friend who has agreed to help. 2. Ignore any idea of suicide, no matter how casual the elderly expresses it.

Central Nervous System

CARDIOVASCULAR SYSTEM

Hypertensive Emergency Background

Hypertension is one of the most common chronic illnesses in elderly in Hong Kong. A study by the School of Public Health of the University of Hong Kong in 2012 revealed that about 1 in 3 adults in Hong Kong has hypertension, and almost 50% of elderly are suffering from the disease. When the heart beats, blood is pumped into arteries. Blood pressure is the pressure against which blood pushes the arterial walls. Blood pressure readings are given in two numbers, written as 120/80 mmHg. The first number is called the “systolic pressure” or “upper pressure”, which is the pressure exerted on the arterial walls when the heart contracts. The second number called the “diastolic pressure” or “lower pressure” is the pressure exerted on the arterial walls when the heart relaxes. Hypertension is a reading of blood pressure greater than 140 (higher pressure) over 90 (lower pressure) mmHg with repeated

measurements when the person is resting. Systolic hypertension is a common condition in elderly. When blood pressure spikes to a dangerous level that can potentially cause organ damage and other complications in the body, it is a hypertensive emergency. The blood pressure has to be lowered to avoid imminent organ damage. High blood pressure can have adverse effects on the brain, heart, kidneys and eyes. Hypertensive emergencies generally occur at blood pressure levels exceeding 180 systolic OR 120 diastolic, but can occur at even lower levels in people whose blood pressure has not been previously high. In elderly, forgetting to take blood pressure medication and interactions between medications are the common scenarios to trigger hypertensive emergencies. Some, however, do not have any underlying causes.

Cardiovascular System

Symptoms and signs

In most cases of hypertension, there are no symptoms present. However, in cases of hypertensive emergencies, the following signs and symptoms may occur: - Severe chest pain - Shortness of breath, that may be increasing - Intense headache - Nausea and vomiting - Blurred vision - Increasing confusion - Numbness/weakness - Difficulty speaking - Seizures - Tinnitus - Fainting episodes - Unresponsiveness

- Recognize the signs and symptoms of hypertensive emergency - Seek emergency medical help

As a first aider

Do’s 1. If the elderly has BP > 180/120 mm Hg and with the above symptoms and signs: - Seek emergency medical help 2. If the elderly is unconscious: - Check for airway, breathing and pulse and perform CPR if necessary 3. If the elderly is conscious: - Help the elderly into a comfortable position, usually sitting - Calm and reassure the elderly 4. If the elderly is vomiting or having seizures: - Put the elderly in recovery position to prevent aspiration and seek emergency medical help 5. If the elderly complains of difficulty in breathing: - Prop him/her up using pillows behind upper back and seek emergency medical help Don’ts Wait for the blood pressure to drop down on its own when symptoms occur

Angina

Background

Heart disease is the 2nd killer disease in Hong Kong after cancer. Coronary heart disease is a major type of heart disease. Incidence and prevalence of ischemic heart disease rise with age. As many as 30% of people aged >65 years in the developed world have angina or myocardial infarction (MI) and a further 30% have covert (asymptomatic) disease. Angina is a sensation of chest pain typically squeezing or pressure like due to ischemic heart disease. When the coronary vessels become narrowed, the blood supply of heart muscle may be impaired. This is aggravated on exertion when oxygen demand increases. Heart attack occurs with severe occlusion of coronary vessel leading to heart muscle death. However, it is not unusual for the elderly to have silent ischemia. Risk factors for cardiovascular diseases include hypertension, hyperlipidemia, diabetes mellitus, smoking and family history of angina or cardiac muscle infarction. The untreated ischemic chest pain can cause cardiac muscle infarction, complicated by sudden cardiac death, shock, acute decompensated heart failure or congestive heart failure.

Cardiovascular System

Ischemic chest pain

Symptoms and signs

Angina Symptoms Site

Central Midline Chest Pain

Onset

Acute

Characteristics

Crushing or stabbing discomfort, chest tight, squeezing/pressure feelings

Radiation

Left Arm, Jaw, Neck

Associated Symptoms

Shortness of breath, sweating, tachycardia, anxiety, nausea and vomiting

Duration

Gradually increasing but usually fading away in 10 minutes

Exacerbating Factors Exercise, stress and coldness

Atypical chest pain

Relieving Factors

Resting and nitrate (antianginal medication )

Severity

Variable, from little pain to severe pain

- Sharp or knife-stabbing like pain brought on by respiratory movements or cough - Primary or sole location of discomfort in the middle or lower abdominal region - Pain that may be localized at the tip of one finger, particularly over the left ventricular apex - Pain reproduced with movement or palpation of the chest wall or arms - Constant pain that persists for many hours - Very brief episodes of pain that last a few seconds or less

! Sudden onset ! Exertional pain ! Intensive pain ! Sweating ! Shortness of breath ! Fainting or loss of consciousness

As a first aider

! ! ! ! ! !

- Assist the elderly to rest - Seek emergency medical help - Monitor the condition closely Do’s 1. If the elderly is conscious a / Assist the elderly in half-sitting position with support for the back and head. b / Assist the elderly to take sublingual nitrates (Nitroglycerin) c / Loosen any tight clothing 2. If the elderly is unconscious a / Put the elderly in recovery position b / Call 999 c / Loosen any tight clothing d / Perform CPR if needed 3. When in doubt, always call 999 in case of sudden severe chest pain Don’ts 1. Leave the elderly alone 2. Wait to see if the symptoms subside 3. Give any medication (except cardiovascular medications) by mouth

Cardiovascular System

Syncope

Background

Syncope is a sudden, transient loss of consciousness due to reduced and inadequate cerebral perfusion. The incidence of syncope increases with age. Some studies showed that as many as a quarter of institutionalized elderly had this problem and the recurrence rate could be as high as 30%. The elderly is unresponsive with a loss of postural tone (ie slumps or falls). In the majority of cases, they would regain consciousness spontaneously. Secondary injury like hip fracture may occur as the elderly loses consciousness and fall. Syncope is not a disease by itself. It is a manifestation of an underlying disorder that causes reduced cerebral perfusion. Some of the important causes are: 1.Transient hypotension caused by the upright posture, straining, or coughing which is exacerbated by low circulating volume (dehydration or bleeding somewhere), hypotensive drugs or concurrent illnesses. Orthostatic hypotension (lower blood pressure on standing than lying down) is the most common cause of syncope. 2. Vasovagal response to pain, fright, emotion leading to slowing of heart beat and then hypotension. 3. Heart diseases such as myocardial infarction, arrhythmia, and aortic stenosis (narrow aortic valve opening)

Symptoms and signs

- Loss of consciousness - Pale, sweaty, absent or very weak carotid pulse - Reduced muscle tone - Possible tongue biting - Possible incontinence - Brief (few seconds) seizure activity - Brief (minutes) period of confusion may occur - Recovery is usually brisk and spontaneous

! Prolonged loss of consciousness ! Irregular pulse ! Chest pain or palpitation before or after the syncope ! Seizure or confusion ! Incomplete recovery of consciousness ! Recurrent syncope within a short period of time

As a first aider

! ! ! ! ! !

- Look for red flags and manage as medical emergency - Stay with the elderly and prevent further injury until the elderly has regained full consciousness Do’s 1. Allow the syncopal elderly to lie supine until he or she is fully conscious 2. Consider raising the elderly’s legs above heart level if postural hypotension is suspected 3. Maintain airway patency and smooth breathing when the elderly is unconscious 4. Loosen belts, collars or other constrictive clothing 5. Check for any injuries 6. For almost all elderly with syncope, medical consultation should be obtained as soon as possible Don’ts 1. Sit the syncopal elderly up 2. Give the elderly food and drinks

Cardiovascular System

Shock

Background

Shock means that cells cannot get enough oxygen and nutrients due to various causes. Shock is life-threatening and requires immediate medical treatment. The outcome is more unfavourable in elderly because of poor body reserve in general. Examples of shock and their causes Types Common causes Hypovolemic Shock

Massive bleeding or dehydration

Cardiogenic Shock

Heart attack

Anaphylactic Shock

Food allergy, insert bite

Septic Shock

Severe infection

Any type of shock can be fatal.

Symptoms and signs

- Dizziness, drowsiness, confusion - Chest discontent or tightness - Shortness of breath - Reduced urination - Cold & clammy skin **When shock is suspected, call 999 immediately. There is no effective way to handle shock at home. **

- Recognize the condition and manage as medical emergency Do’s

As a first aider

1. Seek emergency medical help Call 999 immediately 2. Have the patient lie flat. Raising the elderly’s legs above heart level if possible to restore blood flow to the brain 3. Control any external bleeding 4. Keep the elderly warm 5. Monitor conscious level, breathing and pulse regularly until the emergency service arrives Don’ts 1. Give the elderly any food or drinks 2. Leave the elderly alone

Cardiovascular System

THORAX

Acute Asthmatic Attack Background

Asthma is a small airway disease that causes airway obstruction due to bronchoconstriction (constriction of the airway) and increased sputum production. It is most commonly triggered by allergens exposure. Asthma among older adults are common and can be serious. Although many people have their first episode of asthma at young age, asthma can happen in any ages including elderly. Unlike their younger counterparts, the elderly are more likely to develop severe health problems Chronic Asthma with Airway Remodeling Incresed fibrosis Increased muscle thickness Increased mucus Increased inflammatory cells (CD4 and eosinophils) Effect of Inhibiting NF-kB on Airway Remodeling Decreased fibrosis Decreased muscle thickness Decreased mucus Decreased inflammatory cells (CD4 and eosinophils) Mild Asthma Minimal fibrosis Minimal muscle thickness Minimal mucus

(for example, respiratory failure) even during mild asthma attack. The condition rarely resolves itself and remains as a disabling disorder to the advanced age. Diagnosis of asthma in elderly may be missed due to the masking effect from other illnesses, such as heart disease and emphysema. The less active lifestyle of elderly compared to a young person also lowers the chance of provoking acute asthmatic symptoms (e.g. wheezing and breathing problems).

Thorax

The precipitants of acute asthmatic attack include: Allergens - Dust mites - Pollen - Animal Dander - Perfume - Medication such as aspirin Exacerbation Factors - Cold Weather - Air Pollutants - Smoking - Emotional Stress - Infection Complications Acute - Pneumothorax - Acute Respiratory Failure Chronic - Increase chances of infection of the lung

Symptoms and signs

- Productive cough with sputum, especially recurrent - Wheezing or noisy breathing - Shortness of breath - Insucking chest wall - Use of accessory muscles

! Breathing very fast or very slow ! Unilateral chest pain ! Excessive sweating ! Unable to speak in full sentences ! Altered mental status

! ! ! ! !

Thorax

- Provide symptomatic relief to alleviate bronchoconstriction - Monitor closely to detect any deterioration

As a first aider

Do’s 1. Administer bronchodilator if the elderly has one 2. Keep the elderly calm and comfortable 3. Position the patient upright and loosen all tight clothing 4. Seek emergency medical help if there is no bronchodilator or the elderly does not respond to the bronchodilator Don’ts 1. Leave the elderly unattended 2. Delay medical consultation if the elderly does not improve promptly

Emergency medication Short Acting Bronchodilator (Salbutamol—blue bottle)

Remarks

Dosage - Emergency Relief Give 4-6 puff of bronchodilator, take 4-6 breaths between each puff If the patient is still having asthma attack, repeat the above step after 4-6 minutes.

Canister

Mouthpiece

Thorax

How to use a bronchodilator 1. Remove cap and shake the canister thoroughly 2. Hold the canister upright 3. Breathe out fully 4. Place mouthpiece between lips 5. Press the inhaler and inhale slowly and deeply simultaneously 6. Hold the breath for 10 seconds or more 7. Wait at least 1 minute before taking second dose

How to use a bronchodilator (with spacer) 1. Remove cap and shake the canister thoroughly 2. Insert the bronchodilator inhaler into the spacer 3. Breathe out fully 4. Place mouthpiece of the spacer between lips, ensure air tight 5. Press the inhaler and breathe normally for 5 breaths

Choking

Background

Symptoms and signs

Choking occurs when the elderly’s airway is partially or completely blocked by a foreign body. The foreign body causing choking is commonly a food bolus, though it can be anything like a broken denture. The elderly is prone to choking for various reasons. Their chewing mechanism may be impaired because of dental problem. Swallowing is also affected because of pre-existing stroke. A demented elderly is also at risk because of loss of coordination of mastication and swallowing.

During a meal, - Sudden coughing - Sudden shortness of breath - Difficulty speaking - Making high-pitched noise while breathing - Clutching the throat with one or both hands

Thorax

! Unable to speak or cough ! Impaired consciousness ! Appear exhausted and unable to stand ! Cyanosis

! ! ! !

Apply standard maneuver to remove the foreign body

As a first aider

Do’s 1. Call for help 2. If the elderly is conscious and able to cough: - Encourage the elderly to cough - Stay with the elderly and monitor 3. If the patient is conscious but unable to cough or speak, or begins to exhaust: a / Back blows 1 Position yourself behind the elderly, place one arm diagonally across the chest 2 Bend the elderly forward by 90 degrees 3 Strike the back between shoulder blades with heel of the hand 4 Repeat the above steps 5 times 1

b / Abdominal thrusts 1. Position yourself behind the elderly 2. Locate the elderly’s navel 3. Make a fist and place it below breastbone tip and above navel 4. Grab the fist and give a quick upward thrust into the abdomen 5. Repeat the above steps 5 times 1

breastbone tip navel

c / Perform the above 2 maneuver consecutively 4. If the patient is unconscious: a / Lower the patient to the ground b / Try to look for object obstructing the airway, if it can be seen, try to remove it with fingers c / If it cannot be seen, tilt the patient head and give 2 rescue breaths while checking chest rise d / Perform chest compression to a depth at least 2 inches at 100 compress /min of 5-6 cm at 100-120 beat / min compression to rescue breath ratio is 30 to 2 e / Look for foreign object before delving of rescue breath. If it can be seen, remove it. If not, continue CPR. f / Repeat the above 3 steps until help arrives Don’ts 1. Give the elderly any food or drink 2. Give the elderly vinegar to drink 3. Do finger sweep blindly

Thorax

ABDOMEN

Abdomen

Abdominal Pain Background

Abdominal pain in an elderly can be caused by a variety of conditions. Most of the time, it is caused by simple food poisoning, gastroenteritis or cramps.

abdominal pain often presents late to a hospital. Also, they usually present at a more severe stage and require hospitalization (50-60%) or surgical treatments (20-33%).

However, “acute abdominal pain”, defined as an abdominal pain of less than 6 hours of onset, must be treated with caution. Elderly with acute

The following table shows the most common diseases causing acute abdominal pain in a person above 55 years of age:

By Location

Upper Right Quadrant - Biliary Tract Disease

Upper Left Quadrant - Gastric Ulcer Disease

Lower Right Quadrant - Appendicitis

Lower Left Quadrant - Diverticulitis - Intestinal Obstruction

Abdomen

- Acute pain in abdomen

Symptoms and signs

Abdominal pain can be accompanied by other symptoms in different diseases: Diseases

Symptoms

Biliary tract infection (e.g. cholecystitis, cholangitis)

- Severe pain in the upper right quadrant (URQ) a few hours after meal, pain may radiate to the right scapula - Nausea - Vomiting - Tea colour urine - Fever - Shaking

Appendicitis

- Colicky pain around the belly button that shifts to the lower right quadrant usually after 6 hours - Nausea and vomiting - Constipation - Fever

Intestinal obstruction

- Colicky abdominal pain - Abdominal distension - Constipation - Vomiting

Peptic ulcer disease

- Pain in upper central/left abdomen - Pain comes and goes, lasts for days to weeks - Pain aggravated by spicy food & relieved by milk - Pain starts about 2 hours after meal

Diverticulitis

- Acute onset abdominal pain that shifts from below to umbilicus to the left lower quadrant - Vomiting - Fever

Abdomen

! Persistent pain ! Worsening pain ! Pain in a few hours after meal ! Abdominal distension ! Fever ! Nausea ! Vomiting ! Constipation

! ! Shaking ! ! Reluctant to eat or drink ! ! Inability to tolerate any food or drink by mouth ! ! Abnormal urination or ! defecation ! ! !

! ! ! !

Recognize red flag signs and manage as medical emergency

As a first aider

Do’s 1. Reassure the elderly and help him or her in a comfortable position 2. Sit him or her up if there is severe vomiting 3. Heat pad may help ease the pain 4. Seek emergency medical help in case of red flag symptoms or you are in doubt of the elderly’s condition Don’ts Offer food or drinks if medical emergency is suspected (the elderly may require an emergency surgery)

Remarks

Generally speaking, abdominal pain is a non-specific symptom. It can be caused by benign and serious conditions. Atypical presentation is not uncommon in the elderly. Abdominal pain is no exception. For example, an elderly harboring a serious pathology may only experience mild abdominal pain initially and then suddenly deteriorates. We should never underestimate the seriousness of the symptom of abdominal pain in the elderly.

Abdomen

Vomiting

Background

Vomiting is commonly caused by gastroenteritis, food poisoning and motion sickness. However, some conditions such as outbreak of norovirus in institutions, gastroesophageal reflux disease, appendicitis, intestinal obstruction, metabolic

disturbance, head injury, cancer and many others can also cause vomiting. Drugs such as opioids and chemotherapy can induce vomiting. When caring for a vomiting elderly, it is important to prevent dehydration and look out for underlying causes.

Vomiting can be accompanied by various symptoms of different diseases:

Symptoms and signs

Diseases

Symptoms

Viral gastroenteritis, food poisoning

- Watery diarrhea (usually non-bloody – bloody diarrhea may indicate a more severe infection) - Abdominal cramps and pain - Nausea - Fever

Motion sickness

- Uneasiness - Cold sweat - Dizziness

Intestinal obstruction

- Abdominal pain - Nausea - Constipation - Inability to have a bowel movement or pass gas - Abdominal distension

Appendicitis

- Colicky pain around the belly button that shifts to the lower right quadrant usually after 6 hours - Nausea and vomiting - Constipation - Fever

Diseases

Symptoms

Biliary tract infection

- Severe pain in the URQ a few hours after meal, pain may radiate to the right scapula - Nausea - Tea colour urine - Fever - Shaking

Diverticulitis

- Acute onset abdominal pain that shifts from below to umbilicus to the left lower quadrant - Fever

Peptic ulcer

- Vomiting of blood (may be red or black), dark blood in stools or tarry stool if complicated by bleeding - Nausea - Unexplained weight loss - Change in appetite

Gastroesophageal reflux disease

- Acid regurgitation - Heartburn sensation - Chest pain - Difficulty in swallowing - Dry cough - Hoarseness or sore throat

Diabetic acidosis

- Excessive thirst - Frequent urination - Nausea - Abdominal pain - Fruity breath - Shortness of breath - Confusion

Head injury

- Loss of consciousness - Confusion or disorientation - Headache - Nausea - Drowsiness - Dizziness or loss of balance - Sensory changes (e.g. blurring of vision, ringing in ears, changed smell or taste, increased sensitivity to light or sound) - Memory or mood changes

Abdomen

! Severe abdominal pain ! Signs of central nervous system involvement (confusion, stiff neck, photophobia) ! Bloody vomitus or stool ! Severe dehydration ! Inability to take food and drink by mouth

As a first aider

! !

! ! !

- Recognize red flag signs and manage as medical emergency - Relieve the patient’s symptoms by antiemetic medication and maintain hydration if no serious causes are suspected Do’s 1. In case red flag signs occur, seek emergency medical help 2. In simple vomiting, a / Advise the elderly to rest b / Give clear fluid (water, unsweetened fruit juice) frequently in small amount c / Give easy-to-digest food (congee, banana, potato) Don’ts Give solid food

Constipation

Background

Constipation refers to difficulty in passing stools. It can be caused by inadequate fiber or fluid intake, inadequate physical activities, intestinal diseases or diseases such as overactive parathyroid, scleroderma (a connective tissue disease), Parkinsonism, stroke and diabetes. Medications such as antacid and overuse of laxatives can also cause constipation.

Constipation can be complicated by fecal impaction, in which the rectum becomes filled with large, dried and hardened masses of stool that cannot be passed. It may be further complicated by precipitating urine retention.

Abdomen

Symptoms and signs

- Sense of incomplete evacuation - Hard and small stool - Swollen abdomen - Abdominal pain

! Bloody stool ! Severe abdominal pain ! Bloating ! Change in bowel habit ! Watery overflow diarrhea ! Weight loss

As a first aider

! ! ! ! ! !

- Recognize red flag signs as well as fecal impaction and manage as medical emergency - Relieve the patient’s symptom by laxative for simple case Do’s 1. Increase fluid intake (extra 2 to 4 glasses of water per day) 2. Drink warm liquid in the morning 3. Increase fiber intake (fruit, vegetables and cereal) 4. Use mild stool softener or laxatives for NO LONGER than 2 weeks Don’ts Attempt to dislodge an impacted stool with your fingers at home

Dehydration

Background

Symptoms and signs

If the excess water loss from vomiting and diarrhea is not promptly replenished, an elderly may develop dehydration. Dehydration can begin to develop when a person loses as little as 1% of his body weight through fluid loss. Without prompt treatment, the elderly may develop shock.

- Dry mouth & dry eyes - Dry and/or cracked lips - Thirst - Headache (lightheadedness) - Dark urine - Reduced urine output - Cramping

Common causes of dehydration include excessive sweating (exercise, fever, hot weather), diarrhea, vomiting and excessive urine output due to medical conditions. Elderly with chronic diseases such as diabetes, heart failure, and kidney diseases is prone to dehydration. Hot humid weather, physical disability and negligence by caretaker are also risk factors.

Abdomen

In severe dehydration, the following symptoms may occur: ! Irritability and confusion ! Dizziness ! Low blood pressure ! Palpitation ! Rapid breathing ! Fever

! ! ! ! ! !

- Recognize red flag signs and manage as medical emergency - Rehydrate and monitor hydration status

As a first aider

Do’s 1. Give fluid to drink. Water is usually sufficient but oral rehydration solutions can help with salt replacement. Oral Rehydration Salt Oral rehydration therapy is the administration of fluid by mouth to prevent or correct the dehydration that is a consequence of diarrhoea. In addition to water replenishment, oral rehydration solution is designed to replace the lost ions and correct any underlying acid-base imbalance due to excess water loss. Oral rehydration salts are available commercially. Alternatively, they can be prepared at home with simple ingredients. When preparing oral rehydration solution, you MUST follow the instructions on the packet. Adding too much or too little water may worsen the patient’s condition.

How to make Oral Rehydration Solution from Salt & Sugar a / Wash your hands b / Measure 1 litre of drinking water into a clean container c / Measure 1 levelled teaspoon of SALT and 8 levelled teaspoons of SUGAR into the water. (A levelled teaspoon is where the salt or sugar is FLAT in the spoon, NOT piled up) d / Mix the salt and sugar into the water well until you cannot see the salt or sugar at the bottom of the container e / Taste the solution. It should never taste very salty. DO NOT boil up this solution once it is made up f / Give the drink to the elderly with diarrhoea

SALT

SUGAR levelled teaspoon

1 Litre DRINKING WATER

Treatment should continue until the diarrhea stops. Patients should be allowed to drink freely as they need. Rehydration is generally adequate when the person no longer feels thirsty and has a normal urine output 2. Perform stretching & massage to relieve muscle cramps 3. Monitor the input output balance and hydration status of the elderly 4. Seek medical attention immediately if the condition does not improve Don’ts Consume milk or milk products, alcohol and caffeine

Abdomen

PELVIS AND PERINEUM

Acute Retention of Urine Background

Urinary retention is the inability to empty the bladder. Urinary retention can be acute, chronic or acute on chronic. Acute urinary retention in men becomes more common with age and peaks at their 50s-60s. In men 40 to 83 years old, the overall incidence of urinary retention is 4.5 to 6.8 per 1,000 men. For men in their 70s and 80s, the overall incidence increases to 100 per 1,000 men and 300 per 1,000 men. The risk factors for male urinary retention are kidney stones, prostatitis, benign prostate hypertrophy, and prostate cancer. In female, acute urinary retention is less common. It can happen if the bladder sags or moves out of the normal position (cystocele) or is pulled out of position by a sagging of the lower part of the colon (rectocele). The risk factors for female urinary retention are history of kidney stones, history of urinary tract infections, and those with recent gynecological surgery. The causes of acute urinary retention can be classified into extramural, mural and intraluminal.

Extramural obstruction can be caused by an enlarged prostate in male, any pelvic masses pressing against the bladder or urethra and constipation. Mural causes can point to weak bladder muscle or masses arising from the bladder wall. Intraluminal causes include stones in urethra, urethral stricture and tumor at bladder neck or urethra. Acute urinary retention can also be caused by urinary tract infections leading swelling or irritation, nervous problems interfering with signals between the brain and the bladder, spinal cord problems and medications such as those used in flu, cough or nausea and vomiting. In most cases, the bladder has to be drained by passing a small catheter through the urethra in the emergency department. At the same time, any known precipitating factors have to be corrected, like the medications mentioned above have to be stopped. In other cases where a reversible factor is found, a catheter may not be required. For example, if the urinary retention is caused by fecal impaction, the elderly should be able to pass urine once he or she opens the bowel.

Pelvis and Perineum

Symptoms and signs

- Inability to urinate - Painful, urgent need to urinate - Dribbling of urine - Pain or discomfort in the lower abdomen - Bloating of the lower abdomen

! Blood in urine ! Loin pain ! Fever ! Back pain or prior history of back trauma ! Lower limb weakness or numbness

! ! ! ! !

Recognize the condition and manage it as medical emergency Do’s

As a first aider

1. Help the elderly to take a posture most comfortable to him or her 2. Seek emergency medical help Don’ts 1. Continue medication that might worsen the retention 2. Drink plenty of water 3. Try to urinate forcefully

Urinary Tract Infection Background

An urinary tract infection (UTI) is an infection in any part of the urinary system — kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. Women are at greater risk of developing a UTI than men. Infection limited to bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to kidneys and blood stream.

The annual incidence of UTIs in the elderly is around 10% and it may be as high as 30% for those living in nursing homes and other institutions.The mortality rate in bacteremic elderly patients with UTI is as high as 33%. In severe urinary tract infection, other systemic manifestations may arise, including high fever, shaking and chills, nausea, vomiting, palpitation, dizziness and even collapse. It can also be complicated by kidney damage and renal failure.

Different types of UTI may result in different signs and symptoms, depending on the part of urinary tract affected.

Symptoms and signs

Part of urinary tract affected

Signs & Symptoms

Kidneys (acute pyelonephritis)

- Pain at upper back and flank

Bladder (cystitis)

- Pelvic pressure - Lower abdomen discomfort

Urethra (urethritis)

- Burning sensation with urination

Urinary tract infections don’t always cause signs and symptoms, but when they do they may include: - A strong, persistent urge to urinate - A burning sensation when urinating - Passing frequent, small amount of urine - Urine that appears cloudy - Urine that appears red, bright pink or cola-colored — a sign of blood in the urine - Smelly urine - Pelvic pain, in women

Pelvis and Perineum

! High or persistent fever ! ! Chills or rigors ! ! Loin pain !

- Recognize red flags and manage it as medical emergency - Consult family doctor early if there is symptom of UTI

As a first aider

Do’s 1. Seek emergency medical help call 999 in case of severe infection with systemic symptoms. For a severe UTI, you may need treatment with intravenous antibiotics in a hospital 2. Give paracetamol as indicated to lower body temperature and decrease pain 3. Take the entire course of antibiotics prescribed by doctor to ensure that the infection is completely gone 4. Drink plenty of water to dilute urine and keep bladder empty 5. Wipe from front to back after urinating and after a bowel movement in female. This helps to prevent bacteria in the anal region from spreading to the vagina and urethra Don’ts 1. Use potentially irritating feminine products. Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra 2. Drink coffee, alcohol, and soft drinks containing citrus juices and caffeine until your infection has cleared

HIGH FEVER

High Fever

Fever means a persistently elevated core body temperature above the normal daily variation.

Background

There are different set points for different methods of measurement. Method of measurement

Set points for fever

Measured rectally

> 38ºC (> 100.4ºF)

Measured in the ear

> 38ºC (> 100.4ºF)

Measured orally > 37.5ºC (> 99.5ºF) Common causes for fever include: - Infection e.g. influenza, gastroenteritis, urinary tract infection - Inflammation e.g. autoimmune diseases, inflammatory joint diseases.

Symptoms and signs

- Shivering or feeling cold - Sweating - Muscle pain

! Body temperature above 40 °C ! ! Stiff neck ! ! Convulsion ! ! Repeated vomiting ! ! Difficulty in breathing ! ! Change in consciousness ! ! Significant deviation from the ! usual status

As a first aider

- Recognize hyperpyrexia and red flag symptoms (see above) - Lower the body temperature - Seek medical advice if there are any concerns about the elderly’s condition. Do’s 1. Give the elderly enough water to drink to maintain hydration 2. Dress lightly 3. Take a lukewarm bath to help lowering the body temperature 4. If the situation has not improved or has worsened, seek further medical help 5. Medications, e.g. ibuprofen and paracetamol, may be taken as instructed by doctor 6. If in doubt, seek emergency medical help Don’ts 1. Wrap the elderly with too many clothes or thick blankets, as this will further increase the elderly’s body temperature

Remarks

Hyperpyrexia Hyperpyrexia is a fever with a body temperature above 40 °C. It may indicate a serious underlying condition, Furthermore, it may lead to confusion, seizure and organ failure. This is a medical emergency and further help should be sought.

Normal

Fever

Hyperpyrexia

High Fever

EXTREME TEMPERATURE TOO HOT

Heat Exhaustion Background

Heat exhaustion occurs when a person exposed to a hot environment and sweating cannot dissipate the heat generated within the body. It may also occur if a person lives in a hot environment without adequate air circulation and does not drink an adequate amount of water. The elderly are at a greater risk for heat exhaustion because of their underlying medical conditions (for example, poor circulation, skin changes, and chronic medication usage) which may limit the ability to sweat. The risk factors for heat exhaustion in elderly include extreme hot weather, medications (such as antidepressants, antipsychotics, and tranquilizers which may impair the ability of the body to sweat), alcohol consumption, and overweight.

Symptoms and signs

- Excess sweating - Headache - Dizziness - Confusion

- Nausea & vomiting - Muscle weakness and cramps - Rapid, weak pulse

! Signs of progression into heat stroke !

- Lower body temperature - Replace body water and salts

As a first aider

Do’s 1. Stop any physical activity immediately 2. Rest in a cool, shaded area 3. Provide casualty with cool electrolyte water and sports drinks 4. Monitor casualty’s level of response, hydration status 5. Seek further medical help if casualty does not recover, unable to drink or whenever you are in doubt

Extreme Temperature - Too Hot

Heat Stroke Background

Heat stroke is a medical emergency. It is the most severe form of heat illness in which the body temperature of a person is greater than 40.6 °C (105.1 °F). Due to environmental heat exposure the body temperature can rise rapidly and may lose its ability to cool down by sweat. When the body temperature reaches 40°C, the hyperthermia effect with systemic involvement including central nervous system will result. Heat stroke can cause death or permanent disability if not treated promptly. Elderly are more vulnerable to hyperthermia as their adaptation ability to sudden changes in temperature is reduced with ageing. In addition, they are more likely to suffer from chronic medical conditions and receiving medications that can change normal body responses to heat. Hot and humid weather, dehydration and poorly ventilated room are the risk factors for heat stroke in elderly.

Symptoms and signs

As a first aider

- Hot, dry skin - Lack of sweating - Headache - Dizziness, drowsiness, obtundation

- Confusion, seizure - Nausea & vomiting - Muscle weakness and cramps - Rapid, weak pulse

- Recognize the condition and manage as medical emergency in all cases of heat stroke - Cool down the temperature of the elderly - Rehydrate the elderly Do’s 1. Seek emergency medical help, call 999 immediately 2. Rest in a cool, shaded area 3. Remove unnecessary clothing 4, Cool the elderly by fanning or wetting the skin with water 5. Rehydrate patient orally only if fully conscious and able to swallow 6. Monitor the elderly’s level of response until help arrives

EXTREME TEMPERATURE TOO COLD

Hypothermia Background

Hypothermia is defined as having a core body temperature below 35 °C (95 °F). It is most commonly caused by prolonged exposure to low temperature and inadequate clothing in cold weather. It can also be caused by impaired thermoregulation mechanism of the body.

Moderate Hypothermia (28-32°C /82.4-89.6°F) - Vigorous shivering - Cold, pale skin - Slurred speech Severe Hypothermia (<28°C /<82.4°F) - Shallow and slow breathing - Weak and slow pulse - Confusion - Shivering may stop - Unconsciousness

34 33 32 31 30 29 28 27 26

Severe

Symptoms and signs

Mild Hypothermia (33-35°C /91.4-95°F ) - Shivering - Hypertension - Fast pulse - Rapid breathing

Hypothermia

The risk factors for hypothermia in elderly include chronic illnesses (such as diabetes and hypothyroidism), reduced mobility (for example, due to stroke or Alzheimer’s disease), starvation, malnutrition, alcohol or drug abuse (such as sleeping pills, opioids).

Moderate

Every year there are 10-20 cases of severe hypothermia among the elderly in Hong Kong.

Mild

Elderly are vulnerable to hypothermia since they are more likely to suffer from chronic medical conditions and receiving medications that can change normal body responses to change of temperature. Hypothermia can develop in elderly after relatively short exposure to cold weather or even a small drop in temperature.

38 Normal

Extreme Temperature - Below Normal

! Body temperature below 32°C ! ! Symptoms of moderate and ! severe hypothermia

As a first aider

- Recognize red flag signs of moderate or severe hypothermia and manage as medical emergency - Prevent further heat loss - Re-warm the elderly slowly Do’s 1. Seek emergency medical help ,call 999 immediately in case of red flag signs occur 2. For unconscious elderly, check airway, breathing and circulation, perform CPR if no breathing and pulse 3. If the elderly is conscious, give warm drinks and high energy food 4. Rest the elderly in a warm & dry place 5. Remove any wet clothing 6. Wrap the elderly with blankets, make sure the head is covered as well 7. Measure body temperature using a low-reading thermometer 8. Rectal measurements are more accurate than oral measurements Don’ts 1. Give the elderly alcohol 2. Place the elderly directly next to any heat source

Extreme Temperature - Below Normal

EAR NOSE THROAT

Nose Bleeding Background

Bleeding can arise from any part of the nasal cavity. The most common site of bleeding is from the anterior part of the nasal septum. The so-called Little’s area. It bleeds when tiny blood vessels on the mucosal surface of the nostrils rupture. Very often, it is a result of trauma like nose pricking or forceful sneezing. Sometimes it is a symptom of another disorder. For instance, nose bleeding may be a manifestation of high blood pressure. Of course, the most worrisome cause is malignancy. Among southern Chinese, nasopharyngeal cancer is a Posterior ethmoid artery

Anterior ethmoid artery

Little area (Kiesselbach plexus)

Sphenopalatine artery

Superior labial artery

Greater palatine artery

diagnosis every doctor would consider. Elderly commonly experience nasal bleeding. Some statistics showed that they accounted for 29-50% of cases of nasal bleeding. In the elderly with nasal bleeding, a secondary cause must be sought especially if the bleeding is unprovoked. Nose bleeding becomes an emergency when it is not controlled by simple pressure or it is prolonged and massive. An elderly may become very ill if a lot of blood is lost from nasal bleeding. Massive blood loss from the nose can lead to death.

Ear, Nose, Throat

Below are some of the causes of nose bleeding: Local causes - A blow to the nose - Sneezing, picking or blowing the nose - Rhinitis - Tumor (rare) Systemic causes - Bleeding disorder, use of anti-clotting drugs (eg: aspirin, NSAIDs, warfarin, Plavix) It is associated with older age, hypertension and dry weather.

Symptoms and signs

- Bleeding from nostril, on one side or both - Blood stained sputum and saliva when blood from the nose drips down to the pharynx posteriorly - Nausea and vomiting if a lot blood is swallowed - Bloody tear because of the communication between the nose and eyes via the nasolacrimal duct - Dizziness and other signs of blood loss, especially the amount of blood loss is great

! Nasal bleeding that is ! unprovoked, prolonged, recurrent, or massive ! Associated symptoms of ! abnormal nasal discharge, hearing impairment, headache and neck swelling

- Stop or reduce blood loss - Maintain a patent airway and avoid aspiration of blood

As a first aider

Do’s 1. Reassure and keep the elderly calm 2. Sit the elderly up and tilt the head forward to allow the blood to drain from nostrils 3. Ask the elderly to breathe through mouth and pinch the soft parts ( just below the nasal bridge) of nose for up to 10mins. Do it by the first aider if the elderly is unable to pinch his or her nose 2

4. Use a clean cloth or tissue to mop up any dribbling 5. If bleeding continues, re-apply pressure for another 10 minutes 6. Once bleeding stops, patient remains leaning forward and cleans around the nose with lukewarm water 7. Seek medical help if bleeding cannot be stopped by local pressure for around 20 minutes 8. Arrange medical consultation if there are associated symptoms mentioned above Don’ts Let the elderly tip the head back since blood may then run down the throat and induce vomiting or choking

Ear, Nose, Throat

Acknowledgement

These books are funded by the grant from the ‘We Are with You’ project. This grant allowed us to convene a series of basic life support workshops, exhibitions and talks to the public, and these two books reflect our vision to serve the community, especially the old and the underprivileged, with our knowledge and expertise in Emergency Medicine. We would like to acknowledge and thank all the students of the Emergency Medicine Interest Group for their devotion to serve others and making these two books a success. KL Fan LP Leung

急症醫學興趣小組

香港大學急症醫學部

出版

銀齡急救基本法

編輯樊潔玲醫生梁令邦醫生

前言

免責聲明

衰老過程

9 10 13 16 18

基本生命支援術基本生命支援術按壓式心肺復甦術常規旁觀者心肺復甦術自動體外心臟去顫器 (AED) 復原臥式

21 23 25 27

中樞神經系統中風癲癇頭部受傷抑鬱症狀及自殺

31 33 36 38

心血管系統高血壓急症心絞痛昏厥休克

41 44

咽喉急性哮喘窒息

48 51 54 56

腹部腹痛嘔吐便秘脫水

60 62

盆腔急性尿瀦留(尿滯留) 尿道感染

發高燒

68 69

體溫過高中暑嚴重中暑

體溫過低體溫過低

耳鼻喉鼻出血

鳴謝

前言

早前，一群香港大學醫科生組成了急症醫學興趣小組，盼以其專業知識服務香港社會。在香港大學急症科教學人員之指導下，他們更撰寫了《銀齡急救基本法》、《長者急症ABC》二書。人口老化是全球普遍國家須面對之課題。本港亦不例外，65歲或以上的人口比例，預計由2011年的百分之十三，將迅速遞增至2046 年的百分之三十，情況不容忽視。隨著社區年長人口數字之攀升，普羅大眾愈趨積極尋求長者醫療保健妙法，回應有關訴求為本書寫作之因由。本書涉獵層面甚廣，原意為照顧長者之人士提供不同急救方法，與此同時希望一般社會大眾受惠；倘若遇上危急情況，他們亦可藉本書內容，及時為身體不適或受傷的長者施救。恕本書涵蓋之內容未見全面，亦算不上為權威性刊物，只盼為讀者帶來啟發，引發其興趣，對有關議題作延伸學習；若遇上突發情況，他們能藉有關知識，迅即作出應對之策。最後，本人謹代表香港大學急症醫學部及急症醫學興趣小組，藉此感謝「We Are With You」基金，鼎力支持本書之編制工作。

樊潔玲醫生梁令邦醫生二零一六年六月

免責聲明作者、編者及出版商盡力確保本書之準繩度；然而，也不能保證資訊完全正確無誤，絕不負責相關內容為任何人士所帶來之損失。在採納本書之建議前，讀者宜先諮詢有關專家之意見或再三查證文獻資料。

前言

衰老過程

肌肉 - 力量和質量﹙約30 - 40％﹚下降 - 容易疲勞 - 復原力下降 - 肌肉組織中的脂肪含量較高

皮膚 - 皺紋和鬆弛現象出現 - 皮膚變薄及呈暗黑 - 在面部、頸部、手部的變化更為明顯 - 傷口癒合緩慢、皮膚出現潰瘍甚至不能康復 - 對寒冷靈敏度下降，排汗量減少 - 容易受紫外線的傷害

一般 - 體重下降 - 身體脂肪比例下降

免疫系統 - 容易受感染 - 對疫苗反應減少/減慢

心臟和血管 - 心跳率及心臟收縮力在靜止狀態時沒有變化 - 運動時心跳率及心臟收縮力只會輕微增加 - 心臟發大 - 心臟和血管組織硬化 - 血壓上升

眼 - 水晶體變黃 - 較容易患上白內障 - 對光暗適應力變慢 - 淚液分泌減少 - 靜態視力靈敏度輕微下降 - 動態視力靈敏度顯著下降

老化的生理/剖析衰老過程是指身體功能隨年齡增長而有所轉變，增加患病機會。在環境及遺傳因素的改變下，這是相當複雜的自然現象。在這過程中，我們身體的各個器官及系統會呈現不同程度的變化。以下是各項的描述：

衰老過程

骨骼 - 骨質流失 - 女性在更年期後骨質流失加速 - 男性骨質流失較慢 - 骨質疏鬆症的發病率較高

神經系統 - 反應遲緩 - 觸覺及振動靈敏度下降，特別是腳部 - 對溫度靈敏度下降 - 神經元損失 - 腦體積縮小

呼吸系統（呼吸） - 橫隔膜強度下降 - 肺容量和肺活量下降 - 肺部殘餘氣體增加

其他系統 - 受損顫抖 - 嗅覺靈敏度下降 - 口渴感覺減少 - 平衡力下降 - 對高頻音調靈敏度下降

腎臟、泌尿及生殖系統 - 過濾功能削弱 - 濃縮和稀釋尿液功能削弱 - 腎臟體積縮小 - 膀胱功能削弱引致排尿不清 - 男性及女性對性高潮感覺遲緩 - 男性在性愛後需要更多時間休息才能再次勃起

消化系統 - 胃酸量增加 - 便秘次數增加 - 營養吸收力減少 - 肝臟體積縮小

基本生命支援術

基本生命支援術 (BLS) 「基本生命支援術」包含多個急救程序，如心肺復甦術、控制出血情況、治療休克、中毒、穩定受傷和/或傷口狀況，及施以基本急救。其他項目會在稍後的章節中討論；在此章節中，我們將主要討論的是心肺復甦術、復原臥式狀況及自動體外心臟去顫器之使用方法。

心肺復甦術復原臥式

自動體外心臟去顫器

為什麼認識基本生命支援術? 認識基本生命支援術是非常重要的，因為意外及危急情況隨時發生！事實上，在只有少量設備或沒有任何設備的情況下都可以處理緊急醫療情況。只要認識這些簡單技巧，任何人都可以拯救別人寶貴生命。

為什麼要學習旁觀者心肺復甦術？施行旁觀者心肺復甦術既不複雜，又能確保提高突發性心臟驟停患者的存活率，有關系列之動作能支援突發性心臟驟停患者維持其呼吸及血液循環，並有助保持血液通往各大器官，讓其換取更多時間，獲得更多治療機會。

患者平均年齡有目擊者在場

71.5 50% 獲得用心肺復甦術協助

15%

突發性心臟驟停是什麼? 突發性心臟驟停(SCA) 是指心臟突然不能有效收縮，不能提供血液輸送氧氣到身體各組織器官，包括大腦和心臟本身出現擾亂，或甚至停止情況。這種情況非常危險，而這亦是全球人口中，引發死亡的主要原因之一，而在長者人口中情況更為顯著。在香港，突發性心臟驟停患者平均年齡為 71.5 歲，約三分之二的病例發生在家中，當中50%是有目擊者在場。可是只有 15%的患者獲得旁觀者施以心肺復甦術等協助；與其他已發展國家相比，這數字是非常之低。故此，只要更多市民願意認識及學習施行心肺復甦術，將可拯救更多突發性心臟驟停患者的生命。

基本生命支援

旁觀者心肺復甦術如何幫助?

按壓式心肺復甦術

生存鏈

假如施援者沒有受過心肺復甦術的訓練，或不希望跟陌生人口部接觸，你可以嘗試施行按壓式心肺復甦術。這跟常規的旁觀者心肺復甦術一樣有效。可以下列口訣謹記施行步驟：

生存鏈緊密串連，涵蓋五大步驟，為突發性心臟驟停患者增加存活機會。步驟如下: 1. 及早尋求協助（如撥打999） 2. 及早施行心肺復甦術 3. 及早進行除顫程序（即配合自動體外心臟去顫器急救） 4. 及早提供專業護理（由專業人員處理） 5. 良好及後護理上述每一個步驟必須及早完成。按旁觀者心肺復甦術常規，施援者已施行首3個關鍵步驟。下列展示有關應用步驟：

1 2 3

評估現場 + 檢查 + 電話求援 + 胸部按壓

1 評估現場 2 檢查

評估現場環境，對施援者及長者是否安全

檢查長者反應：呼叫長者；搖動長者的肩膀

呼吸：觀察長者胸部，看其有否出現呼吸異常；或檢查長者有否發出任何呼吸聲音

3 電話求援如果長者沒有反應及呼吸異常，要立刻尋求援助，如：－撥打 999 －要求旁人協助，把自動體外心臟去顫器（AED）送達現場進行胸外按壓

4 胸外按壓

基本生命支援

按壓式心肺復甦術胸外按壓假如施援者訓練充足及具備信心檢查脈搏，可用兩隻手指放在患者頸部前側，檢查其脈搏情況。

A. 位置施援者跪在長者身旁，將一隻手放在長者胸骨中心。

C. 深度利用體重，用力向下按長者的胸部約 5-6厘米（2英寸以上）。

B. 姿勢再將手置於另一隻手上面，將手指緊扣，雙臂保持垂直，謹記施壓時不可彎曲雙臂。

D. 頻率重複及快速按壓，速率約每分鐘 100-120次。

x 100 - 120/分鐘

E. 回彈確保每次按壓後，長者胸腔有足夠回彈。

重複此過程直到－長者恢復意識，有正常的呼吸和心跳－救護車抵達－自動體外心臟去顫器被送達現場－施援者累極並不能繼續

常規旁觀者心肺復甦術與按壓式心肺復甦術施行之方法類似，可以下列口訣記着有關方法：

評估現場 + 檢查 + 電話求援 + C A B 1 評估現場 2 檢查

評估現場對施援者及長者是否安全

檢查長者反應：呼叫長者；搖動長者的肩膀

呼吸：觀察長者胸部，看其有否出現呼吸異常；或檢查長者有否發出任何呼吸聲音

3 電話求援如果長者沒有反應及呼吸異常，要立刻尋求援助，如：－撥打 999 －要求旁人協助，把自動體外心臟去顫器（AED）送達現場進行胸外按壓

C - 胸外按壓 4 CAB （心肺 A - 暢通氣道復甦術） B - 人工呼吸

基本生命支援

常規旁觀者心肺復甦術

C - Circulation 血液循環胸外按壓假如施援者訓練充足及具備信心檢查脈搏，可用兩隻手指放在患者頸部前側，檢查其脈搏情況。

A. 位置施援者跪在長者身旁，將一隻手放在長者胸骨中心。

C. 深度利用體重，用力向下按長者的胸部約 5-6厘米（2英寸以上）。

B. 姿勢再將手置於另一隻手上面，將手指緊扣，雙臂保持垂直，謹記施壓時不可彎曲雙臂。

D. 頻率重複及快速按壓，速率約每分鐘 100-120次。

x 100 - 120/分鐘

E. 回彈確保每次按壓後，長者胸腔有足夠回彈。

A - Airway 暢通氣道如能確認長者的頸部沒有受過損傷，可用按額提頦法：頭向後仰，頦向上翹。

如懷疑長者的頸部曾受損傷，可以下顎推力代替。

B - Rescue Breaths 人工呼吸每30次按壓，進行人工呼吸2次施援者與長者進行口對口吹氣時，應盡量使口部密封並緩緩吹氣每次吹氣至少持續1秒假如長者的胸部回復上升，這次人工呼吸便是有效

在常規的旁觀者心肺復甦術中，胸外按壓和人工呼吸的比例為30：2，即30次按壓，然後2次人工呼吸，然後30次按壓 ⋯⋯

重複此過程直到－長者恢復意識，有正常的呼吸和心跳－救護車抵達－自動體外心臟去顫器被送達現場－施援者累極並不能繼續

基本生命支援

自動體外心臟去顫器（AED）它的原理和使用技巧其實並不難掌握。突發性心臟驟停患者，其心臟突然停止跳動。假如患者在數分鐘內得不到治療，可引發死亡。突發性心臟驟停（SCA）主要有兩大成因，但都涉及心臟不規則跳動，也被稱為心律不正。最常見的成因是心室纖維性顫動（V-FIB），即下心室顫動快速而不規則。另一個原因是心室撲動，這是指心室持續在短時間內快速跳動。在這種情況下，自動體外心臟去顫器（AED）可以幫助心律及心跳恢復正常。心肺復甦術亦有助增加生存機會率。自動體外心臟去顫器在公共場所非常普及，如商場、機場、酒店、學校亦有安裝。只要根據這些圖象指示，便可找到。

AED 它是本地緊急醫療系統（EMS）不可缺少的一環，社區成員知道其位置所在亦十分重要。在遇上突發性心臟驟停的情況，市民亦可以快速找到自動體外心臟去顫器。

市面上充斥不同品牌的自動體外心臟去顫器，但使用步驟都是大同小異。

ON-OFF

使用自動體外心臟去顫器（AED）的步驟 1. 開啟自動體外心臟去顫器（AED） ON-OFF

2. 將兩塊可傳電的軟墊貼在患者胸部（胸的右上方，胸的左下方）（若長者身體是濕的，則須擦乾胸部） 3. 按下分析按鈕，讓自動體外心臟去顫器（AED）分析心律 ON-OFF

如果自動體外心臟去顫器（AED）建議震動患者： 4. 確保沒有人，包括施援者，其身體沒有接觸患者，並告訴大家：「不要接近！」 5. 按「震動」鍵

基本生命支援

復原臥式如果長者不省人事，但其頸部沒有受傷及仍然可呼吸，這情況下應以復原臥式擺放長者的身體。這樣可以防止任何口腔分泌或嘔吐物阻塞長者之呼吸道，確保其呼吸暢通。

1. 跪在長者右方。

2. 屈曲長者的右手，使其手肘成90度平放在地上。

6. 頭向後仰，頦向上翹。假如先前沒有為長者暢通氣道 + 施行人工呼吸 + 心肺復甦術，現在應該進行有關步驟。

保持監測長者的氣道 + 呼吸，直到救護人員到達。如果長者情況不太嚴重，在30分鐘後可轉動身體到另一側。

基本生命支援

3. 握住長者左手並使其手背貼在臉頰。

4. 提起長者的左腿，使其膝蓋屈成90度。

90˚

5. 讓長者的左手貼近右臉頰，抓緊其膝蓋，彎曲其腿部，拉向施援者，使長者轉向右邊。施援者可利用長者的手臂，以防長者滾動。

中樞神經系統

中風中風是一種嚴重急症。這病症是指供往大腦的血液受阻，引致腦細胞缺氧受損，並失去功能。

背景

隨年齡增加，中風情況愈趨普遍。而中風常與血液循環系統疾病有關，如高血壓。及早識別和盡快入院接受治療（宜於3小時內），可提高康復機會。在香港，每年近三千人死於中風，而它亦是全港排行第四的致命疾病。一般來說，中風患者通常是超過50歲的人士。中風成因如下：－有血塊凝在血管中，阻塞血液流入大腦－血液突發性地大量湧入腦部

症狀

— 面肌無力 — 手臂無力 — 說話困難 — 頭痛 — 噁心 — 反應遲緩 — 臉部、手臂、腿麻痺或癱瘓 — 暈眩，身體平衡不協調 — 視線模糊 — 失禁

中樞神經系統

— 確認中風的症狀，安排緊急救助 — 安撫和慰問傷者，直至救援人員到達

急救員目標

應該快速測試以識別傷者是否中風 1. 中文版 — 測試是否中風口訣「微笑殭屍會說話」 a / 面（面肌無力） ·叫傷者微笑 ·如果傷者中風，只能以半邊臉微笑，臉部看起來不對稱 b / 手臂（手臂無力） ·叫傷者閉目及提起雙臂 ·如果傷者中風，只能夠提起一隻手臂或手臂顯得乏力 c / 語音（語音問題） ·檢查傷者能否清楚說出並理解你的說話 ·如果傷者中風，未必能夠清楚地說話或做出合理的反應 d / 時間 ·如果發現任何跡象，立即撥打999作緊急求助 ·在情況許可下，應記錄最早出現的症狀及病發時間等 2. 安撫傷者，讓傷者處於舒適狀態 3. 監測傷者之反應水平，呼吸和脈搏，直致救援人員到達避免 1. 給傷者飲食

備註

具體案例短暫性腦缺血發作（TIA） TIA是指輕微中風。與一般中風情況類似，但症狀僅持續數分鐘，而傷者情況將逐漸改善，及後亦會恢復狀態。傷者應尋求醫生專業意見。一般情況下，治療方法跟治療中風類近。

癲癇－大腦電波活動過度活躍，身體及肌肉受其干擾，不自主收縮起來－意識突然喪失和四肢抽搐

背景

在極少數情況下，患者意識可得以保留。原因－癲癇症－阿滋海默症 (其中一種老人痴呆症) －中風－頭部受傷－腦損傷性疾病（如神經退化疾病、腫瘤、感染）－曾中風或出現低血糖之情況，讓大腦缺乏吸收營養－酗酒/濫用藥物

症狀

－突然出現神志不清－肢體僵直或彎曲－呼吸困難，嘴唇呈灰藍色，臉部和頸部顯得紅腫－出現連串痙攣動作，例如：牙關緊閉、呼吸嘈雜、面部抽搐、咬舌頭、流口水，甚至口吐白沬等－大、小便失禁－發病過後到完全清醒時，患者通常無法回憶發病經過－發病過後，患者感到疲倦和昏昏欲睡－在癲癇症發作之前，可能有短暫的警告期（先兆），例如：突然產生奇怪的感覺，嗅到特殊的氣味

中樞神經系統

！病人反覆病發或是第一次病發！病人不知病發原因！癲癇發作時間多於5分鐘！病人昏迷時間多於10分鐘

！！！！

－認識危險訊號和進行醫療急救－保護患者和確保自己免受傷害

急救員目標

應該 1. 遇上危險訊號，尋求緊急醫療救助，立即撥打999 2. 保護病人 — 掃清任何有潛在危險的物品。如果病人接近牆壁或堅硬的物體，可利用衣服或枕頭鋪墊病發者之四周，並勸導旁觀者保持距離 3. 保護病人頭部，鬆開緊身衣服 4. 平躺病人（如果確認病人脊髓沒有損傷） 5. 密切留意病人反應、呼吸氣道及呼吸情況 6. 注意其發作和持續時間 7. 檢查其身上有否受到任何損傷，有需要時施展急救避免 1. 移動患者 2. 把任何東西塞進患者的嘴裡或嘗試強行約束其行動

頭部受傷

背景

長者多因不慎跌倒而造成其頭部受傷，而交通意外則為造成長者頭部嚴重受傷的主因。腦內出血情況並不罕見，同時亦大大推高長者之死亡率。

頭皮破損

症狀

中樞神經系統

－意識危險訊號，應立即召喚救護車。－進行傷口急救護理

急救員目標

應該 1. 如發現任何危險訊號，應即撥打999，尋求緊急醫療救助 2. 遇上昏迷患者，應保持其呼吸道暢通，並檢查其呼吸、血液循環及施行心肺復甦術（CPR） 3. 直接壓住傷口 a / 處理頭部傷口 b / 利用紗布包紮傷口 c / 利用繃帶固定紗布。如果血液持續滲透，於面層放置新的紗布 4. 幫助病人躺下，微微抬起其頭部和肩膀 5. 持續監視和記錄其生命徵兆（如反應、呼吸、脈搏等），直到救援人員到達避免 1. 讓傷者飲食

！鼻子或耳朵流出清澈或血色液體！眼部附近位置呈現瘀青！嗜睡！混亂 / 行為異常！意識不清！記憶力轉差！虛弱！麻痺！劇烈頭痛！反覆嘔吐！抽搐（痙攣）！呼吸不規律

! ! ! ! ! ! ! ! ! ! ! !

抑鬱症狀及自殺背景

在香港，18至65歲的人口群組中約有8.4％人口患有抑鬱症；而老年人的患病率更高，約為9.7％，每10萬人當中有10至13人自殺。隨著年齡增加，自殺的風險亦隨之增加，65歲或以上長者群中，每10萬人當中有30人自殺，而75歲或以上長者群中，每10萬人當中有50人自殺。而在性別分組中，男性和女性長者的自殺率比例為1.3比1。因此，與其他國家比較，本港普遍年齡群組的自殺率相若，但其長者自殺比率顯然較高，女性自殺比率亦不容忽視。抑鬱症是其中一種最為常見的老人精神疾病，可惜很難被診斷出來，患者因而經常得不到合適的治療。其實只要有合適治療及作預防措施，老人的抑鬱情況亦可得到改善。

中樞神經系統

根據美國精神醫學學會的《精神疾病診斷與統計手冊》（DSM-V），抑鬱症的定義為：

症狀

任何人具有下列5項或以上的症狀，而當中包括第1或第2個症狀，並持續出現最少2星期。－情緒低落－對事物失去興趣－缺乏體力和疲勞－覺得自己沒有價值，過份自卑或自責－不想生存 / 產生自殺念頭－難以集中精神或作出決定－行動較慢，心情煩躁，易發脾氣－睡眠困難，有時睡眠過多－厭食或過量進食

風險因素－家族遺傳－女性－殘疾人士和疾病患者（特別針對情況嚴重者）－居住在老人院的長者－經歷喪親之痛－社交孤立－慢性疼痛病患－感官受損／障礙（如聽覺或視覺）

如長者有自殺傾向，這為辨別其患上抑鬱症最明確的訊號。抑鬱症的長者可能會認為未來是非常絕望而自殺是唯一出路。普遍來說，患者會不斷反覆嘗試自殺，直至自殺行動成功為止。自殺行為可以分為「明顯自殺」或「隱藏自殺」。明顯自殺行為包括：！濫用藥物（如阿片類藥物、抗抑鬱藥、！對乙酰氨基酚、苯二氮䓬；常見於女性身上）！自殘（如吊頸、吞槍、跳樓、跳海；常見於！男性身上）隱藏自殺行為在長者群組中較為常見，包括：！社交恐懼！！嚴重缺乏自我價值！！拒絕飲食及藥物治療！

急救員目標

－接觸，評估和協助有自殺危機的人。如果發現高危人士，應立即尋求醫療幫助。－提供情感上的支持，並鼓勵尋找專業人士的協助。應該 1. 聆聽 2. 表現同理心 3. 直接詢問抑鬱症長者關於自殺的想法和評估其決定自殺危機的嚴重性 4. 對於一個自殺的人，你應該： ·告訴他，你是關心及想幫助他 ·明確指出，抑鬱症是可以透過藥物治療的，給予長者希望 5. 應該直接詢問關於自殺的想法，例如可以問： ·「你是否有自殺的念頭？」或 ·「你是否想殺死自己？」 6. 要確定自殺危機的嚴重性，你應該直接問有關自殺的計劃，例如可以問： ·「你已決定如何自殺？」或 ·「你決定何時會這樣做？」或 ·「你有沒有採取任何措施來實行自殺計劃？」 7. 愈深層次的計劃表示自殺風險愈大，但這絕不代表沒有計劃安排的人沒有風險。故此，必須認真對待長者所有自殺的想法避免 1. 將有自殺傾向的長者獨留自處。如果不能和他們在一起，必須安排別人代替陪同，例如家庭成員或朋友等

中樞神經系統

心血管系統

高血壓急症

背景

在香港，高血壓是最常見的老人慢性疾病之一。根據2003至2004 年度的人口健康調查顯示，15歲及以上的人口中，27.2%受訪者患有高血壓。年紀愈長則愈容易患上高血壓，15至24歲群組的患病率為5.2%，而75歲或以上的長者群組更高達73.3％。

老年收縮期高血壓在長者群組中是常見的情況。

心臟跳動時，血液便會泵入動脈。血壓是指血液推向動脈壁時產生的壓力。血壓讀數中有兩個數字，標記為120/80毫米汞柱；第一個數字為「收縮壓」或「上壓力」，這是代表施加在動脈壁時心臟收縮的壓力，第二個數字為「舒張壓」或「下壓力」是代表施加在動脈壁時心臟放鬆的壓力。

高血壓急症一般發生在血壓水平超過180（上壓力）或120（下壓力），但對部分長期處於較低血壓者而言，亦可能在上述準則的情況下病發。

高血壓是指當人體處於休息狀態下並經多次量度後，血壓指數高於140（上壓力）90（下壓力）毫米汞柱。

高血壓急症是指，當血壓尖峰到達危險程度時，有機會引起器官受損或其他併發症的情況。而在這情況下，必須立即降低血壓，以避免器官受損傷。

對長者而言，下列原因均可能導致高血壓急症： — 忘記服用血壓藥物 — 藥物之間可能發生的相互作用 — 大多數是突發性（沒有根本原因）

心血管系統

症狀

在某些情況下，高血壓是沒有任何症狀，而一般情況下，會出現下列跡象和症狀：－劇烈胸痛情況－出現呼吸急促情況增加－劇烈頭痛－噁心和嘔吐－視野模糊－神智愈來愈混亂－麻痺/虛弱－說話困難－癲癇發作－耳鳴－昏厥－反應遲鈍

－辨識高血壓急症的症狀和徵兆－尋求緊急醫療救助

急救員目標

應該 1. 如果患者血壓高於180/120毫米汞柱和對主要器官造成傷害（如神經系統、心血管、子癇前症等）－立即撥打999，尋求緊急醫療幫救助 2. 如果患者昏迷︰－檢查其氣道、呼吸和脈搏，如有需要便施行心肺復甦術 3. 如果患者意識清醒：－幫助患者處於舒適狀態，通常是讓其坐下來－保持冷靜，安撫患者 4. 如果患者出現嘔吐或抽搐：－以復原臥式安頓患者，以防止其出現窒息情況 5. 如果患者出現呼吸困難：－可用枕頭支撐患者背部，幫助呼吸避免 1. 讓患者行走。假如患者必須行走，便須小心協助，以防其跌倒 2. 讓患者進食／喝水 3. 讓患者飲用任何含有咖啡因或酒精的飲料

心絞痛

背景

在香港，心臟疾病繼癌症之後已成為第二號殺手。而冠狀動脈心臟疾病是心臟疾病的主要成因。隨年齡增長，冠狀動脈心臟疾病（IHD）的發病率大大提高。在已發展國家中，超過30％的 65歲或以上人士是死於心絞痛或心肌梗死（MI）和另外30％轉化成沒有明顯徵狀的疾病。心絞痛患者會感到胸痛，如有擠壓或壓迫感覺，這是由缺血性心臟疾病引起。隨著冠狀血管變窄，心臟供血肌肉可能受損害。當需氧量增加時，這情況更會加劇。當冠狀動脈血管嚴重受阻時，心臟肌肉便會死亡，即心臟病發。然而，長者普遍會出現輕微缺血情況。引發心血管疾病的危險因素眾多，包括高血壓、高脂血症、糖尿病、吸煙和具有家族成員患上心絞痛或心肌梗死之病史。如缺血性胸痛未得到適當處理的話，可引起心肌梗死、心源性猝死、休克、急性失代償性的心力衰竭或充血性心力衰竭。

心血管系統

症狀

缺血性胸痛心絞痛症狀描述（嚴重及長期的）位置

胸部中央劇痛

病發

情況可以十分嚴重

特點

劇痛不適，胸部感覺緊壓

輻射狀影響範圍

左手臂、下巴、頸部

伴隨症狀

呼吸急促、出汗、心跳急促

持續時間

逐漸增加，但通常在10分鐘內消失

惡化因素

運動、壓力和寒冷可加劇病情

緩解因素

透過休息和服食硝酸藥物，緩解病症

嚴重性

隨程度增加，從少許疼痛至劇烈疼痛

非典型胸痛

－咳嗽或呼吸帶來嚴重痛楚－唯一／主要於腹部中央或旁邊位置感到不適－手指頂端局部出現疼痛－胸壁或手臂的運動或會觸碰，延續疼痛感覺－持續疼痛達數小時－很短暫的疼痛發作，時間維持數秒或更短－疼痛感覺擴散至下肢

！突發性出現！痛楚感覺密集且使力！出汗！呼吸急促！昏厥或失去知覺

急救員目標

！！！！！

－協助病患長者休息－尋求緊急醫療救助－密切觀察患者情況應該 1. 如果病患長者仍有意識： a / 協助病患長者處於半坐狀態，支撐其背部和頭部 b / 協助病患長者含服硝酸鹽（硝酸甘油） c / 鬆開病患長者任何緊身衣飾 d / 協助病患長者到醫院求診 2. 如果病患長者失去意識： a / 協助病患長者，並躺在他／她的身旁 b / 撥打999，尋求協助 c / 鬆開病患長者任何緊身衣飾 d / 重新協助病患長者，躺在他／她的身旁和施行心肺復甦術，直到救護車到來 3. 如果有疑問或患者情況急轉直下，立即撥打999，尋求緊急協助避免 1. 讓病患長者獨處 2. 等待病患長者症狀自行消退 3. 讓病患長者服用任何藥物（心血管治療藥物除外）

心血管系統

昏厥

背景

「昏厥」是指患者因腦內血壓驟降或不足，導致出現意識短暫喪失的情況，繼而失去反應，姿態失控。約四分一居於護老機構的長者曾遇上這問題，而復發率為30%。隨年齡增長，昏厥情況更為普遍，更為部分患者造成其他嚴重傷害（如髖部骨折）。原因 1. 站立過久、進食、外來壓力或咳嗽亦可引致短暫低血壓；而脫水、服食降血壓藥物或併發感染均會令情況加劇。一般而言，起立性低血壓暈厥是最為常見的 2. 血管迷走神經對疼痛、驚嚇、情緒的反應，會導致低血壓和昏厥 3. 罹患心臟疾病，如心肌梗塞、心律不正常、主動脈狹窄，亦可釀成昏厥

症狀

先兆: －面色蒼白、出汗、脈搏微弱或停止；肌肉張力低－短暫癲癇發作（情況維持數秒鐘）－可能出現咬舌、失禁情況－昏厥持續時間短暫（維持數分鐘）－可能會出現短暫的精神錯亂（維持約數分鐘）

！失去意識超過1分鐘！！微弱及不規則脈搏！！劇烈胸痛！

－辨識危險訊號和進行醫療急救－將不尋常或多次昏厥情況告知家庭醫生，向其查詢

急救員目標

應該對於仍有知覺的病人： 1. 讓病人坐下，並將病人頭部放於兩膝之間 2. 讓病人躺下，提高病人雙腿（高於心臟水平），以恢復血液流向大腦 3. 鬆開病人腰帶、衣領或其他緊身衣物 4. 為免復發，不要太快扶起病人 5. 檢查病人有否因昏厥跌倒為其造成傷害對於已昏迷的病人： 1. 保持其呼吸道暢通，並檢查呼吸、血液循環及施行心肺復甦術 2. 密切監測其意識、呼吸狀況和循環功能避免 1. 太快把病人扶起 2. 讓病人飲食

心血管系統

休克「休克」意指患者細胞無法獲得足夠的氧氣和營養物質。如出現有關症狀，需要立即就醫，否則情況會急轉直下。

背景

如不能及時治療，將會危及患者性命。若發生在老年人身上，情況會更壞，因為老年人的身體反應較為遲緩。主要類型及原因如下：類型

原因

低血容量性休克

大量出血

心源性休克

心臟攻擊

過敏性休克

過敏

感染性休克

嚴重感染

無論是出血、敗血症或心源性休克，死亡率均超過20％。

症狀

－噁心或嘔吐－皮膚呈蒼白、濕潤－手和腳冰冷－呼吸和脈搏急促－尿量減少－意識水平改變 **當有疑似休克病例，應立即撥打999，因為在家裡沒有任何有效的治療方法。**

－認識情況和進行醫療急救應該

急救員目標

1. 尋求緊急醫療救助，立即撥打999 2. 讓患者平躺。如情況許可，請提高患者雙腿（高於心臟水平），以恢復血液供應往大腦 3. 控制任何外部出血情況 4. 保持患者身體溫暖 5. 監控患者意識，呼吸和脈搏穩定，直到醫療人員到達避免 1. 給患者任何食物或飲料 2. 讓患者獨處

心血管系統

咽喉

急性哮喘

背景

哮喘是一種慢性氣道疾病，由於支氣管收縮（氣道收縮）、痰量增加及積聚，導致患者的氣道受阻並出現呼吸困難。接觸過敏原是最常見誘發哮喘的成因。哮喘在中老年人中是常見的病患，亦可導致嚴重後果。不少人在少年時曾試過哮喘病發，但事實上任何年紀的人皆有機會患上哮喘，長者亦不例外。即使只是輕度哮喘發作，長者卻容易因哮喘得到更嚴重的健康問題，如呼吸衰竭。而這病很難治癒，對長者的健康影響更甚。長者哮喘絕不容易察覺，常有延誤確診的情況，不少長者因心臟疾病和肺氣腫掩蔽效應而錯過及早求醫的機會。長者生活方式不太活躍，使年輕一輩減低察覺長者患上急性哮喘症狀的機會。

由呼吸道重塑引致的慢性哮喘纖維化增加肌肉厚度增加黏液增加炎症細胞增加（CD4與嗜酸性粒細胞）抑制性NF-kB對於呼吸道重塑的影響減低纖維化減低肌肉厚度減低黏液減低炎症細胞（如CD4與嗜酸性粒細胞）溫和性哮喘輕微的纖維化輕微的肌肉厚度增加微量的黏液

咽喉

急性哮喘發作的加速物包括：過敏原－塵蟎－花粉－動物皮屑－香水－藥物，如阿司匹林

惡化因素－寒冷天氣－空氣污染－吸煙－情緒緊張－感染

併發症急性－氣胸－急性呼吸衰竭慢性－增加肺部受感染機會

－咳嗽帶痰，特別是反覆發作－氣喘或呼吸有雜音

症狀

！呼吸節奏急促或突然放慢！胸部單側感疼痛！出汗過多！無法完整說出句子！精神狀態轉變

！！！！！

－舒緩症狀，緩解其支氣管收縮狀況－密切監測情況有否進一步惡化

急救員目標

應該對於仍有知覺的病人： 1. 如長者擁有支氣管擴張器，立即協助使用 2. 協助長者保持冷靜及舒適狀態 3. 協助病人垂直站立，鬆開所有的緊身衣物 4. 如長者對支氣管擴張劑沒有反應，應該立即尋求緊急醫療救助避免 1. 讓病人獨處 2. 如情況持續轉壞，立即尋求協助

咽喉

藥物急救短效支氣管擴張劑（沙丁胺醇 – 中藍瓶）

備註

沙丁胺醇小罐

劑量－緊急救援－ 4至6份支氣管擴張劑，每次抽吸4至6次－如果病人哮喘持續，可在4至6分鐘後重複上述步驟

吸氣口

如何使用支氣管擴張劑 1. 取下蓋子，搖勻噴霧器 2. 垂直緊握噴霧器 3. 徹底呼吸 4. 放在嘴唇之間 5. 按下噴霧器，同時慢慢地深入吸氣 6. 暫停呼吸10秒或以上 7. 在服用第二劑前，須等待至少1分鐘

如何使用支氣管擴張劑（連同專門口罩使用） 1. 取下蓋子，搖勻噴霧器 2. 將支氣管擴張吸器與口罩連接 3. 深呼吸 4. 將口罩摺口放在嘴唇之間並確保密封 5. 按下噴霧器，並正常呼吸5次

咽喉

窒息

背景

症狀

當長者的氣道被異物阻塞，便會出現窒息的情況。引起長者窒息的成因眾多，如誤吞異物（食物團），也可以是誤吞假牙所致。而牙齒健康問題亦無形削弱他們的咀嚼能力；曾患上中風的長者，吞嚥能力亦受到影響；患上老人癡呆症的長者，也會因為咀嚼的協調問題和吞嚥的能力下降而增加窒息風險。

在用餐時，出現以下症狀：－突發性咳嗽－呼吸突然加速－說話困難－發出高亢噪音－以單手或雙手緊抓咽喉

！無法說話﹑咳嗽！失去意識！精疲力竭，無法站立！黃萎病(發紺症)

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採用標準動作，幫助病人清理呼吸道應該

急救員目標

1. 發現危險訊號時，立即撥打999，尋求醫療支援 2. 如果患者有意識和咳嗽 - 鼓勵患者咳嗽 - 與患者保持接觸及監察情況 3. 如果患者意識清醒，但無法咳嗽： a / 拍背法 1 站在患者身後，把一隻手環抱病人胸部 2 使患者90度彎曲向前 3 利用一隻手的掌根位置，在患者兩肩胛骨之間拍擊 4 重複上述步驟5次 1

咽喉

b / 腹部衝擊 1 站在患者身後 2 找出病人肚臍位置 3 緊握拳頭，並放於患者胸骨尖和肚臍上方 4 緊握拳頭，並快速用力推向腹部 5 重複上述步驟5次 1

胸骨尖肚臍

c / 連續執行上述2項方法 4. 如果患者昏迷： a / 使患者平躺在地上 b / 嘗試尋找阻礙氣道物件，如能找到，請立即用手指協助清除 c / 如沒有發現阻礙氣道物件，便傾斜病人頭部，並在檢查胸部時施予兩次人工呼吸 d / 進行胸部按壓30次，每次的深度至少2英寸及保持按壓，每分鐘最少100次 e / 再次尋找異物，如有發現應即時清除 f / 重複首3個步驟，直到救援人員到達避免 1. 給長者任何食物或飲料 2. 給長者喝醋 3. 用手強行移除異物

腹部

腹痛造成老人腹痛的原因眾多，但普遍情況皆是由較溫和的原因引起，如食物中毒、腸胃炎或痙攣。

背景

「急性腹痛」定義為少於6小時發病的腹痛，如遇上這情況，必須立即處理。然而，普遍長者延誤求醫，在很晚期及情況非常嚴重的情況才到醫院求診，大大增加對住院治療或手術治療的需求。以下為長者群（超過55歲）急性腹痛最常見成因： 1. 膽道疾病 2. 盲腸炎 3. 腸阻塞 4. 消化性潰瘍 5. 憩室炎

位置

左上方－消化性潰瘍

右上方－膽道疾病

左下方－憩室炎－腸阻塞

右下方－盲腸炎

疾病

症狀

膽道感染（BTI）（包括膽囊炎、膽管炎）年老病患者之發病率和死亡率更為明顯。年齡超過70歲的長者中，過半數患有膽結石，高達20％的患者更會出現併發症。而患上嚴重膽道感染的長者，更會出現血流感染（BSI），約8％至20％為社區性菌血症。對年老病患者而言，繼泌尿道感染後，膽道感染是第二種最常引起敗血症的原因。

症狀－在用膳後，右腹上方持續劇烈疼痛達數小時，疼痛感覺可能延至右側肩胛骨－噁心－嘔吐－尿液帶茶色－發熱－發抖

盲腸炎－初期圍繞肚臍位置每人一生約有7%機會患上盲腸炎（每15人當出現絞痛，6小時中有1人患病），發病率為每10萬人當中有10 後轉移到右下腹人。在長者群組中，發病率約為5％至10％。－噁心和嘔吐－便秘假如盲腸炎患者得不到及時合適的治療，這－發燒樣便會造成嚴重後果，甚至死亡。假如不及早處理，發炎的闌尾可能破裂並化膿流入腹腔，引起腹膜炎，而闌尾破裂率可高達70％以上；而長者的死亡率更較年青人高16倍。故此，向長者灌輸「延誤診斷盲腸炎將會導致高死亡率和發病率」的概念是非常重要。腸阻塞當腸道部分被阻塞，就會引起腸道蠕動（波浪狀運動），出現絞痛狀況。如果阻塞情況持續，腸壁便會受到傷害。情況更甚的，腸道會出現破穿的情況。在長者群組中，腸梗塞通常由結腸癌、憩室症和糞便嵌塞引起。

－腹部絞痛－腹脹－便秘－嘔吐

消化性潰瘍－腹部中上方/左方感「消化性潰瘍」是指胃或小腸被侵蝕，多由幽覺疼痛門螺旋桿菌感染和長期使用非類固醇抗發炎－疼痛感覺短暫，情藥NSAID所引起的。而這疾病引發的併發症況持續數天至數星眾多，如腸道破損、出血或便秘。如長者長期不等期服用非類固醇抗發炎藥NSAIDs或類固醇，－吃辛辣食物會加劇更大大增加其腸道破損及出血的風險。腸道疼痛感覺，飲牛奶破損是一種外科急症，如果不及時治療，便則可以舒緩有關有機會發展到危及生命的腹膜炎。情況－用膳約2小時後出現疼痛感覺

腹部

疾病

症狀

憩室炎－劇烈腹痛蔓延至「憩室炎」是指結腸內的憩室發炎，接近30％的肚臍位置，甚至長者患有此症。急性憩室炎近似盲腸炎，一旦左下腹出現穿孔情況，出血便會發展成慢性憩室炎。－嘔吐慢性憩室炎往往很容易病變成結腸癌，此時必－發燒須由醫生進行檢查。假如發現身邊長者有不尋常腹痛及上述症狀，應該尋求醫生施予合適治療。

！劇烈疼痛持續數天（不要再延誤治療）！腹部受傷造成的傷害！呼吸困難！發高燒！大小便帶血！無法吞嚥食物！排便乏力，特別是連同嘔吐時侯

急救員目標

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－辨識危險訊號，施行醫療急救－諮詢家庭醫生及尋求合適治療應該 1. 安撫患病長者，協助病者處於舒適狀況 2. 如患者有呼吸困難情況，應協助患者端坐 3. 利用熱墊或熱水袋裹在毛巾中，緩解患者疼痛感覺 4. 如發現危險訊號，應立即尋求緊急醫療援助避免 1. 如果患者需要緊急醫療援助，不要給予食物或飲料（長者可能需要進行緊急外科手術）

嘔吐

背景

嘔吐並不單因消化道出現問題而引起，亦有可能因其他原因造成，如頭部受傷、中樞神經系統受感染等。當照顧一位嘔吐中的長者時，防止其脫水、協助保持平衡及替其找出潛在原因是很重要的。原因－食物中毒－顱內壓增加－暈浪（因乘搭車、船）－藥物服用（如含嗎啡成份的止痛藥）嘔吐可以伴隨不同疾病引起的其他症狀而發生

症狀

疾病

症狀

病毒性腸胃炎，食物中毒

－水性腹瀉（通常是非血性的，血性腹瀉顯示更嚴重的傳染病）－腹腔痙攣和疼痛－噁心－發燒

暈車、暈船等

－不自在－冒冷汗－暈眩

腸塞

－腹部疼痛－噁心－便秘－腸臟不能蠕動或讓氣體通過－腹脹

闌尾炎

－臍孔位置附近出現絞痛，並會在6小時後轉移至右下腹－噁心和嘔吐－便秘－發燒

腹部

疾病

症狀

膽管感染

－餐後數小時後右上腹劇痛，痛楚會擴散至右肩胛骨－噁心－小便呈茶色－發燒－顫抖

憩室炎

－急性的腹腔疼痛發作，疼痛感會移向肚臍和左下腹位置－發燒

胃潰瘍

－吐血，血絲帶紅或黑如果出現內出血情況，大便帶有黑色的血－噁心－體重沒因由地下降－胃口轉差

胃酸反流病

－胃酸倒流－燒心感覺－胸痛－吞嚥困難－乾咳－聲音沙啞或喉嚨疼痛

糖尿病引起的酮酸中毒

－極度口渴－尿頻－噁心－腹部疼痛－呼吸急速－神志不清

頭部受傷

－失去知覺－神志不清或混亂－頭痛－噁心－昏昏欲睡－暈眩或失去平衡力－感官的轉變（如視力模糊、耳鳴、口味或嗅覺轉變、對光或聲音的敏感度增加等）－記憶或情緒轉差

！右下腹疼痛！！中樞神經系統受創！（出現精神錯亂、頸項硬直、畏光的跡象）！嘔吐或大便帶血！！嚴重脫水！！無法使用藥物治療！

急救員目標

－辨識危險訊號並施行醫療急救－利用止吐藥物，協助減輕病人症狀和保持患者身體水份充足－諮詢家庭醫生及尋求合適治療應該 1. 如發現危險訊號，應立即尋求緊急醫療救助 2. 勸說多作休息 3. 頻密地（每隔1至2小時）給予適量水份作補充 4. 給予容易消化的食物（如粥、香蕉、馬鈴薯等）避免 1. 餵食固體食物

腹部

便秘「便秘」是指腸道習慣改變、排便頻率降低、糞便乾硬，或會有宿便的情況出現。

背景

原因－缺乏纖維或沒有攝取足夠的液體－運動不足－藥物作用（如抗酸藥、濫用瀉藥）－疾病如甲狀旁腺過度活動症（如甲旁亢）、硬皮病（如結締組織病）、柏金遜症、中風和糖尿病

併發症－糞便嵌塞 •大、乾而硬的糞便填塞直腸但不能排出 •直腸壁受損，可能出血甚至穿孔。 •症狀：慢性便秘、水性腹瀉、腹脹及腹痛

症狀

－排便後仍有便意－硬而小的糞便－腹部腫脹－腹痛

（重度脫水）！糞便帶血！劇烈腹痛！體重下降！便秘超過2星期

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－辨識危險訊號，施行醫療急救－利用輕瀉劑，協助減輕病人症狀

急救員目標

應該 1. 增加液體攝取量（每日額外多喝2至4杯水） 2. 早上喝溫熱的飲料 3. 增加纖維的攝取量（如水果、蔬菜和穀物等） 4. 使用輕劑量大便軟化劑或瀉藥，為期不要超過2星期避免 1. 勿在家中嘗試用手取出糞便

腹部

脫水

背景

若嘔吐和腹瀉造成過量水份流失而不能及時補充水份，長者體內便會出現脫水情況。流失了相當於百分之一體重的水份時，脫水便開始發生。如果長者得不到及時治療，便有機會造成中暑和休克的情況。

原因－出汗過多（運動、發燒、炎熱天氣）－腹瀉－嘔吐－由於藥物影響以致排尿量過多風險因素－慢性疾病（糖尿病、心臟衰竭、腎病）－炎熱潮濕天氣－長者－殘疾或缺乏照顧

症狀

－口乾和眼乾－嘴唇乾裂－口渴－頭痛（頭昏眼花）

－尿赤－排尿量減少－抽筋

（重度脫水）！焦躁和精神錯亂！頭暈！低血壓！心悸！發燒

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－辨識危險訊號並施行醫療急救－補充水分和監控水份狀況

急救員目標

應該 1. 為長者提供飲料補充水分。單喝水通常已經是足夠的，而服用口服補液溶液更可幫助鹽份補充口服補液鹽「口服補液療法」是用於糾正或阻止腹瀉造成的缺水情況。除了補水用途，亦可補充因缺水造成失去的離子及保持酸鹼平衡。口服補液鹽一般在市面有售，市民亦可以在家中自行製備。然而必須依照包裝上的說明指示，如添加過多或過少的水，便可能加速惡化患者的病情。據世界衛生組織（WHO）的指引，每包口服補液鹽須包含－葡萄糖：13.5克－氯化鈉：2.6克－檸檬酸鈉：2.9克－氯化鉀：1.5克整包應溶解在一公升的水中。另外，口服補液溶液可以提早在家中製備。你只需要預備－ 1茶匙的鹽 + － 8茶匙的糖 + － 1升清潔飲用水

鹽

糖茶匙

1升清潔飲用水

治療應該持續至腹瀉不再為止，患者要盡量多飲水，直至不感口渴及排尿正常為止。

腹部

2. 伸展和按摩肌肉，以紓緩痙攣狀況 3. 留意長者的水份吸收及排出狀況 4. 如果病情沒有好轉，應該立即尋求醫療救助避免 1. 食用含牛奶成分或牛奶製品、酒精和咖啡因

盆腔

急性尿瀦留（尿滯留）背景

「尿瀦留」是指膀胱無法清空尿液。而此症可以分為急性或慢性，當中急性尿瀦留是屬於急症一種。男性：通常50 至60歲，大部分個案是由於前列腺腫大引起。女性：個案多是因膀胱出現下垂、移位（膀胱膨脹）或直腸出現下垂、移位而引起。流行病學隨著年齡的增加，男性出現尿瀦留的情況變得越來越普遍。－在40至83歲的男性群中，每 1,000人中，有4.5至6.8人病發。－約70歲的男性群中，每1,000 人中，有100人病發。－約80歲的男性群中，每1,000 人中，有300人病發。在女性羣中，出現尿瀦留的情況則不太常見。

風險因素男性：－腎結石－前列腺癌－前列腺炎－良性前列腺肥大女性：－曾患腎結石－曾患上尿道感染（UTIs）－孕婦－近期曾接受過婦科手術成因－尿道受阻塞．前列腺肥大．膀胱結石－尿道狹窄－由感染引起腫脹或刺激作用－神經系統出現問題，大腦和膀胱信號失效－膀胱肌肉乏力－便秘－服食藥物，如抗組胺藥、抗柏金遜症藥物及咳嗽藥水等

症狀

急性尿瀦留可能出現以下症狀，如發現便須立即求醫：－排尿乏力－疼痛，急須排尿－下腹部感疼痛或不適－下腹腹脹尿瀦留引起的併發症：－尿道感染－膀胱受損－腎臟受損

！小便帶血！腰部疼痛！發燒！背部疼痛或！下肢無力或麻痺

！！！！！

了解患者狀況及盡快施予急救應該

急救員目標

1. 立即致電999，尋求緊急醫療救助，及早入院進行引流導管排尿治療避免 1. 服用可能加重病情藥物，如抗組胺藥、抗柏金遜症藥物和咳藥水 2. 喝大量水 3. 試圖強行小便

盆腔

尿道感染尿道感染（UTI）意指任何的泌尿系統部位受感染，包括腎臟、輸尿管、膀胱和尿道。

背景

大多數感染個案涉及下尿道部位，即為膀胱和尿道。婦女患上尿道感染的風險比男性高。如患者膀胱受到感染，會感到明顯痛楚。然而，如果尿道感染擴散至腎臟和血液的話，後果便會相當嚴重。在一般長者群中，受尿道感染的發病率約為10％，住在老人院或療養院的長者則有高達30％的發病率，而長者因尿道發炎引發菌血症的死亡率則高達33％。不同的尿道部份受感染，都會有不同的症狀

症狀

泌尿道部分影響

症狀和徵兆

腎臟（急性腎炎）

－上背部和兩腰（側面）疼痛

膀胱（膀胱炎）

－出現盆腔腫脹－小腹不適

尿道（尿道炎）

－排尿時有灼熱感

尿道感染不常出現症狀，徵兆亦不明顯，但當發生下列情況時便須多加留意：－經常有強烈便意－小便時有燒灼感－尿頻，但每次只排出少量尿液－尿液混濁－尿液帶血，呈紅色、鮮粉紅色或可樂色－發出強烈氣味－女性會出現盆腔疼痛

併發症 1. 嚴重感染（如尿膿毒症）－高燒．發抖、發冷．噁心．嘔吐－心跳急促－頭暈－暈倒 2. 腎受損 3. 腎功能衰竭

！尿膿毒症的症狀！排尿量顯著減少

！！

－了解患者狀況及盡快施予急救－如發現尿道感染症狀，應盡快諮詢家庭醫生

急救員目標

應該 1. 如患者受嚴重感染（如尿膿毒症），應撥打999，尋求緊急醫療援助 2. 對於嚴重尿道感染，患者可能需要到醫院，接受抗生素靜脈注射治療 3. 服用乙酰氨基酚，降低體溫及疼痛感覺 4. 必須服用經醫生處方的抗生素，並完成整個治療程序，以確保沒有感染，完全康復 5. 飲用大量水份，以稀釋尿液及幫助排尿 6. 女性在小便後清潔時，須用衛生紙由前往後擦抹。這有助防止細菌從肛門進入到陰道和尿道 7. 行房後盡快小便，以減少細菌滋生避免 1. 不要使用具刺激性的女性用品。不少女性在生殖器部位使用除臭噴霧劑或其他女性用品，如沖洗器和粉劑，尿道因而會受到刺激 2. 在康復前，切記不要飲用酸性、刺激性、及含有咖啡因的飲料，如咖啡、酒類、及含有柑橘成分的飲料

盆腔

發高燒

發燒是指體溫高於平常情況。不同的量度位置有不同的準則。

背景

量度的方法

發燒準則

肛探

> 38℃

耳探

> 38℃

口探

> 37.5℃

原因－受感染，如流感、傳染性單核細胞增多症、腸胃炎、尿道感染等－炎症，如自身免疫疾病、炎性關節病等，動手術後亦較容易發燒－癌症（情況較為罕見）

症狀

－發抖或發冷－出汗－肌肉疼痛

！落枕（頸強直）！痙攣！反覆嘔吐！呼吸困難

！！！！

發高燒

急救員目標

－辨識高燒和危險訊號－降低體溫－如對病者有任何疑慮，應立即尋求醫療意見應該 1. 每4小時為病者量度體溫1次 2. 讓病者飲用大量的水，以補充水分 3. 給病者穿著寬鬆及透氣衣服 4. 溫水沐浴有助降低體溫 5. 如果情況沒有改善或惡化，應立即再次尋求醫療幫助 6. 服用醫生處方藥物，例如布洛芬和撲熱息避免 1. 為病者穿過多衣服或蓋上厚被，令其體溫進一步上升

備註

高熱「高熱」是指體溫高於40℃的發熱。這表示可能罹患嚴重疾病，或導致精神錯亂、癲癇和器官衰竭。這情況是屬於急症，應立即尋求幫助。

正常

發燒

高熱

體溫過高

中暑

背景

當人處於炎熱環境，而排汗又不足以消散體內潛熱，中暑便會發生。另外，在炎熱及空氣流通不足的環境下，如沒有足夠的水份補充，也可能出現中暑的情況。老人中暑多因身體狀況問題而削弱了排汗能力，包括循環不暢、皮膚變化，以及服用慢性藥物。風險因素－極端高溫天氣－服用藥物，如抗抑鬱藥、抗精神病藥和鎮靜劑，均可能損害身體的排汗能力－飲酒－超重

症狀

－出汗過多－頭暈－噁心、嘔吐－脈搏快速且細弱

－頭痛－精神錯亂－肌肉無力和痙攣

！患者病情惡化！開始有心絞痛跡象

！！

－幫助患者降低體溫－幫助患者補充水分和鹽份

急救員目標

應該 1. 立即停止任何涉及體力勞動活動 2. 在陰涼地下休息 3. 為患者提供冰涼的水電解質液和運動飲料 4. 監測患者反應，為其補充水份 5. 如果患者不能復原或不能飲水，應立即尋求醫療協助

嚴重中暑

背景

嚴重中暑屬於急症情況。這是最嚴重的身體過熱病症。因外在環境因素及身體缺乏調節下，體溫上升至40.6℃ （105.1° F）。身體的溫度迅速上升，不能及時排汗，導致體溫無法下降，便會發生嚴重中暑的情況。由於體溫升至40℃以上，高溫會影響身體功能系統，包括中樞神經系統。如不及時治療嚴重中暑的情況，可引致死亡或終身殘廢。對於溫度的突然變化，普遍長者的適應能力較差，故此他們更容易受到高熱症影響。如長者患有長期疾病及服食藥物，也會影響身體對高溫作出反應及調節。風險因素－高溫及潮濕天氣－脫水－房間通風不足

症狀

急救員目標

－皮膚乾燥、發熱－頭痛－精神混亂－肌肉乏力和痙攣

－排汗極少－頭暈－噁心及嘔吐－脈搏快速而微弱

－辨識患者狀況及施以急救治療－幫助患者降溫－幫助患者補充水分應該 1. 撥打999，尋求緊急醫療援助 2. 安排患者到陰涼地方休息 3. 脫去患者不必要的衣服 4. 運用下列方法使患者降溫 a / 風扇 b / 用水潤濕皮膚 5. 只有在患者完全清醒及能吞嚥的情況下，使用口服補水溶液 6. 監測患者反應，直到救援人員到達

體溫過高

體溫過低

背景

「體溫過低」是指體內溫度低於攝氏35度（華氏95 度）。長期處於低溫環境而保暖衣物不足，是體溫過低最常見的成因。另外，溫度調節機制受損亦會釀成體溫過低的情況。

36 35 34

在香港，每年約有10至20宗長者嚴重低溫症個案。

30 29 28 27 26

體溫過低

重度：（<攝氏 28度）－呼吸淺而慢－脈搏緩慢，微弱－神智不清－發抖情況可能暫停－失去意識

重度

中度：（攝氏28-32度）－劇烈的顫抖－皮膚冰冷，顯蒼白－言語不清

32 中度

輕度：（攝氏33-35度）－發抖－高血壓－脈搏急促－呼吸急促

輕度

對長者而言，短暫處於寒冷天氣或輕微溫度下降，足以令其體溫出現過低情況。

風險因素－患有慢性疾病，如糖尿病、甲狀腺功能減退－患者行動不便，如中風、老年癡呆症－飢餓－營養不良－酗酒或濫用藥物，如安眠藥、阿片類藥物

症狀

正常

長者較易受低溫症影響。通常患有長期疾病及服食藥物的長者，其身體對低溫作出的反應也會備受影響。

體溫過低

！體溫低於攝氏32度！中度和重度低溫症狀

急救員目標

！！

－辨識患者狀況及施以急救治療－防止患者體溫進一步降低－幫助患者回復正常體溫應該 1. 發現危險訊號，即時撥打999，尋求緊急醫療救助 2. 對於昏迷的患者，檢查氣道，呼吸和血液循環；如患者呼吸和脈搏停頓，應即時施行心肺復甦術 3. 把患者移往溫暖和乾燥的地方 4. 脫去患者身上任何濕透的衣服 5. 用毛毯包裹患者全身及頭部 6. 如果患者保持清醒，應為其餵食熱飲和高熱量的食物 7. 使用低溫溫度計量度患者體溫，直腸量度比口腔量度較為精確

耳鼻喉

鼻出血

背景

鼻腔內任何部份均有機會出血，而當中最常見的位置是鼻中隔。當鼻腔內微小的血管出現破裂情形，便會發生鼻出血的情況。另外，身體內系統性的疾病亦會導致鼻出血的情況。鼻出血情況有時會難以控制或停止，並導致低血容量休克及死亡。據統計，長者鼻出血情況非常普遍，約佔百分之29％至50％。當中，長者在後鼻腔部分出血情況是比較常見，而這情況亦是較難控制及處理。

成因局部性－鼻子受到撞擊－打噴嚏，挖鼻過深－鼻炎－少數由腫瘤引起全身性出血性疾病，及曾使用抗凝血藥（如阿士匹林、非類固醇抗炎類藥、華法林、氯吡格雷等）鼻出血亦與年老、高血壓和乾燥的天氣等因素有密切關係。

後組篩竇動脈

篩前動脈

血管叢

蝶腭動脈

上唇動脈

大腭動脈

症狀

－鼻孔出血－高血壓－亦有可能引起貧血和低血壓等情況－身體其他部位出現出血性疾病

！大量出血！出血不止！有休克跡象！有嚴重傷勢跡象！有出血性疾病及使用抗凝血劑跡象

！！！！！

－辨識到危險訊號和施以急救處理－運用急救方法控制鼻出血情況

急救員目標

應該 1. 讓病人坐下來並將頭部向前傾，以便血液從鼻孔流出 2. 要求傷者用口呼吸，用手按壓鼻樑下的位置約10分鐘 1

3. 用乾淨的布或紙巾抹去血液 4. 放置一個冷敷／冰袋在鼻樑上方或；利用潔淨的紗布或藥棉，填塞前鼻孔 5. 如果出血情況持續，再按壓10分鐘 6. 如果出血停止，病人仍須繼續向前傾斜，利用微溫清水清潔鼻子 7. 避免施力或擤鼻涕，以免阻礙血液凝固過程 8. 如果出血情況重複出現，需要再次用手於有關位置施予壓力避免 1. 讓患者仰後頭部，以避免血液倒流至喉嚨，誘發嘔吐或窒息 2. 讓患者說話、吞嚥、咳嗽、吐痰或用力吸氣，因為有關動作可能擾亂血液凝固過程

耳鼻喉

鳴謝

在「We Are With You」項目撥款資助下，《銀齡急救基本法》、《長者急症ABC》二書順利出版，並成功從深入淺出的角度，向市民灌輸專業急救知識，服務長者及弱勢社群的熹願得以實踐。一系列以「基本生命救援」為主題之工作坊、展覽及座談會亦順利舉辦，讓大眾受惠，實在感激萬分。另外，二書之所以成功面世，急症醫學小組的同學功不可沒，在此感謝他們一直以來的努力付出。樊潔玲醫生梁令邦醫生

Elderly First Aid Handbook Book A

Articles inside

Ear Nose Throat

Extreme Temperature - Too Cold

Heat Stroke

Extreme Temperature - Too Hot

High Fever

Acute Urine Retention

Urinary Tract Infection

Dehydration

Constipation

Vomiting

Abdominal Pain

Acute Asthmatic Attack

Choking

Shock

Syncope

Angina

Cardiovascular System

Depression and Suicide

Head Injury

Seizure

Stroke

Process of Ageing

Automated External Defibrillator (AED

Recovery Position

Basic Life Support