Resuscitation of older adults in the emergency department poses unique challenges for physicians. Understanding the differences between a typical resuscitation process compared to a resuscitation of an older adult is essential to appropriately manage and treat this population. In this episode Dr. Cliff Reid joins Dr. Christina Shenvi to explore these differences and the associated challenges, and highlight some tools he uses in his own practice. Cliff Reid, MD, is an Emergency, Retrieval, and Critical Care Physician and educator in the greater Sydney area with a focus on resuscitation of adults and children.

• Physiological changes that occur as patients age alter what is expected and unexpected during assessment of patients (eg. vitals, physical examination)
  • The ABCDE method for assessing older patients requires a nuanced approach for older adults.
• Typical difficulties and dangers of resuscitation are amplified in older patients who often have multiple pathologies, comorbidities, and acute complaints
• Cognitive stop points can be used to avoid common traps.
  • One cognitive forcing strategy is to ask what else could be going on, to avoid premature closure or anchoring.
  • The “5 D’s” as are one cognitive forcing strategy. When treating sepsis, make sure to consider: Drugs (antibiotics), Drainage, Debridement, Device Removal and Don’t Forget the Valves.
• Resuscitation should involve assessing the patient’s goals with an understanding of their baseline status and projected course.
  • An acute health assessment should accompany a chronic health assessment. Consider their resilience to disease and treatments, functional capabilities, and comorbidities.
• Older adults typically need earlier and more aggressive resuscitation because they have lower functional reserve. However, there is often a narrower margin for treatment and side effects with medications and fluid resuscitation.