: 7 1 2003 Introduction of Geriatric Emergency Medicine Soon- Joo Wang, M.D. Departm ent of Em ergency Medicine, Hallym University Sacred Heart Hospital,.,.,, 13.1% 65, 2030. 20% 1).,,. 35% 65 2).. 65 74 100, 1 31.4, 75. 55.8 4). 15.7%, 46%, 46%,. 75 47% 3). 45 64 2, 5). 50%,, 6)..,. 1/3 1,. 78%,. - 1 -
So o n- Joo Wa ng. Introduction of Geriatric Emergency Medicine 1 7).. 78%,, 77%., 30..,..,. 21%, 8).,.,.,. 2, 9)..,,,. 1.,. (%) 30 9 1. (%) 30 50 8 (%) 7 1.3. 2. 1.. 2.. 3.. 4.,,. 5.. 6.. 7.. 8.,. 9.. 10.. - 2 -
.,,,,.,..,. ( 1).,. 2.,.,,.,..,... 1..,,,,.., 48, 20% 3 10).,,.., - 3 -
So o n- Joo Wa ng. Introduction of Geriatric Emergency Medicine..,..,, : -,,, :. : :,. :,. 3.,,, 11,12)..,,... 4.5., 2.1.,,,, X- (,, ), CT, MRI, (, ),,,., (,, (, ), ),...,..,,, - 4 -
..,. 1.,,..,.,..,,,.,.,..,,,,,..,,.,.,.,,.,,,,.. - 5 -
So o n- Joo Wa ng. Introduction of Geriatric Emergency Medicine,. Mettag. ( ), 119 ( ), ( ), ( ),,., START, AVPU,,. 1,., 2.,.,,,.. 1990,,,,,.,.,,,.,. (Triage),,,,,,,.,,,. 3.. 2000 9-6 -
. 13).,.,,,..,.. 3 (Chain of Survival),. ( 3.) (Automatic. Exter- nal Defibrillator, AED),,,.. 4.,., 8 15%, 14,15). 20%., 28%. 3. (Cha in of Surviva l) 1. (early access): 2. (early CPR): 3. (early defibrillation): 4. (early ACLS): - 7 -
So o n- Joo Wa ng. Introduction of Geriatric Emergency Medicine. 16)...,. 30% 17).,,., 50 89%,, 1/3, 1/5,.,..,... 48%,, 44%, 32%..,, 18,19). 10,.,,. 70 20%, 65 70 20%. 80 23 50%, 25)..,. 5. 20). 2 1). 1/5 22)..,., 23,24). 67% - 8 -
. 26)., 30). 85 75% 27). 63%., 20% 2 8). 4 3 1). 29).,,,. 35 59% 32)..,,......., CT,,..,,., 2 6%,,, 6.. 4., (%) 2-41 9.6-23 2.5-15.2 7.3-14 4-9.6 2.3-7 2-7.3 3.4-7,,,,,,,.,,, - 9 -
So o n- Joo Wa ng. Introduction of Geriatric Emergency Medicine..,,...,,.,,,.,,..,,,.,,,,..,,,,..,.,,..,.,.,,..,, 7..,,, - 10 -
.,, 36)..,,,,,..,,.,.. 14%,,, 33).,..,..,.,. 1) US Bureau of Census: Stastical abstract of the United States 1990. ed 110, Washington DC: US., Government Printing Office 1990. 34). 2) Desai MM, Zhang P. Surveilance for morbidity, and mortality among old adults-united States,,, 1995-1996. MMWR 48(7), 1999. 35). 3) Strange GR, Chen EH. Use of emergency department by elder patients: A five year follow-up. study. Acad Emerg Med 1998;5:1157. (sundown syndrome) 4) McCraig LF. National Hospital Ambulatory Care Survey: 1992 Emergency Department Summary. - 11 -
So o n- Joo Wa ng. Introduction of Geriatric Emergency Medicine Washington DC, National Center for Health Statistics, Center for Disease Control and Prevention, US Department of Health and Human Services 1994. 5) Signal BM, Hedges JR, Rousseau EW. Geriatric patients emergency visits Part I: Comparison of geriatric and younger patients. Ann Emerg Med 1992;21:802-7. Accid Ann Prev 1995;27:167. 16) Zieltow SP. Multisystem geriatric trauma. J Trauma 1994;37:985. 17) DeMaria EJ. Evaluation and Treatment of the elderly trauma victim. Clin Geriatrir Med 1993;9 :461. 18) Levy DB, Hanlon DP, Townsend RN. Geriatric Trauma, Clin Geriatrir Med 1993;9:601. 6) McNamara RM, Rousseau E, Saunders AB. 19) Lonner JH, Koval KJ. Polytrauma in the elderly. Geriatric Emergency Medicine: A survey of Clin Orthop Rel Res 1995;318:136. practicing emergency physicians. Ann Emerg Med 1992;21:796. 7),,,... : 2002;p21-2. 8).. 1994;37(9):1028-33. 9) Sanders AB. Emergency Care of the Elder Person. St Louis: Berverly Cracom 29-41, 1996. 10) Horattas MC, Guyton DP, Wu D. A reappraisal of appendicitis in elderly. Am J Surg 1990;160:291. 11) Ettinger WH. Pattern of use of the emergency department by elderly patients. J Gerontol 1987; 42:638. 12) Baum SA, Rubenstein LZ. Old people in the emergency room: Age-related differences in emergency department use and care. J Am Geriatr Soc 1987;35:398. 13) American Heart Association. Guideline 2000 for Cardiopulmonary Resuscitation and emergency Cardiovascular Care - An international consensus on science. Circulation Supp 2000;102(8);I1-11. 14) Kundson MM. Mortality factors in geriatric trauma patients, Arch Surg 1994;129:448. 15) Shiller WR, Knox R, Chleborad W. A five-year experience with severe injuries in elderly patients. 20) Norman DC, Grahn D, Yoshikawa TT. Fever and aging. J Am Geriatr Soc 1989;33:859. 21) Wasserman M. Utility of fever, white blood cell, and differential count in predicting bacterial infection in the elderly. J Am Geriatr Soc 1989;37: 537. 22) Macre CA. Fever in geriatric emergency patients: clinical features associated with serious illness. Ann Emerg Med 1995;26:18. 23) Beck-Sague C, Benerjee S, Jarvis WR. Infectious diseases and mortality among US nursing home residents. Am J Public Health 1993;83:1739. 24) Michielsen W. Bacterial surveillance cultures in a geriatric ward. Age Ageing 1993;22:221. 25) Emori TG. Nosocomial infections inelderly patients in the United States, 1986-1990, National Nosocomial Infections Surveillance System. Am J Med 1991;91:289S. 26) Haley RW. Nosocomial infections in US hospitals, 1975-1976: Estimated frequency by selected characteristics of patients. Am J Med 1981;70:947. 27) Bugliosi TF, Meloy TD, Vukof LF. Acute abdominal pain in the elderly. Ann Emerg Med 1990; 19:1383. 28) Tilfer S. Acute abdominal pain in patients of 50-12 -
. years of age. Scand J Gstroenterol 1988;144:47. 29) Muder RR. Bacteremia in a long-term care facility: A five-year prospective study of 163 consecutive episodes. Clin Infect Dis 1992;14:647. 30) Muller RT. Painless myocardial infarction in the elderly. Am Heart J 1990;119:202. 31) Aronow WS. Prevalence of presenting symptoms of recognized acute myocardial infarction and of unrecognized healed myocardial infarction in elderly patients. Am J Cardiol 1987;60:1182. 32) Solomon CG. Comparison of clinical presentaion of acute myocardial infarction in patients older than 65years of age to younger patients: The Multicenter Chest Pain study experience. Am J Cardiol 1989;63:772. 33) Tabitz E. Identification of chemical abuse in the elderly admitted to emergency. Clin Gerontol 1991; 11:27. 34) Casey DA. Depression in the elderly. South Med J 1994;87:559. 35) Muller-Sphan F, Knok C. Clinicl presentation of depression in the elderly. Gerontology 1994;40: 10. 36) Little JT. Sundown syndrome in severely demented patients with probable Alzheimer disease. J Geriatr Psychiatry Neurol 1995;8:103. - 13 -