When to Go to the Emergency Room
In the course of caring for an elderly person or one with Alzheimer’s disease, it is likely that an accident will occur or that the person will appear to be seriously ill. A person with dementia can fall and break a bone, and not complain of pain.
On the other hand, a relatively minor illness or discomfort may make the person extremely upset. Because of his dementia, the person may not be able to help you to decide what kind of care is needed. Is this an emergency?
If it is, you should call 911, the ﬁre department or whatever agency is in charge of sending the Emergency Medical Service in your area. You should not try to take the person to the emergency room on your own. Call for an ambulance if a person has these symptoms—
✔ becomes unconscious or has a marked change in mental state
✔ sudden severe chest pain
✔ a fall that results in severe pain or inability to move
✔ an accident that results in a blow to the head
✔ uncontrollable bleeding
✔ high fever accompanied by confusion and delusions
✔ difﬁculty breathing
✔ has no signs of breathing (no movement or response to touch or voice)
✔ repeated or forceful vomiting; is vomiting blood or is bleeding from the rectum
✔ failure to urinate for more than twelve hours
✔ sudden slurring of speech, loss of vision or balance, extreme weakness
✔ violent or uncontrollable behavior
✔ swallowed a poisonous substance
✔ has had a seizure
✔ has a severe headache and slurred speech
✔ has pressure or severe pain in the abdomen that does not go away
✔ if moving the person could cause further injury
✔ if trafﬁc or distance would cause a life-threatening delay in getting to the hospital
✔ if the person is too heavy for you to lift or help
Ambulance service is expensive and may not be covered by insurance. Use it when you believe there is an emergency.
In An Emergency
Step 1: Call 911.
Step 2: Care for the victim.
Also call 911 for emergencies involving ﬁre, explosion, poisonous gas, fallen electrical wires, or other life-threatening situations.
Items to Take to ER
insurance policy numbers
a list of medical problems and medications being taken
the personal physician’s name and phone number
the name and number of a relative or friend of the person in your care
your own wallet, with identiﬁcation, credit card, and some cash for food, reading material
a pair of shoes, clothes, and a coat to be worn home if the person is not admitted to the hospital.
If the person in your care has signed a Do Not Resuscitate (DNR) order, have it available to show the paramedics. Otherwise, they are required to initiate resuscitation (reviving the person). The order must go with the patient. The Do Not Resuscitate order must be with the patient at all times.
Make sure 911 is posted on your phone or ideally is on speed-dial. Keep written driving instructions near the phone for how to get to your house. If you have a speakerphone, use the speaker when talking to the dispatcher. This way, you can follow the dispatcher’s instructions while attending to the emergency.
Any chest pain that lasts more than a few minutes is related to the heart until proven otherwise. CALL 911 IMMEDIATELY. Don’t wait to see if it goes away. Danger signs include—
pain radiating from the chest down the arms, up the neck to the jaw, and into the back
crushing, squeezing chest pain or heavy pressure in the chest
shortness of breath, sweating, nausea and vomiting, weakness
bluish, pale skin
skin that is moist
If the person is unresponsive (no movement or response to touch or voice), call 911. Be prepared to start CPR.
Courses in CPR are available from your local American Red Cross, hospital, or other agency.
Taking Care of Yourself
Better Sleep for Better Dieting
If you are trying to lose weight, get a sufﬁcient amount of sleep. If you are not getting enough sleep while dieting, you may be hungrier and struggle to adhere to the regimen.
Sounder sleep rules:
Reserve your bedroom for only sleep and intimacy. Make your bedroom a sanctuary from the normal hustle and bustle of life.
Make a sleep schedule. Before that sleep period starts, give yourself time to unwind slowly. Dim the lights in your bedroom an hour before sleep.
Make sure your room is cool at around 67 degrees.
Don’t eat a large meal two to three hours before going to sleep.
Limit alcohol. It can help you fall asleep more quickly, but later it disrupts sleep.
Avoid caffeine for at least three hours before going to sleep.
Most of all try to clear your mind of hurts, worries and future planning.
Source: Annals of Internal Medicine; New York Times; WebMD
Don’t Fall – Be Safe
Messy Floors? Are papers, magazines, books, shoes, or other objects strewn on the ﬂoor? Always keep objects off the ﬂoor.
Life is ten percent what you make it and ninety percent how you take it!
DOCTOR: Breathe in and out.
PATIENT: Is there any other way?
A major cause of emergency room visits for frail or demented older adults is dehydration, which occurs when a person is either not getting enough liquids or excreting too much urine. The most common symptom is headache.
React FAST—The Cincinnati Stroke Scale is used by EMTs to identify a stroke. The acronym FAST is for quick identiﬁcation of stroke symptoms:
F FACE—Facial Droop: Have the person smile or show teeth. Is the smile even or lop-sided?
Normal: Both sides of the face move equally or not at all.
Abnormal: One side of the patient’s face droops.
A ARM—Motor Weakness: Check for arm drift: close eyes, extend arms, palms up
Normal: Arms remain extended equally, or drift equally or do not move at all.
Abnormal: One arm drifts down when compared with the other.
S SPEECH—Have the person repeat, “You can’t teach an old dog new tricks.”
Normal: The phrase is repeated clearly and correctly.
Abnormal: Words are slurred, abnormal, or they can’t speak.
T TIME—Last Seen Normal: This is important in determining the type of treatment they receive.
The FAST test is a helpful tool that people can use to reduce the time to treatment, because time lost is brain lost.
Emergency situations are common when caring for a person with chronic illness. Many injuries can be avoided through preventive measures. When a crisis does occur, use common sense, stay calm, and realize that you can help. Read the issue and answer True or False to the questions below.
1. A person with dementia can fall and break a bone, and not complain of pain. TF
2. You should not try to take the person to the emergency room on your own. TF
3. If the person in your care has signed a Do Not Resuscitate (DNR) order, have it available to show the paramedics. TF
4. Ambulance service is expensive and may not be covered by insurance. Use it when you believe there is an emergency. TF
5. A major cause of emergency room visits for frail or demented older adults is dehydration. TF
6. When one side of a person’s face suddenly droops, it may be a warning sign of stroke. TF
7. Any chest pain that lasts more than a few minutes is related to the heart until proven otherwise. Call 911 immediately. TF
8. Also call 911 for emergencies involving ﬁre, explosion, poisonous gas, fallen electrical wires, or other life-threatening situations. TF
9. High fever accompanied by confusion and delusions is not an emergency. TF
10. A person’s failure to urinate for more than twelve hours can wait until the next scheduled doctor’s visit. TF
KEY: 1. T; 2. T; 3. T; 4. T; 5. T; 6. T; 7. T; 8. T; 9. F; 10. F
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