Atypical presentation: MI or infection may appear as weakness, confusion or a fall.
Before you read
Test yourself first: 5 questions
Question 1 of 5
In the SAMPLE history, what does the 'L' stand for?
Answer: A. SAMPLE is Signs and symptoms, Allergies, Medications, Past medical history, Last oral intake and Events leading up to the problem. Last oral intake matters for patients who may need surgery or who have a diabetic problem.
Question 2 of 5
Two patients both have crackles. Patient A has them only over the right lower back, with fever and a productive cough. Patient B has them over both lower backs, with swollen ankles and breathlessness when lying flat. The distribution points toward:
Answer: A. Where a sound is heard matters as much as what it is. Crackles confined to one area with fever and a productive cough suggest a localized process such as pneumonia, while crackles at both bases with ankle swelling and orthopnea suggest fluid backing up into both lungs. Crackles have several causes, so treating them as one process discards the most useful information, and bronchospasm produces wheezes, not crackles.
Question 3 of 5
A patient with deeply pigmented skin has a pulse oximeter reading of 92% and looks mildly short of breath. Current evidence about oximeter accuracy suggests you should:
Answer: A. Studies and regulatory reviews have found that pulse oximeters can overestimate oxygen saturation in patients with darker skin pigmentation, so hypoxia may be hidden behind a borderline reading. The error runs toward a falsely high number, not a falsely low one, and moving the probe does not remove it. The reading is weighed against work of breathing, mental status and skin findings.
Question 4 of 5
An adult's radial pulse is easy to find and strikes your fingers forcefully. This quality is described as:
Answer: A. Bounding describes a strong, full pressure wave, and quality is recorded alongside the rate because two patients at 100 beats a minute can have completely different perfusion. Thready is the opposite finding — weak and easily obliterated — so confusing the two would reverse what you are telling the next provider about this patient.
Question 5 of 5
The back of a supine trauma patient is best examined:
Answer: A. The roll is usually the only unhurried look you will get at the posterior surface, so the exam happens during the movement you were already making. Reaching blindly underneath finds far less than a direct look, and waiting for a complaint misses the patients who cannot feel or report what is back there.
Keep the streak going with more questions like these, each with a full rationale.
Key points to remember
- Atypical presentation: MI or infection may appear as weakness, confusion or a fall.
- Beta blockers can prevent a fast pulse, so shock may look stable.
- Blood thinners turn a minor head bump into a possible brain bleed.
- Ask what caused a fall — the fall may be the symptom of a medical problem.
- New confusion is delirium until proven otherwise; ask family about the baseline.
Field priorities
- Low threshold for spinal motion restriction after a ground-level fall.
- Bring the medication list or containers to the hospital.
- Suspected abuse or neglect: document objectively and report per law.
Coaching the patient
- Normal vital signs in an older patient on heart medications may be false reassurance.
Red flags: act now
- A fall on a blood thinner
- New confusion with fever
- Injuries that do not match the story
Geriatric Patients: FAQs
What are the priority actions for Geriatric Patients in the field?
Low threshold for spinal motion restriction after a ground-level fall. Bring the medication list or containers to the hospital. Suspected abuse or neglect: document objectively and report per law.
What findings in Geriatric Patients change your plan or your transport decision?
A fall on a blood thinner. New confusion with fever. Injuries that do not match the story.
What do I need to know about Geriatric Patients for the NREMT?
Atypical presentation: MI or infection may appear as weakness, confusion or a fall. Beta blockers can prevent a fast pulse, so shock may look stable. Blood thinners turn a minor head bump into a possible brain bleed. Ask what caused a fall — the fall may be the symptom of a medical problem.
What should the crew communicate or document for Geriatric Patients?
Normal vital signs in an older patient on heart medications may be false reassurance.
