Dr. Kusum Mathews is a pulmonary and critical care physician and researcher at Mt. Sinai in NYC. She staffed the first week of her hospital’s COVID ICU. The week started off with only a few COVID-19 positive patients and escalated to having patients spilling over into multiple ICU areas by the end of the week. Dr. Mathews discusses her experiences with vent management, the ethics of vent distribution, and coping mechanisms in the stressful and challenging working environment caring for critically ill patients with COVID-19.
Week one in the COVID ICU
Why COVID-19 is a Geriatric Emergency
We are in the midst of the 2020 COVID-19 pandemic. The mortality is highest in older adults. Dr. Teresita (Tess) Hogan and a team of Emergency Physicians recently wrote an article on things we should think about as we care for and work to protect our older patients. In this episode, Dr. Hogan and I discuss some of the unique challenges in preventing spread in this population, based on her paper in the Journal of Geriatric Emergency Medicine on COVID-19 in the elderly.
Posted in General Principles, Infections
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Four Models of Care for Geriatric EDs
Many EDs around the world are working to become Geriatric EDs or geriatric-friendly EDs. Dr. Lauren Southerland led a group that looked at what models of care different EDs were using to become accredited geriatric EDs. They found four basic themes or models. Here we discuss the four models, and why one or the other may work best in a given health care system.
Posted in Systems and Administration
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Ten Commandments of Geriatric EM Care
Christian Nickel, an Emergency Physician in Basel, Switzerland, has developed 10 commandments (or suggestions) for providing high quality geriatric EM care. This is a dense, high-yield episode in which we cover a wealth of practical tips for improving the care of older patients.
Principles of Geriatric EM Care
The Greatest Generation. There’s a reason the oldest patients in our Emergency Departments have earned this title. They’re resilient, stoic, and sometimes even sneaky. They’re our absolute favorite patients to care for. And if your ED is anything like ours, there are days where it seems like the average age in the department is over 75. In this episode, Paul Dekoning, MD, and Lauren Bailey, MD, PhD discuss some of the unique aspects of geriatric emergency care, how they present (and how they don’t), as well as some tips and tricks we’ve learned along the way. While some of these tips may seem tongue-and-cheek, we’ve found them to be reliable and easy to remember. Listen for ideas, wit, and wisdom you can use on your next shift.
Posted in General Principles
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How to Do a Discharge Risk Assessment in the ED
For older patients, there are risks of being discharged home, but also risks of being admitted to the hospital. In some cases in the ED the decision to admit or discharge a patient is not cut and dry. In this episode, Dr. Lauren Southerland and I talk about some of the issues and walk through how to do a discharge risk assessment. This podcast is inspired by a recent paper published by Dr. Southerland with colleagues in the US, Australia, and New Zealand that can be found here.
Hypertensive Emergency Management with Clevidipine
If you haven’t used clevidipine for hypertensive emergencies, you may want to give it a try. It comes as a pre-mixed bottle, has a fast onset (2 minutes), you can titrate up at 90 second intervals, and the terminal half-life is 15 minutes! Its onset and half-life are very similar to propofol, so if the BP drops due to other factors (hemorrhage, loss of sympathetic tone, etc) then you can easily titrate it down.
Listen in to learn more about indications, dosing, titration, and potential contra-indications! You can listen by clicking the play button below, or subscribing to GEMCAST on iTunes. If you prefer to read the details, here is an article Leah and I wrote on the topic in EP Monthly.
Advance Care Planning – What does it all mean?
This month we are looking at advance directives, DNR orders, living wills, MOST, and POLST forms. If you don’t understand what all of those are, then you should definitely listen! I am joined by Drs. Ferdinando Mirarchi and Marie-Carmelle Elie who are researchers and leaders in the realm of palliative care and advance care planning.
Unfortunately, advance care planning is complicated by regional differences, policies, and differing scopes of definitions for orders. Listen for more information and ideas.
This episode is timed to coincide near April 16th which is National Healthcare Decisions Day! This exists (per their website here) “to inspire, educate, and empower the public and providers about the importance of advance care planning.”
Posted in Uncategorized
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Retiring the Term “Mechanical Fall” for Older Patients
ED physicians and APPs see older patients in the ED for falls every. single. shift. On this episode, geriatric EM expert Shan Liu talks about preventing future falls from the ED, and the fact that we should retire the term “mechanical fall”. Unfortunately, this term is potentially misleading and can downplay the serious nature of the patient’s falls risk.
Falls are very common among older adults and come with a high risk of future falls and also of trauma-related morbidity and mortality. There is more we could be doing in the ED to prevent future falls.
Posted in Systems and Administration, Trauma
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Be ADEPT: An approach to the older patient with confusion or agitation
Older adults often present to the ED for or with confusion or agitation. It is important to have a framework for assessing these patients, diagnosing the presence of delirium or dementia, looking for underlying causes, preventing worsening, treating the underlying condition, and sometimes treating the symptoms. The ADEPT tool is the newest one in a toolbox of resources being released by ACEP to provide quick access to basic clinical guides while on shift. This episode is introduced by former ACEP president, Sandy Schneider, and covers the details of the ADEPT tool.
