Author Archives: Christina Shenvi

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, … Continue reading

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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 … Continue reading

Posted in Systems and Administration, Transitions of Care | Leave a comment

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 … Continue reading

Posted in Cardiology and Pulmonology, Medications and Adverse Drug Events | Leave a comment

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 … Continue reading

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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 … Continue reading

Posted in Systems and Administration, Trauma | 1 Comment

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 … Continue reading

Posted in Medications and Adverse Drug Events, Neurology and Psychiatry, Systems and Administration | Leave a comment

Are Orthostatic Vital Signs Helpful in the ED?

There is some confusion, disagreement, and misunderstanding surrounding orthostatic vitals in the ED. Older patients have a high rate of incidentally-found positive orthostatic vital signs, typically because of heart-rate changes. So emergency physicians may be reluctant to request orthostatics. However, … Continue reading

Posted in Cardiology and Pulmonology, Medications and Adverse Drug Events, Neurology and Psychiatry, Trauma | 1 Comment

Subdissociative Dose Ketamine in Older Adults? – Maybe

IV subdissociative dose ketamine (SDK) is used with increasing frequency for acute pain management in the ED. However, most studies have excluded older adults in assessing its efficacy and safety. In this episode, Sergey Motov (@painfreeED) discusses his recent paper “Intravenous … Continue reading

Posted in Medications and Adverse Drug Events | 3 Comments

Urinary Infections and Catheters in Older Adults

UTIs, UICs, and CAUTIs in older adults! In this episode, Mary Mulcare, EM and geriatric-EM-trained physician in NYC and I discuss how to diagnose UTIs in older adults, and the confounding factors of asymptomatic bacteriuria, sterile pyuria, and colonization. We … Continue reading

Posted in Infections, Medications and Adverse Drug Events | 1 Comment

Trauma in Older Adults

Older adults who suffer traumatic injuries have worse outcomes than younger patients. In this episode Dr. Zara Cooper (acute care and trauma surgeon at Brigham and Women’s hospital) and I discuss some of the reasons for this, and also ways … Continue reading

Posted in Medications and Adverse Drug Events, Trauma | 3 Comments