Author Archives: Christina Shenvi

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 | Leave a 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

New Geriatric ED Accreditation – and why you should care

The way we currently provide geriatric emergency care is not sustainable. With the growing aging population, the dwindling medicare dollars, and the recognition that we need to improve the quality of geriatric care, we have to find ways to transform … Continue reading

Posted in Systems and Administration | 2 Comments

Preventing Falls in the Elderly: An EMS Story

The risk of falls increases as we age. Unfortunately, so does the risk of injury, morbidity, and mortality following a fall. Falls risk is considered a geriatric syndrome, with multi-factorial causes. Falls are a the #1 cause of trauma-related mortality … Continue reading

Posted in Medications and Adverse Drug Events, Systems and Administration, Trauma | 2 Comments

Practical Tips for Providing Palliative Care in the ED

ACEP’s 2013 Choosing Wisely campaign identified engaging palliative care or hospice services in the ED as one of their 10 recommendations. Palliative care can help with symptom management, support families and patients, and help clarify their goals of care. Most … Continue reading

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Eye Emergencies in the Elderly – Part 2

This is a continuation of our discussion of Eye Emergencies in the elderly with ophthalmologist and retina specialist, Dr. Bryan Hong. Many thanks to the Life in the Fast Lane blog for including eye emergencies part 1 in their LITFL … Continue reading

Posted in Ophthalmology | Tagged , | 3 Comments

Eye Emergencies in the Elderly – Part 1

Eye concerns are a common reason for elderly patients to visit the ED. Their causes can range from benign to serious, time-sensitive, vision-threatening entities. In this episode, ophthalmologist and retina-specialist Dr. Bryan Hong talks us through his approach and initial … Continue reading

Posted in Ophthalmology | 5 Comments