Urinary Infections and Catheters in Older Adults

liquid-gold.jpgUTIs, 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 discuss how to diagnose a UTI, how to pick medications, dos and don’ts of when to place a urinary catheter, and how to create a protocol at your institution to reduce IUCs and CAUTIs. You may think this topic is simple, cut, and dry, but it is not. Treating a non-existent UTI can do harm, because of all the side effects of medications. But not treating a true UTI can also do harm, as it can lead to sepsis. Placing urinary catheters sometimes is absolutely required, and other times is less clear. It too has risks and benefits. Particularly in frail elderly patients, UTIs and also IUCs can lead to delirium and deconditioning.

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

Trauma in Older Adults

heart crossOlder 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 to avoid missing injuries in older adults. Falls are the most common cause of trauma in older patients, and understanding how falls are a geriatric syndrome can help you understand how to help prevent future falls.

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

New Geriatric ED Accreditation – and why you should care

time-for-a-change-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 the systems in which we care for our older patients. Now there is a new step forward in this direction: EDs around the country can become accredited through ACEP as a Geriatric EDs (or geriatric-friendly ED) at three different levels. This accreditation is setting a new standard for geriatric care and for what it means to be a geriatric ED (GED). The accreditation is set up to work for any hospital from the smallest, rural ED, to a large, urban center with its own, separate GED space. Chris Carpenter, a major force behind the GED guidelines and accreditation, talks with me about why this is important, why you should care, and responds to potential criticisms and concerns.

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Posted in Systems and Administration | 2 Comments

Preventing Falls in the Elderly: An EMS Story

step-98822_1280The 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 in older adults, and a major cause of ED visits, hospital admissions, and admission to nursing facilities. Often, a patient at high risk for falls is not identified until after they have suffered an injury. Orange County EMS developed a system to help identify patients who were at high risk for falls, perform a comprehensive home visit, and connect those individuals with appropriate services to help reduce the rate of future falls and help those patients maintain their independence and functionality in their home environment.

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

Practical Tips for Providing Palliative Care in the ED

holding hands wikimediaACEP’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 EDs, however, do not have real-time palliative care consults available at all times, or at all! So the emergency physician is usually the person providing palliative care for patients in the ED. In this episode Alisha Benner discusses what palliative care is and shares pearls for better symptom management, communication with patients, and active management at the end of life.

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Eye Emergencies in the Elderly – Part 2

eyes-1574829_960_720This 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 Weekly Review!

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Posted in Ophthalmology | Tagged , | 3 Comments

Eye Emergencies in the Elderly – Part 1

L0036581 A selection of glass eyes from an opticians glas eye case.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 management of four common ophthalmologic emergencies.

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Posted in Ophthalmology | 5 Comments

How to Reverse Oral Anticoagulants

brain-2062057_1920.jpgThe number of new oral anticoagulants has grown dramatically in the last few years. And with that growth has come the need for new reversal agents. Reversing anticoagulation in patients with acute intra-cranial hemorrhages can be complex and dependent on what medication your hospital stores. It is important to know what is out there, what you can use, and how effective it is likely to be.

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

How to Identify and Intervene in Cases of Elder Abuse

eye-626870_960_720Elder abuse is a common and under-recognized problem among older adults. In the Emergency Department, we are uniquely positioned to identify patients who may be at risk. In this episode, Tony Rosen (https://weillcornell.org/anthonyrosen), an Emergency Physician and researcher with fellowship training in Geriatric Emergency Medicine, who works at Cornell in NYC discusses what constitutes elder abuse, its prevalence, how to identify it, and what to do when you suspect it.

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Posted in Trauma | Leave a comment

The Atypical is Typical for ACS in Older Adults

pulse-trace.jpgChest pain is one of the most common reasons why people present to the ED. The chief complaint of “Chest Pain” typically triggers an automatic EKG, and potentially a workup for acute coronary syndrome (ACS). However, many patients who are having ACS do not present with chest pain. Instead, they may have dyspnea, diaphoresis, nausea, vomiting, abdominal pain, or other non-specific symptoms. Which patients are most likely to present this way? Older adults. In this GEMCAST, Amal Mattu talks about ACS presentations, workup, and management in older adults, and why the atypical is typical!

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Posted in Cardiology and Pulmonology | 2 Comments