Geriatric Emergency Medicine, An Issue of Clinics in Geriatric Medicine, E-Book

Christopher R. Carpenter

Description

This issue of Clinics in Geriatric Medicine features expert clinical reviews on Geriatric Emergency Medicine which includes current information on topics such as palliative medicine and emergency care, alternative management strategies, transitions of care, the emergency department observation unit and the older patient, generalized weakness, altered mental status, trauma management, acute pain management, acute visual changes, orthopedic emergencies, dizziness, palpitations, acute stroke syndromes, abuse and neglect, and electrolyte and endocrine emergencies.

Sujets

• Médecine
• Spécialités médicales
• Medical
• Geriatrics

Informations

• Publié par: Elsevier
• Date de parution: 28 février 2013
• Nombre de lectures: 0
• EAN13: 9781455771790
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Clinics in Geriatric Medicine
Geriatric Emergency Medicine
Christopher R. Carpenter, MD, MSc, FACEP, FAAEM
Emergency Medicine, Evidence Based Medicine, Washington University in St. Louis, Campus Box 8072, 660 S. Euclid Avenue, St. Louis, MO 63011, USA
ISSN  0749-0690
Volume 29 • Number 1 • February 2013
Table of Contents
Cover image
Title page
Contributors
Forthcoming Issues
Preface
Palliative Medicine and Geriatric Emergency Care
Opening remarks
Introduction
Recognizing unmet palliative needs in the emergency department
Communication
Palliative emergencies in the elderly
Symptom management
Ethical issues at EOL in the emergency department
Managing the elderly under hospice care in the emergency department
Referring an eligible emergency department patient to hospice care
Managing the actively dying patient in the emergency department
Summary
Evolving Prehospital, Emergency Department, and “Inpatient” Management Models for Geriatric Emergencies
Introduction
Prehospital geriatric care opportunities
The geriatric ED
Geriatric emergency care beyond the ED
The Hospital at Home model
Summary
Transitions of Care for the Geriatric Patient in the Emergency Department
Introduction
Methods
Results
Discussion
Summary
Emergency Department Observation Units and the Older Patient
Introduction
Development of emergency department observation units
Characteristics of emergency department observation units
Relationship of specific observation unit protocols to the care of older adults
Medicare implications of observation status
Summary
Generalized Weakness in the Geriatric Emergency Department Patient
Introduction
A nebulous complaint
Summary
Altered Mental Status in Older Patients in the Emergency Department
Introduction
The spectrum of acute brain dysfunction
Risk factors for developing acute brain dysfunction
The effect of acute brain dysfunction in the emergency department on outcomes
Underrecognition of delirium in the emergency department
Assessment of the dysfunctional brain in the emergency department
Initial management of patients with altered mental status in the emergency department
The diagnostic evaluation of patients with acute brain dysfunction
Emergency department management of patients with delirium
Disposition
Communication during transitions of care
Improving delirium recognition in the emergency department: challenges and future research
The American Delirium Society
Summary
Trauma in the Older Adult
Epidemiology
Mechanisms of geriatric trauma
Triage and evaluation of the geriatric patient with trauma
Comorbidities in geriatric trauma
Patterns of injury and specific injuries
Intensive care management of geriatric patients with trauma
The trauma team for geriatric patients
Outcomes in geriatric trauma
Acute Pain Management in Older Adults in the Emergency Department
Introduction
Summary
Disclosure
Acute Visual Changes in the Elderly
Introduction
Summary
Geriatric Dizziness
Introduction
Epidemiology
Temporal characteristics of dizziness
The underlying cause of dizziness
Risk factors for dizziness
Impact of dizziness
The diagnostic approach to the patient with dizziness
Treatment of dizziness
Outpatient and prehospital management of the dizzy patient
ED management
Clinical and medicolegal pitfalls
Discharge from the ED
Future directions
Summary
Emergency Management of Palpitations in the Elderly
Introduction
Quality of life
Definition
The aging heart
Pathophysiology of cardiac arrhythmias
Epidemiology of palpitations
Cause
Presentation of disease
Diagnosis and historical clues
Cardiac arrhythmias as a cause of palpitations
Standard 12-Lead EKG
Ambulatory monitoring
External monitors
Implantable monitors
Choice of device
Emergency department management
Atrial fibrillation
Atrial flutter
Inappropriate sinus tachycardia
Premature ventricular and atrial contractions
Nonsustained ventricular tachycardia
Ventricular tachycardia
Summary of ED management
Summary
Treating the Elderly Stroke Patient
Overall burden of ischemic stroke
Stroke within the elderly community
Disparities in treatment rates between the elderly and their younger counterparts
Small numbers of elderly subjects in randomized controlled trials
Outcomes based on comparison of treated patients greater than 80 versus less than 80 years of age
Outcomes based on treated versus not treated in greater than 80 years old cohort
Early neurologic improvement in the elderly
Endovascular treatment in the elderly
Even smaller cohort of patients greater than 90 years old
Age and risk of hemorrhagic transformation after thrombolysis
Recent advances in knowledge
ED management of stroke: a brief overview
Future directions
Controversies in treatment
Summary
Elder Abuse and Neglect
Introduction
History
Definition of key terms
Summary
Appendix
Acute Kidney Injury, Sodium Disorders, and Hypercalcemia in the Aging Kidney
Introduction
Renal aging
Structural changes in the aging kidney
Functional changes in the aging kidney
Hyponatremia
Hypercalcemia
Acute renal failure in geriatric patients
Concluding remarks
Index
Contributors
Forthcoming Issues
Preface

Christopher R. Carpenter, MD, MSc, FACEP, FAAEM
American College of Emergency Physicians Geriatric Section Chair, Associate Professor, Emergency Medicine, Director of Evidence Based Medicine, Washington University in St Louis, Campus Box 8072, 660 S. Euclid Avenue, St Louis, MO 63011, USA
E-mail address: [e-mail]


Christopher R. Carpenter, MD, MSc, FACEP, FAAEM, Guest Editor
Aging baby-boomers present an unprecedented challenge to the house of twenty-first century medicine, including the contemporary emergency department. This challenge was recognized over 2 decades ago when the first Geriatric Task Force in emergency medicine convened to highlight the issues that a generation of physicians now confronts. Ultimately, the Task Force combined efforts with Geriatricians to yield clinicians and researchers focused on improving emergency care for older adults. These challenges extend well beyond the traditional science of medicine to include ethical, logistical, and fiscal concerns that clinicians in overbooked offices or overcrowded emergency departments around the world face every day. Technological advances merge an increasingly expensive and fragmented health care system with an aging population larger than history has ever seen.
The foundation for efficient and cost-effective care of geriatric adults rests on collaborative protocols and reliable transitions of care. When health is compromised by acute disease, or by chronic disease decompensation that exceeds the individual’s capacity to recover independently, emergency department care often provides the initial stage toward recuperation. Sitting at the crossroads between the inpatient and the outpatient world, the emergency department provides ready access to lab and imaging studies that might take weeks to obtain in other settings. One key challenge for the modern physician is to balance the incessant and expensive advancement of technology with the likelihood of return to health while effectively communicating diagnostic and therapeutic options with patients and caregivers. To accomplish these objectives, geriatric adult health care providers must understand the art and science across a broad spectrum of medical specialties, including emergency medicine.
Effective and reliable health care of the older adult requires a village. In this issue of Clinics in Geriatric Medicine , authors provide an up-to-date evidence-based review of common geriatric presenting complaints in today’s emergency department. The perspectives include Medicine and Surgery specialists, as well as emergency physicians. The range of issues spans a vast range of complaints and pathology in the emergency department, from the elderly patient with nonspecific complaints like dizziness or weakness to the frail trauma victim. Evolving management models are also explored. For example, one article defines and reviews new concepts like the geriatric-specific emergency department and Hospital at Home care, both of which provide options to restructure the health care delivery system. The role of observation medicine is also reviewed. The concept of transitions of care is defined with pragmatic ideas to enhance the exchange of information between patients, providers, and other stakeholders during the tenuous management of acute disease. Another article explores the opportunity and appropriate settings in which to provide palliative care in the emergency department. This issue provides these discussions and significantly more, from a group of clinicians and investigators dedicated to the continual advancement of geriatric care.
This issue is dedicated to clinicians of all specialties who alleviate suffering in geriatric patients every day throughout the months and years that become a career. Geriatric adults represent a “canary in the coal mine” for our health care system because if we as a profession can effectively care for this challenging population we will undoubtedly provide exceptional management for the nonelderly. Personally, I owe a tremendous debt to each author group for providing thoughtful and well-referenced reviews on particularly challenging topics. All of these author groups were carefully selected based on their clinical expertise, passion for geriatrics, and research profile. I would also like to thank Yonah Korngold and the Elsevier staff for their unyielding guidance and support throughout the various stages of development of this issue. I acknowledge my family and Washington University colleagues who provided me with time and a listening ear as many ideas were formulated