Gemcast

Chris Carpenter, one of the authors of the Geriatric ED guidelines, presents 5 high-impact, low-cost ways to make your ED and your practice more geriatric-friendly. For the full show notes with references and to leave comments, see: https://gempodcast.com/2016/06/29/5-ways-to-geriatricize-your-ed/ Geriatric EDs, or Senior EDs, have been popping up around the country. The idea behind them is that having a separate space, a distinct staff, and specialized protocols, can help provide better care to older adults. However, for many EDs and hospital systems this is simply not feasible. In this episode, Chris Carpenter (@GeriatricEDnews) presents five high-yield, low-cost ways that those of us working in non-senior EDs can take some of the principles of geriatric emergency medicine and apply them either to our own practice or implement them in our own EDs, without a lot of funding. For more about Geriatric EDs, check out this ALiEM blog post. https://www.aliem.com/2014/geriatric-emergency-departments-coming-hospit

Jeff Kline talks about PEs in older adults. What's different and what's the same for older vs younger patients? Find out here! See gempodcast.com/2016/06/02/pulmonary-emboli-in-older-adults/ for a full description, links, and to leave comments! Not a day goes by that an Emergency Physician doesn’t at least consider PE in a patient who presents with chest pain, dyspnea, or syncope. We have become familiar with using risk stratification tools like the Wells Score and the PERC criteria. But what do you do in older adults? All of them will automatically NOT be PERC negative because of their age. In this episode, with PE guru Jeff Kline, we discuss the presentation of PE in older adults, including the demographics, diagnosis, and how treatment may differ from younger adults in small, sub-massive, and massive PEs. Selected References: 1. Zondag W, Vingerhoets LM, Durian MF, et al. Hestia criteria can safely select patients with pulmonary embolism for outpatient treatment irrespective of right ventricular funct

Tim Platts-Mills shares his pearls about pain management for older adults in the ED. See here to leave a comment: https://gempodcast.com/2016/05/02/pearls-and-pitfalls-of-pain-management-in-older-adults/ Pain is the number one reason why people seek care in the Emergency Department (ED). One major goal of acute care is diagnosing the cause of the pain, but another is helping relieve the suffering associated with pain. In older adults, some of the risks of pain management with opioids are amplified, such as the risk of sedation and falls. With NSAIDs, there is a higher risk of acute renal insufficiency and electrolyte abnormalities, as well as cardiovascular risks with longer treatment. How should we approach acute pain management in the ED, and on discharge in older patients? In this podcast episode, Tim Platts-Mills, an expert and researcher on pain in older adults talks us through some ideas for non-opiates, opiates, and other adjuncts. We discuss some of the risks of over-treatment and under-treatment,

Bryan Hayes and David Juurlink explain why several common meds we use in the ED can cause dangerous complications for older patients. See http://gempodcast.com/2016/03/30/dangerous-med-combos-in-older-adults/ to leave a comment. Look twice at the med list before you prescribe these! Two distinguished guests join me this month, David Juurlink (@DavidJuurlink) and Bryan Hayes (@PharmERToxyGuy) to discuss medication interactions. There are many medications that we commonly prescribe in the ED that can have potentially deadly side effects when combined with other meds that a patient is already on. It is important to always check the patient’s medication list prior to writing a new script. We present two examples of clinical cases in which commonly used medications could prove dangerous in combination with other medications: cellulitis, and a community-acquired pneumonia. We discuss potential side effects from medication interactions (with a little pathophysiology thrown in), and some alternative medications tha

Katren Tyler and Dane Stevenson talk about their protocolized pathway to make sure patients with hip fractures get the best care possible. See http://gempodcast.com/2016/03/01/hip-fracture-management-pathways-in-older-adults/#more-130 for the full shownotes and to leave a comment! Hip fractures are a common injury among older adults and have a staggering one-year mortality of 20-30%. In this episode we discuss a multi-disciplinary pathway to improve the acute care of patients with hip fractures. It can help standardize care, improve pain control, decrease pain-related delirium, reduce the time from the ED to the operating room, and decrease the hospital length of stay. Also, if you have never heard of the fascia iliaca compartment block for pain management in patients with hip fractures, this could be practice-changing for you! References and Resources: Femoral Nerve Block podcast from the ultrasound podcast: http://www.ultrasoundpodcast.com/2012/03/episode-24-femoral-nerve/ Fascia Iliaca block Video: h

May Yen, toxicologist, talks about Digoxin and CCB toxicity in older adults. For the full description and to leave comments, please go to: http://gempodcast.com/2016/02/11/geriatric-toxicology-part-3-digoxin-and-ccbs/ Connect on twitter: @gempodcast Digoxin and Calcium Channel Blockers are both medications that can cause unstable bradycardias. Patients who overdose on them can present extremely ill-appearing, and require rapid intervention and stabilization. In this final geri-tox episode, Dr. May Yen talks about identifying and managing patients, particularly older adults, with these overdoses. Who needs digibind? How much insulin is used in high-dose insulin euglycemic therapy? What are some last ditch efforts for severe calcium channel blocker overdoses? We also drop some board review pearls. For example, those halos classically associated with cardiac glycosides such as digoxin seem to be much more prevalent on board exams than in real life. Image credit: en.wikipedia.org/wiki/File:Van_Go…_Art_Projec

May Yen describes the signs, symptoms, and treatment of acetaminophen overdoses in older adults. For the Show Notes, see the gemcast website: http://gempodcast.com/2016/01/11/geriatric-toxicology-part-2-acetaminophen/ Connect on twitter: @gempodcast Acetaminophen overdoses can be deadly if they are not rapidly identified and treated. While the treatment is relatively simple, there are still subtleties and ambiguities. How do you identify who needs treatment? Which patients should be transferred to a facility that has liver transplantation capabilities? What are “line-crossers”? In this episode, May Yen talks us through some of the finer points of identifying and managing acute and chronic acetaminophen overdoses, particularly as it relates to older adults. Image Credit: https://en.wikipedia.org/wiki/Paracetamol#/media/File:Tylenol_rapid_release_pills.jpg Sound credits: sounds from freesound.org by Jobro and HerbertBoland

May Yen talks us through acute and chronic salicylate toxicity in older adults, the symptoms, and management. For the Show Notes, see the gemcast website: http://gempodcast.com/2015/12/15/geriatric-toxicology-1-salicylates/ Connect on twitter: @gempodcast Toxicologic emergencies can present differently in older adults compared with younger patients. The physiologic changes of aging make older patients more prone to accidental overdoses because of a narrowed therapeutic window. In this podcast, toxicology-trained Emergency Physician, Dr. May Yen, talks about why older adults are at risk for therapeutic misadventures. We then discuss the management of acute and chronic salicylate toxicity. Patients with severe salicylate overdoses can be some of the sickest and most difficult to manage patients in the ED. This will be part one of a series on geriatric toxicology. Stay tuned for 3 more cases in future episodes! Image credit: https://it.wikipedia.org/wiki/Salicilati Sound credits: sounds from freesound.org b

For the Show Notes, see the gemcast website: http://gempodcast.com/2015/11/11/high-risk-medications-and-adverse-drug-events/ Adverse drug events (ADEs) are a major problem among older adults who present to the Emergency Department. ADEs come in 5 types. 1 in 6 hospitalizations among older adults involves an ADE, and half of the hospitalizations for ADEs are deemed preventable. What medications should be used with caution or avoided in older adults? What are safer alternatives? In this podcast we discuss the types of ADEs, which patients are at greatest risk, the highest risk medications, alternatives to the high-risk medications, and ways to prevent ADEs. Leah Hatfield, an ED pharmacist, shares her wisdom. References: 1. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015. 2. Hanlon JT, Semla TP, Schmader KE. Alternative medications for medicati

Judith Tintinalli discusses her thoughts about caring for an older patient with a severe ICH as part of a multidisciplinary team. For the show notes and blog site, see: http://gempodcast.com/2015/11/11/15/ What does Dr. Tintinalli do when she has a dying patient and a family who needs help to make decisions and understand the options? – She gets involved. She calls the PCP. She gets palliative care on the line. She advocates for the patient to help make sure their wishes are understood and honored. There comes a time when you go from prolonging life to prolonging death. Knowing when that point is can be hard. Listen to hear her thoughts in this post from 10/2015. There are many models for how palliative care can work in an ED. We can provide it ourselves to a certain extent, and in some cases, can consult palliative care services to help with end-of-life decisions. But we should do something to make sure we consider the patient’s wishes before performing aggressive measures that could leave the patient wi

Kevin Biese describes the signs and symptoms of delirium in older adults, and drops some pearls on how to manage it safely. For the shownotes and blog site, see: http://gempodcast.com/2015/11/11/diagnosing-and-managing-delirium-in-older-adults/ Welcome to GEMCAST! In this inaugural episode, first published 09/2015, Kevin Biese talks us through some practical tips for preventing, identifying, and managing delirium in older adults in the Emergency Department. Delirium is incredibly common among older adults in the ED, but is easy to miss. It is also an independent predictor of 6 month mortality. How is it diagnosed? Why does it matter that we identify it? How can you prevent it? How do you safely treat symptoms of agitation in an older adult? How can you differentiate it from dementia in the acute care setting? – Take a listen. References: 1. Barrio K, Biese K. Delirium, dementia, and other mental health disorders of older adults. In: Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Tintinalli’s emergency me