BOOK
Geriatric Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book
Brendan G. Magauran Jr | Kalpana N. Shankar | Joseph H. Kahn
(2016)
Additional Information
Book Details
Abstract
This issue of Emergency Medicine Clinics focuses on Geriatric Emergencies. Articles include: Recent Trends in Geriatric Emergency Medicine, Resuscitation of the Elderly, Pharmacology in the Geriatric Patient, Trauma and Falls in the Elderly, Sepsis and Infectious Emergencies in the Elderly, Evaluation of the Geriatric Patient with Chest Pain, Evaluation of Dyspnea in the Elderly, Abdominal Pain in the Geriatric Patient, Neurologic Emergencies in the Elderly, Evaluation of Syncope, Altered Mental Status and Delirium, and more!
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Geriatric Emergencies | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITORS | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Geriatric Emergency Medicine\r | vii | ||
| Preface: Geriatric Emergencies\r | vii | ||
| Current Trends in Geriatric Emergency Medicine\r | vii | ||
| Geriatric Resuscitation\r | vii | ||
| Pharmacology in the Geriatric Patient\r | vii | ||
| Geriatric Trauma\r | viii | ||
| Sepsis and Other Infectious Disease Emergencies in the Elderly\r | viii | ||
| Evaluation and Management of Chest Pain in the Elderly\r | viii | ||
| Dyspnea in the Elderly\r | viii | ||
| Abdominal Pain in the Geriatric Patient\r | ix | ||
| Neurologic Emergencies in the Elderly\r | ix | ||
| Evaluation of Syncope in Older Adults\r | ix | ||
| The Geriatric Emergency Department\r | ix | ||
| Altered Mental Status and Delirium\r | x | ||
| Palliative Care in the Emergency Department\r | x | ||
| EMERGENCY MEDICINE\rCLINICS OF NORTH AMERICA\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| November 2016 | xi | ||
| February 2017 | xi | ||
| May 2017 | xi | ||
| RECENT ISSUES | xi | ||
| May 2016 | xi | ||
| February 2016 | xi | ||
| November 2015 | xi | ||
| CME Accreditation Page | xiii | ||
| PROGRAM OBJECTIVE | xiii | ||
| LEARNING OBJECTIVES | xiii | ||
| ACCREDITATION | xiii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | xiii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | xiii | ||
| TO ENROLL | xiii | ||
| METHOD OF PARTICIPATION | xiv | ||
| CME INQUIRIES/SPECIAL NEEDS | xiv | ||
| Foreword: Geriatric Emergency Medicine | xv | ||
| REFERENCES | xvi | ||
| Preface: Geriatric Emergencies | xvii | ||
| Current Trends in Geriatric Emergency Medicine | 435 | ||
| Key points | 435 | ||
| BACKGROUND | 435 | ||
| UNITED STATES HEALTH SPENDING | 436 | ||
| GERIATRIC EMERGENCY DEPARTMENTS | 436 | ||
| FRAIL SENIORS | 440 | ||
| PREHOSPITAL CARE | 440 | ||
| SCREENING AND PREDICTION TOOLS | 441 | ||
| MEDICATION SAFETY | 442 | ||
| DETECTING DELIRIUM | 442 | ||
| TRAUMA AND FALLS | 443 | ||
| LONG-TERM CARE AND HOME HEALTH CARE | 445 | ||
| PALLIATIVE CARE | 447 | ||
| SUMMARY | 447 | ||
| AUTHOR'S NOTE | 447 | ||
| REFERENCES | 448 | ||
| Geriatric Resuscitation | 453 | ||
| Key points | 453 | ||
| INTRODUCTION | 453 | ||
| ETHICAL CONSIDERATIONS | 454 | ||
| RESUSCITATION | 454 | ||
| Airway | 455 | ||
| Breathing | 455 | ||
| Intubation | 456 | ||
| Circulation | 456 | ||
| DETECTING SHOCK | 457 | ||
| Hypovolemic/Vasodilatory | 459 | ||
| Cardiogenic | 463 | ||
| Obstructive | 463 | ||
| SUMMARY | 464 | ||
| REFERENCES | 464 | ||
| Pharmacology in the Geriatric Patient | 469 | ||
| Key points | 469 | ||
| INTRODUCTION | 469 | ||
| PATIENT EVALUATION OVERVIEW | 470 | ||
| PHARMACOLOGIC TREATMENT OPTIONS | 472 | ||
| Pathophysiology | 472 | ||
| Cardiovascular system | 472 | ||
| Respiratory system | 472 | ||
| Gastrointestinal system | 472 | ||
| Urinary system | 472 | ||
| Endocrine system | 472 | ||
| Nervous system | 473 | ||
| Pharmacology | 473 | ||
| Cardiac medications | 474 | ||
| Analgesics | 474 | ||
| Neurologic medications | 475 | ||
| Endocrine medications | 475 | ||
| NONPHARMACOLOGIC TREATMENT OPTIONS | 475 | ||
| COMBINATION THERAPIES | 477 | ||
| TREATMENT RESISTANCE/COMPLICATIONS | 478 | ||
| INTEGRATING CLINICAL PHARMACISTS IN THE EMERGENCY DEPARTMENT | 478 | ||
| SUMMARY | 478 | ||
| REFERENCES | 479 | ||
| Geriatric Trauma | 483 | ||
| Key points | 483 | ||
| INTRODUCTION | 483 | ||
| Epidemiology | 483 | ||
| Geriatric Anatomy and Physiology | 484 | ||
| Frailty, aging versus underlying disease | 484 | ||
| Head and neck | 484 | ||
| Chest | 484 | ||
| Cardiac | 484 | ||
| Pulmonary | 484 | ||
| Abdomen | 485 | ||
| Liver and kidney disease | 485 | ||
| Musculoskeletal | 485 | ||
| Fragile bones and skin | 485 | ||
| History: Mechanism of Injury | 485 | ||
| Falls | 485 | ||
| Mortality | 485 | ||
| Risk factors | 486 | ||
| Motor vehicle collision | 486 | ||
| Pedestrian struck | 486 | ||
| Clinical work-up | 487 | ||
| Triage/history of present illness | 487 | ||
| Injury severity score: is it helpful in trauma evaluation? | 487 | ||
| Past medical history/medications and reversal agents | 487 | ||
| Initial Management and Resuscitation | 488 | ||
| Do-not-resuscitate status | 488 | ||
| Assessment for unstable patients | 488 | ||
| Reversing anticoagulants | 488 | ||
| Diagnostic Evaluation | 489 | ||
| Head injuries | 489 | ||
| Cervical spine injuries | 490 | ||
| Thoracic trauma | 490 | ||
| Musculoskeletal injuries | 490 | ||
| Disposition | 491 | ||
| Summary | 491 | ||
| Special Situations | 492 | ||
| Elder abuse | 492 | ||
| Risk factors and types of elder abuse | 492 | ||
| Health impact of elder abuse | 492 | ||
| Management principles | 492 | ||
| Assessment | 492 | ||
| Capacity | 492 | ||
| Disposition | 492 | ||
| Reporting | 493 | ||
| Hypothermia in the elderly | 493 | ||
| Survival of elderly with hypothermia | 493 | ||
| Rewarming techniques | 493 | ||
| Suicide in the elderly | 493 | ||
| Observations in suicidal elders | 494 | ||
| Detecting suicidal ideation in the elderly | 494 | ||
| Treatment | 494 | ||
| REFERENCES | 494 | ||
| Sepsis and Other Infectious Disease Emergencies in the Elderly | 501 | ||
| Key points | 501 | ||
| INTRODUCTION | 501 | ||
| AGING AND INFECTION | 502 | ||
| SEVERE SEPSIS AND SEPTIC SHOCK | 503 | ||
| PNEUMONIA AND INFLUENZA | 507 | ||
| URINARY TRACT INFECTION | 510 | ||
| CENTRAL NERVOUS SYSTEM INFECTION | 512 | ||
| SKIN AND SOFT TISSUE INFECTIONS | 513 | ||
| EXPANDING INFECTIOUS DISEASE CONSIDERATIONS IN THE ELDERLY | 514 | ||
| SUMMARY | 514 | ||
| REFERENCES | 514 | ||
| Evaluation and Management of Chest Pain in the Elderly | 523 | ||
| Key points | 523 | ||
| ACUTE CORONARY SYNDROME | 524 | ||
| Definition | 524 | ||
| Presentation | 525 | ||
| Diagnostic Testing | 525 | ||
| Electrocardiograph | 525 | ||
| Cardiac enzymes | 526 | ||
| Risk Stratification | 526 | ||
| Management | 527 | ||
| Overview of Therapy | 527 | ||
| Antiischemic Therapy | 527 | ||
| Antiplatelet Therapy | 528 | ||
| Anticoagulation Therapy | 528 | ||
| Reperfusion Therapy | 529 | ||
| ST-elevation myocardial infarction | 529 | ||
| Non–ST-elevation acute coronary syndrome | 529 | ||
| Prognosis | 530 | ||
| AORTIC DISSECTION | 530 | ||
| Definition and Classification | 530 | ||
| Epidemiology | 530 | ||
| History and Physical Examination | 531 | ||
| Initial Diagnostic Tests | 531 | ||
| Electrocardiograph | 531 | ||
| d-Dimer | 532 | ||
| Chest radiograph | 532 | ||
| Helical computed tomography | 532 | ||
| MRI | 532 | ||
| Echocardiography | 532 | ||
| Aortography | 532 | ||
| Management | 533 | ||
| PULMONARY EMBOLISM | 533 | ||
| Presentation | 533 | ||
| Risk Stratification | 534 | ||
| Diagnosis | 534 | ||
| Treatment | 534 | ||
| PNEUMOTHORAX | 535 | ||
| History and Physical Examination | 536 | ||
| Diagnostic Testing | 536 | ||
| Treatment | 536 | ||
| Prognosis | 537 | ||
| ESOPHAGEAL PERFORATION | 537 | ||
| Presentation | 537 | ||
| Diagnosis | 538 | ||
| Treatment | 538 | ||
| SUMMARY | 538 | ||
| REFERENCES | 538 | ||
| Dyspnea in the Elderly | 543 | ||
| Key points | 543 | ||
| KEYWORD DEFINITIONS | 543 | ||
| Dyspnea | 543 | ||
| Elderly | 543 | ||
| INTRODUCTION | 544 | ||
| RELEVANT PHYSIOLOGY IN THE GERIATRIC POPULATION | 544 | ||
| Cardiovascular Physiology | 544 | ||
| Respiratory Physiology | 544 | ||
| APPROACH TO AN ELDERLY PATIENT WITH DYSPNEA | 545 | ||
| EVALUATION OF THE STABLE PATIENT | 545 | ||
| History | 545 | ||
| Physical Examination | 546 | ||
| Adjuncts to Physical Examination | 546 | ||
| Evaluation of the unstable patient | 548 | ||
| Evaluation | 548 | ||
| History | 548 | ||
| Physical Examination | 548 | ||
| Adjuncts | 548 | ||
| Treatment | 549 | ||
| Oxygen | 549 | ||
| Noninvasive positive pressure ventilation | 549 | ||
| Intubation | 549 | ||
| CAUSES OF ACUTE DYSPNEA IN ELDERLY PATIENTS | 550 | ||
| Pulmonary | 550 | ||
| Chronic obstructive pulmonary disease | 550 | ||
| Asthma | 550 | ||
| Parenchymal lung disease | 551 | ||
| Pneumonia | 552 | ||
| Pulmonary embolism | 552 | ||
| Pneumothorax | 553 | ||
| Allergic reaction | 553 | ||
| Cardiovascular | 555 | ||
| Heart failure (right, left, or biventricular) | 555 | ||
| Myocardial infarction/coronary artery disease | 555 | ||
| Valvular dysfunction (aortic stenosis) | 556 | ||
| SUMMARY | 556 | ||
| REFERENCES | 557 | ||
| Abdominal Pain in the Geriatric Patient | 559 | ||
| Key points | 559 | ||
| INTRODUCTION AND EPIDEMIOLOGY | 559 | ||
| PRESENTATION | 560 | ||
| Physiology | 560 | ||
| Polypharmacy | 560 | ||
| SPECIFIC CONDITIONS | 561 | ||
| Peptic Ulcer Disease or Upper Gastrointestinal Bleeding | 561 | ||
| Biliary Disease | 561 | ||
| Pancreatic Disease | 562 | ||
| Bowel Obstruction | 564 | ||
| Volvulus | 565 | ||
| Diverticulitis | 565 | ||
| Appendicitis | 566 | ||
| Abdominal Aortic Aneurysm | 567 | ||
| Mesenteric Ischemia | 567 | ||
| Extra-Abdominal Causes | 569 | ||
| General Management Strategies | 569 | ||
| SUMMARY | 570 | ||
| REFERENCES | 570 | ||
| Neurologic Emergencies in the Elderly | 575 | ||
| Key points | 575 | ||
| INTRODUCTION | 575 | ||
| ACUTE ISCHEMIC STROKE | 575 | ||
| TRANSIENT ISCHEMIC ATTACK | 580 | ||
| NONTRAUMATIC INTRACEREBRAL HEMORRHAGE | 581 | ||
| ANEURYSMAL SUBARACHNOID HEMORRHAGE | 583 | ||
| CHRONIC SUBDURAL HEMATOMA | 585 | ||
| TRAUMATIC BRAIN INJURY | 587 | ||
| SEIZURES | 588 | ||
| CENTRAL NERVOUS SYSTEM INFECTIONS | 591 | ||
| Community-Acquired Bacterial Meningitis | 591 | ||
| Spinal Epidural Abscess | 593 | ||
| SUMMARY | 593 | ||
| REFERENCES | 593 | ||
| Evaluation of Syncope in Older Adults | 601 | ||
| Key points | 601 | ||
| INTRODUCTION | 601 | ||
| EPIDEMIOLOGY | 602 | ||
| PATHOPHYSIOLOGY | 603 | ||
| CAUSE AND CLASSIFICATION OF SYNCOPE | 604 | ||
| Main Causes of Syncope | 604 | ||
| Unlikely Causes of Syncope | 605 | ||
| Transient ischemic attacks | 605 | ||
| Psychogenic syncope | 605 | ||
| DIAGNOSTIC EVALUATION | 605 | ||
| History | 605 | ||
| History of present illness | 606 | ||
| Past medical history | 606 | ||
| Medications | 606 | ||
| Structured syncope history | 607 | ||
| Physical Examination | 607 | ||
| Testing | 607 | ||
| Electrocardiogram | 607 | ||
| Orthostatic vital sign evaluation | 608 | ||
| Laboratory evaluation | 609 | ||
| Imaging | 609 | ||
| Non-emergency department testing | 609 | ||
| Outpatient testing | 610 | ||
| Treatment | 610 | ||
| Neurally mediated syncope | 610 | ||
| Arrhythmia monitoring | 611 | ||
| RISK STRATIFICATION IN SYNCOPE | 611 | ||
| The High Risk Features of Syncope | 611 | ||
| Heart disease | 612 | ||
| Arrhythmia | 612 | ||
| Clinical Decision Rules | 612 | ||
| San Francisco syncope rule | 612 | ||
| Osservatorio epidemiologico sulla sincope nel lazio score | 612 | ||
| Rose rule | 614 | ||
| Boston rule | 614 | ||
| Limitations of the Clinical Decision Rules | 614 | ||
| Outcomes in Syncope | 615 | ||
| Mortality | 615 | ||
| Recurrence | 615 | ||
| Falls | 615 | ||
| Benign Syncope | 615 | ||
| Near Syncope | 616 | ||
| EMERGENCY DEPARTMENT DISCHARGE OF ELDER SYNCOPE PATIENTS | 616 | ||
| Follow-up | 616 | ||
| Driving After Syncope | 617 | ||
| Quality of Life | 618 | ||
| COST | 618 | ||
| Overall Costs | 618 | ||
| Observation Units and Cost Control | 619 | ||
| SOLUTIONS, INNOVATIONS, AND GUIDELINES | 619 | ||
| A Structured Approach | 619 | ||
| EUROPEAN SOCIETY OF CARDIOLOGY GUIDELINES | 620 | ||
| A RECOMMENDED APPROACH TO EMERGENCY DEPARTMENT ELDER SYNCOPE EVALUATION | 620 | ||
| Structured History | 620 | ||
| Physical Examination | 622 | ||
| Electrocardiogram | 622 | ||
| Specific Testing or Observation in the Hospital | 622 | ||
| Disposition | 622 | ||
| SUMMARY | 622 | ||
| REFERENCES | 623 | ||
| The Geriatric Emergency Department | 629 | ||
| Key points | 629 | ||
| INTRODUCTION | 629 | ||
| Aging and Emergency Services | 630 | ||
| CONTEMPLATING A GERIATRIC EMERGENCY DEPARTMENT | 630 | ||
| Reasons to Consider a Geriatric Emergency Department | 630 | ||
| Defining Goals | 632 | ||
| Identifying Barriers | 632 | ||
| FINANCIAL ASPECTS | 633 | ||
| Medicare | 633 | ||
| Triple Aim | 633 | ||
| Cost | 633 | ||
| Revenue | 634 | ||
| Savings | 635 | ||
| THE GERIATRIC GUIDELINES | 635 | ||
| THE GERIATRIC EMERGENCY DEPARTMENT | 635 | ||
| Infrastructure | 637 | ||
| Geriatric Care Issues | 639 | ||
| Staffing | 639 | ||
| Staff Education | 640 | ||
| Assessments | 640 | ||
| TRANSITION OF CARE | 641 | ||
| Two-Step Assessment Program | 641 | ||
| Admitted or Transfer Patients | 641 | ||
| Observation | 642 | ||
| Home Services | 642 | ||
| QUALITY IMPROVEMENT | 643 | ||
| THE ELECTRONIC HEALTH RECORD | 643 | ||
| CONCLUDING REMARKS | 644 | ||
| REFERENCES | 645 | ||
| Altered Mental Status and Delirium | 649 | ||
| Key points | 649 | ||
| INTRODUCTION | 649 | ||
| Evaluation of Altered Mental Status and Delirium | 650 | ||
| Delirium risk assessment | 650 | ||
| Assessing level of consciousness (arousal) | 650 | ||
| Assessing cognition | 653 | ||
| Assessing for delirium | 654 | ||
| The confusion assessment method and derivatives | 654 | ||
| Evaluation for Precipitating Causes of Delirium | 655 | ||
| Physical examination | 655 | ||
| NONPHARMACOLOGIC TREATMENT | 657 | ||
| PHARMACOLOGIC TREATMENT | 660 | ||
| Assessment of Decision-Making Capacity | 661 | ||
| OUTCOMES/DISPOSITION | 661 | ||
| Billing and Coding Considerations | 662 | ||
| SUMMARY | 662 | ||
| REFERENCES | 662 | ||
| Palliative Care in the Emergency Department | 667 | ||
| Key points | 667 | ||
| INTRODUCTION | 667 | ||
| COMMUNICATION WITH PATIENTS AND SURROGATES | 668 | ||
| Shared Decision Making | 668 | ||
| Decision Frames | 668 | ||
| Tools and Models to Aid in Communication | 669 | ||
| Communication Behaviors to Avoid | 670 | ||
| Communicating News Over the Telephone | 671 | ||
| SUBSTITUTE DECISION MAKERS AND WRITTEN DIRECTIVES | 672 | ||
| Substitute Decision Makers | 673 | ||
| Health care proxy | 673 | ||
| Surrogate | 673 | ||
| Next of kin | 673 | ||
| Written Directives | 673 | ||
| Advance directives | 674 | ||
| Do-not-resuscitate, do-not-intubate, and do-not-hospitalize orders | 674 | ||
| Physician orders for life-sustaining treatment | 675 | ||
| CATEGORIES OF CARE | 675 | ||
| Palliative Care | 675 | ||
| End-of-Life Care | 676 | ||
| Hospice Care | 676 | ||
| Comfort Measures Only | 676 | ||
| SYMPTOM RECOGNITION | 676 | ||
| SYMPTOM MANAGEMENT | 677 | ||
| General Considerations for the Dying Patient in the Emergency Department | 678 | ||
| Selection of Therapy for the Symptomatic Geriatric Patient at the End of Life | 678 | ||
| Most Common End-of-Life Symptoms | 679 | ||
| Treating Dyspnea | 679 | ||
| Oxygen | 679 | ||
| Opioids | 679 | ||
| Noninvasive positive pressure ventilation | 680 | ||
| Distress Protocol | 680 | ||
| Palliative Sedation | 681 | ||
| SUMMARY | 683 | ||
| REFERENCES | 683 | ||
| Zika Virus | 687 | ||
| Key points | 687 | ||
| INTRODUCTION | 687 | ||
| HISTORY | 688 | ||
| Origins | 688 | ||
| Epidemiology | 688 | ||
| VIROLOGY | 688 | ||
| Classification and Structure | 688 | ||
| Transmission | 688 | ||
| CLINICAL PRESENTATION | 689 | ||
| Initial Signs and Symptoms | 689 | ||
| Acute Sequelae | 690 | ||
| Congenital Complications | 690 | ||
| TESTING AND DIAGNOSIS | 691 | ||
| Diagnostic Criteria | 691 | ||
| Laboratory Testing | 691 | ||
| INFECTION CONTROL AND PUBLIC HEALTH | 692 | ||
| Travel Recommendations/Restrictions | 692 | ||
| Vector Control/Health Care Precautions | 692 | ||
| Implications for Pregnant Women | 692 | ||
| Mass Gatherings and International Implications | 693 | ||
| EVALUATING A SUSPECTED CASE | 693 | ||
| Initial Evaluation/Consideration | 693 | ||
| Serologic Testing | 693 | ||
| TREATMENT/MANAGEMENT STRATEGIES | 694 | ||
| Management of Initial Infection/Sequelae | 694 | ||
| Management of Pregnant Patients with Possible Zika Virus Infection | 694 | ||
| Management of Neonates with Potential Zika Virus | 694 | ||
| PATIENT DISPOSITION | 695 | ||
| Initial Disposition | 695 | ||
| Long-term Follow-up | 695 | ||
| FUTURE DIRECTIONS | 695 | ||
| Zika Vaccine | 695 | ||
| SUMMARY | 695 | ||
| REFERENCES | 696 | ||
| Index | 700 |