Podcasts about geriatric emergency medicine

We explore the expanding field of Geriatric Emergency Medicine. Hosts: Ula Hwang, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Geriatric_Emergency_Medicine.mp3 Download Leave a Comment Tags: Geriatric Show Notes Key Topics Discussed Importance and impact of geriatric emergency departments. Optimizing care strategies for geriatric patients in ED settings. Practical approaches for non-geriatric-specific EDs. Challenges in Geriatric Emergency Care Geriatric patients often present with: Multiple chronic conditions Polypharmacy Functional decline (mobility issues, cognitive impairments, social isolation) Adapting Clinical Approach Core objective remains acute issue diagnosis and treatment. Additional considerations for geriatric patients: Review and caution with medications to prevent adverse reactions. Address functional limitations and cognitive impairments. Emphasize safe discharge and care transitions to prevent unnecessary hospitalization. Identifying High-Risk Geriatric Patients Screening tools: Identification of Seniors at Risk (ISAR) Frailty screens Alignment with the “Age-Friendly Health Systems” initiative focusing on: Mentation Mobility Medications Patient preferences (what matters most) Mistreatment (elder abuse awareness)

Welcome to November's main episode of TheCase.Report! In this episode we dive into all things Parkinson's disease (PD). Our team keep their differentials broad as they work up and diligently manage a 78-year-old man presenting with an acute behavioural change on a background of Parkinson's Disease. We're delighted to have Dr Barry Keane, Consultant in Emergency Medicine at St James's Hospital join us this month as our Adult in the Room to review our work. This episode is bursting with clinical pearls as we discuss what to consider and what not to miss in Parkinson's Disease patients. As always, don't forget to follow us on socials on ⁠⁠⁠instagram⁠⁠⁠, ⁠⁠⁠x⁠ and ⁠⁠⁠facebook ⁠⁠⁠to keep updated with all things TCR. Coffee in hand? Right then, let's get to it!

Pregnancy is common during medical training and in the early years as an attending physician, as these stages often align with individuals' reproductive potential. The experience can vary widely depending on factors such as workplace dynamics, scheduling, and the physical demands of the job. But let's be real - running around a busy ED while carrying extra weight, feeling nauseated (maybe vomiting), and managing all of the physical and emotional changes that come with pregnancy is a real challenge that many of us have lived. There are numerous considerations to navigate, from how we wish to be perceived as a team member to the risks posed by the workload on our bodies. Additionally, departmental or hospital policies may have financial implications that further complicate the situation. Join us as and Dr. Katren Tyler - EM physician and mother of two - as we break it all down. This the second episode in our three part series on infertility, pregnancy and breastfeeding as an Emergency Physician. If  you missed it, go back and check out part 1! And stay tuned for our final episode of the series where we'll delve into some of the challenges surrounding breastfeeding and pumping in the ED.  Does your ED have policies to help support people through pregnancy? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Katren Tyler, Professor of Emergency Medicine and Vice Chair of Geriatric Emergency Medicine and Wellness at UC Davis Resources: Tips for Pregnancy EM Physicians, by Sandra Williams, DO (ACEP) MacVane CZ, Fix ML, Strout TD, et al. Congratulations, You're Pregnant! Now About Your Shifts . . . : The State of Maternity Leave Attitudes and Culture in EM. West J Emerg Med. 2017 Aug;18(5):800-810. doi: 10.5811/westjem.2017.6.33843. Epub 2017 Jul 17. PMID: 28874931; PMCID: PMC5576615. ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

The nation's population of older adults is increasing, but the system of emergency medicine isn't optimally designed for their specific, complex and multi-layered needs. So what can the field do to better adapt to an aging population? Medical support frameworks for older adults remain inadequate, particularly in the emergency department. In today's discussion about older adult care in the ED, Marie Cleary-Fishman, AHA's vice president of clinical quality, is joined by Dr. Kevin Biese. Dr. Biese serves as the University of North Carolina Hospitals Associate Professor of Emergency Medicine, as well as its Co-Director of the Division of Geriatric Emergency Medicine.

It's no secret that the U.S. population is aging. We are fully aware of this in the ED, where many of our sickest patients are older adults. But what many general EM providers don't realize is just how different our elderly patients' needs may be. In this episode, we talk with Geriatric Emergency Medicine specialist, Dr. Jennifer Kristjansson, about some health concerns that predominantly affect our geriatric patients. She highlights key areas we should we aware of and offers advice for optimizing ED care for older adults.   Send us your questions and feedback on social media, @empulsepodcast, via email empulsepodcast@gmail.com, or through our website, ucdavisem.com. Head over to ITunes and leave us a review - it helps us reach more people. And please pass the word along to your friends and colleagues! ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guest: Dr. Jennifer Kristjansson, Assistant Professor of Emergency Medicine at UC Davis; fellowship trained in Geriatric Emergency Medicine Resources: ACEP Geriatric Emergency Department Guidelines *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Dr. Mary Mulcare, Chief Medical Officer at Summus Global, joins Host Jeff Cross in a lively discussion around "care delay," covid regulations on telemedicine that are expiring and how to continue the momentum around leveraging telehealth services. A timely episode as many are heading into Open Enrollment season and are looking to continue to support their employees from a virtual standpoint.About Mary MulcareMary Mulcare, MD, FACEP, is Chief Medical Officer at Summus Global. She oversees the Summus clinical team and supports product, data, and physician network strategy in support of Summus' mission to provide fast, virtual access to high-quality medical expertise across the care continuum. She completed her Emergency Medicine residency at New York-Presbyterian Hospital, was Chief Resident, and then did a fellowship in Geriatric Emergency Medicine at Weill Cornell Medical Center. Dr. Mulcare was an attending Emergency Medicine physician at New York-Presbyterian/Weill Cornell Medical Center and is an Assistant Professor of Clinical Emergency Medicine at Weill Cornell Medicine.  About Summus Global:Summus Global, the leading virtual specialist platform, empowers families by providing access to a network of 4,000+ top specialists across 48 leading hospitals -- within days, from anywhere in the world. Pioneering the future of corporate health benefits, Summus Global partners with companies across the country to create an elevated healthcare experience for their employees and to support better, cost-efficient outcomes across all health questions and stages of care.  Music By: Colin Cross Music

This topic never gets old! Whether you realize it or not, geriatrics is probably a large part of your practice, especially when it comes to high-complexity, high-acuity emergency medicine. Dr. Lauren Southerland will teach us what we can do to better care for older adults. We’ll also discuss how to get involved at the national level and how to pursue a career in geriatric EM if you want to go a step further.

Doug talks about insurance tips, geriatric emergency medicine, and reducing falls around the house.

This podcast features Tony Rosen, MD, MPH, 2018-19 President-Elect of SAEM's Academy of Geriatric Emergency Medicine (AGEM). Dr. Rosen discusses why it's important for SAEM to have AGEM, how AGEM leverages Twitter, and what resources students and residents can use to learn more about geriatrics.

Last Stand in Santa Rosa Imagine you’re working a shift in the Emergency Department when a fast moving wildfire hits. What would you do if you found out your home was burning? Or your family was in danger? And how do you react when the Fire Department tells you they are making a last stand a block away from your hospital? This situation is all too real for many physicians and providers affected by devastating wildfires in California. In this episode, we follow the story of the 2017 Santa Rosa fires from the perspective of three Emergency Physicians, Dr. Josh Weil, Dr. Suzy Fitzgerald, and Dr. Dane Stevenson. Their powerful story, and the lessons learned from their experience, are guaranteed to improve your personal and professional disaster preparedness.  Please also consider donating to ongoing relief efforts following the 2018 California wildfires through the Red Cross.  Do you know your hospital’s disaster plan? Do you have a personal plan? Have you lived through a disaster? Share your experience with us on social media, @empulsepodcast, or on our website, ucdavisem.com.  Hosts: Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guests: Dr. Susan Fitzgerald, Emergency Physician at Kaiser Santa Rosa and Emergency Management Physician Lead in the Diablo Service Area; Kaiser Permanente Northern California (KPNC) Regional Emergency Management Drill and Training Director and the Pediatric Surge Planning Chair for the KPNC Regional Emergency Management Committee. Dr. Joshua Weil, Emergency Physician at Kaiser Santa Rosa and Assistant Physician-in-Chief for Hospital Operations; Member of the American Red Cross Board of Directors, Board Chair for the Ceres Project, and Medical Director for the Jewish Community Free Clinic in Santa Rosa. Dr. Weil has been involved in major disaster relief efforts in the US and internationally, including Sri Lanka, Louisiana, Haiti, and the Philippines. Dr. Dane Stevenson, Emergency Physician at Kaiser Santa Rosa, with a Fellowship in Geriatric Emergency Medicine from UC Davis. Resources: ACEP Disaster Medicine Resources American College of Emergency Physicians Disaster Medicine resources, policies, and public training, including hospital disaster preparedness self assessment tool and hospital evacuation plan template.  “Healing and History after fire & Weil-Mollard Household”  Dr. Josh Weil and his wife, Claire Mollard, share their story on YouTube The story of Josh's goats! on NPR/Capitol Public Radio ***************************************************************** Ski and CME! Join us for the UC Davis Emergency Medicine Winter Conference, March 4th-8th at the Ritz Carlton in Lake Tahoe. Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.   Dr. Joshua WeilDr. Susan FitzgeraldDr. Dane StevensonDrs. Magaña and Medeiros

Paradigm Shifts is a podcast series hosted by the National Foundation of Emergency Medicine (NFEM) The post Paradigm Shifts in Geriatric Emergency Medicine – Episode 01 appeared first on National Foundation of Emergency Medicine.

Host Ryan Stanton, MD, FACEP talks to Marianna Karounos, DO, FACEP about tailoring your work in geriatric emergency medicine, educating elderly patients on how they can be prepared for ED visits, and the importance of an early establishment on the goals-of-care.

Welcome back to EMIGcast! Thinking about completing a fellowship in a subspecialty of emergency medicine? Well, here’s one you may not have considered – geriatric emergency medicine (GEM). In this episode, we travel to Sacramento,...

Tony Rosen discusses how to identify elder abuse and ways to intervene. Elder 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, 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. For State requirements, see here: http://www.napsa-now.org/wp-content/uploads/2014/11/Mandatory-Reporting-Chart-Updated-FINAL.pdf Please see https://gempodcast.com/2016/08/26/how-to-identify-and-intervene-in-cases-of-elder-abuse/ for the full show notes and references.

Have you ever been in any of these situations? ⇒   You have a stable child who just needs fluids, but no laboratory tests ⇒   You’ve tried PO hydration, to no avail, despite anti-emetics ⇒   You’re poking the stable, but dehydrated child repeatedly without success What now? Hypodermoclysis, otherwise known as subcutaneous rehydration. [Insert Player] Clysis comes from the same Greek word that “a flood” – hypodermoclysis refers to flooding the subcutaneous space with fluid, so that it can be absorbed systemically. Sound far-fetched? Well, it turns out, what is old is new again. In 1913, Dr Day first described this technique for a child with severe diarrhea who could not tolerate fluids by mouth. Hypodermoclysis then began to gain popularity with a peak of use in the 1940s, until an innovative breakthrough in 1950. Dr David Massa, a resident anesthesiologist at the Mayo clinic, invented the first catheter-over-needle apparatus. With increasing safety and ready access of IV catheters, IV quickly overshadowed SC. The subcutaneous route of hydration has also been used effectively in geriatric and palliative care for decades, and it is only now beginning to gain popularity again in its original population: children. So, how does it work? In a nutshell, you place a butterfly needle or angiocatheter in the subcutaneous space and you run fluids into it. The tissues quickly absorb the fluids, making them available systemically. That’s it. Everything else is just finesse. The ideal candidate for hypodermoclysis is the stable patient, with mild to moderate dehydration who fails a trial of fluids by mouth, or who needs a bridge to gaining IV access later, after a slow subcutaneous fluid bolus is given. Ok, so how do you do it? Place a topical anesthetic cream, such as EMLA, cover with occlusive dressing (IV dressing), wait 15-20 min "Pinch an inch" of skin anywhere, but the most practical site in young children is between the scapulae Insert a 25-gauge butterfly needle or 24-gauge angiocatheter (preferred by the author), secure Inject 150 U hyaluronidase SC, if available Infuse 20 mL/kg isotonic solution over one hour, repeat as needed or use "bolus" as bridge to IV access You can set the line to gravity, and if it is dripping in, you may leave it be. If you see a very slow drip by gravity, or worse, nothing is dripping, you can set the line on a pump, to deliver up to 20 mL/kg over an hour. Infusion at this rate optimizes the balance we want in minimal discomfort while maximizing the flow rate. This is not a “bolus” in the true sense – but then, when you compare it to the alternative – like IV therapy – and we see a time and cost savings.  Dr Mace and colleagues in the American Journal of Emergency Medicine report substantially decreased cost and ED length of stay when comparing the material and human resources needed to place an IV in a squirmy young child, compared with a simple subcutaneous stick. There will be swelling There will be swelling – that is the goal. It is really painless, and your patient may lie down on his back with the pump going – it is actually pretty comfortable for most children and adults to do. Here’s a tip – since there will be swelling, we want to be careful about how we secure the line, so how you tape it down to the skin is important – we want to avoid a pulling sensation, which can be the beginning of the end of the tolerance for the procedure.  Cover that with an occlusive dressing, as you would an IV site. The footprint of the occlusive dressing is relatively small, so it will travel up on top of the subcutaneous mound you’re creating. As the line exits the occlusive patch, place a thin layer of gauze between the skin and the IV tubing, so that the tubing doesn’t press into the skin. Then—as far away from the puncture site as possible—tape it down securely. The idea is not to tape on the growing mound itself, because the mound may pull at the anchored skin and set a nuclear chain reaction of annoyance and restlessness – and potentially a failed procedure. The swelling will look indurated, a pinkish red.  It’s not an allergic reaction: even with the old preparations of hyaluronidase, allergic reactions were rare, and now they are very rare with the recombinant preparation. It is supposed to swell and look ugly. The subcutaneous tissues will swell to a point where you have a steady state fluid administration rate, and as soon as you stop the infusion, the remaining fluid will start to subside as it is absorbed. A Bridge to IV Therapy? Kuensting et al. in the Journal of Emergency Nursing in 2013 compared subcutaneous fluid infusion with intravenous fluid infusion in children with difficult IV access. They found the mean time from order entry to subcutaneous fluid infusion to be 20 min, compared to the failed IV access group with an average infusion start time of 1.5 hours. The latter group eventually received subcutaneous fluids.  The investigators also found a shorter ED length of stay in the subcutaneous group. In the same study, a subgroup received subcutaneous fluids initially, and later an IV. They found a trend in ease of IV access after subcutaneous fluid therapy. In other words, if your little patient with difficult IV access is hemodynamically stable and amenable to a bolus over an hour, you may choose to start with hypodermoclysis and reevaluate. Predicting Difficult IV Access in Children Much has been studied and written about the predictors of difficult IV access in children. The most often cited are: age < 3 years, weight less than 5 kg, prematurity, obesity, and darker skin tones, where the contrast of vein to skin may not be so apparent. The three main predictors of the score validated by Riker et al. in Annals of Emergency Medicine include the most practical and universal of features: vein palpability, vein visibility, and patient age. If you’re anticipating difficult IV access in the child who can stand to wait an hour for a slow bolus, you may start with the subcutaneous route to get those veins plumper and more visible, to improve your chances of IV access in the very near future. Medications via Subcutaneous Route Certain medications have been used safely via subcutaneous infusion; always check dose, rate, and compatibility.   What about catheter size? You don’t need to use larger needles or angiocathters for older children, adolescents or adults. A 25-gauge butterfly or 24-gauge angiocatheter works well from an infant to an elder. In one study of adults, a half a liter of saline was infused by gravity via a 24-gauge catheter. With IVs, the shorter and larger the bore, the faster the infusion. In subcutaneous infusion, it is not the size of the catheter, but the osmotic gradient that determines the rate of absorption. What if I don't have that fancy hyaluronidase? It’s actually increasingly readily found – and available in generic form. If you have it, please use it – it will make a believer out of you and others. Hypodermoclysis will work without hyaluronidase – the process of subcutaneous rehydration just takes a lot longer to work. In a double-blind cross-over trial Thomas et al. in 2007 compared subcutaneous administration of lactated ringer’s solution by gravity with and without hyalurondase. The hyaluronidase group received their fluids 5 times faster. The average rate of the hyaluronidase group was 382 mL/h versus the fluid only group, who did not receive hyalurinodase; they were substantially slower, at 82 mL/h. It’s worth using if you have it, but still potentially useful if you don’t. Recap: Supplies √    EMLA or any topical anesthetic used for intact skin, placed as soon as the decision is made √    A 25-gauge butterfly needle or 24-gauge angiocatheter √    IV tubing, gauze to pad, tape to anchor √    150 U hyaluronidase, the same dose, regardless of age or size √    Isotonic fluids – you can start with 20 ml/kg √    And finally a well informed team made up by the patient, the parents, and your staff, so that everyone knows what to expect for a successful subcutaneous fluid administration. References Allen CH, Etzwiler LS, Miller MK, Maher G, Mace S, Hostetler MA, Smith SR, Reinhardt N, Hahn B, Harb G; INcreased Flow Utilizing Subcutaneously-Enabled Pediatric Rehydration Study Collaborative Research Group. Recombinant human hyaluronidase-enabled subcutaneous pediatric rehydration. Pediatrics. 2009 Nov;124(5):e858-67. Bruno VG. Hypodermoclysis: a literature review to assist in clinical practice. Einstein (Sao Paulo). 2015 Jan-Mar;13(1):122-8. Cabañero-Martínez MJ, Velasco-Álvarez ML, Ramos-Pichardo JD, Ruiz Miralles ML, Priego Valladares M4, Cabrero-García J. Perceptions of health professionals on subcutaneous hydration in palliative care: A qualitative study. Palliat Med. 2016 Jun;30(6):549-57. Kuensting LL. Comparing subcutaneous fluid infusion with intravenous fluid infusion in children. J Emerg Nurs. 2013 Jan;39(1):86-91. Mace SE, Harb G, Friend K, Turpin R, Armstrong EP, Lebel F. Cost-effectiveness of recombinant human hyaluronidase-facilitated subcutaneous versus intravenous rehydration in children with mild to moderate dehydration. Am J Emerg Med. 2013 Jun;31(6):928-34. O'Hanlon S, Sheahan P, McEneaney R. Severe hemorrhage from a hypodermoclysis site. Am J Hosp Palliat Care. 2009 Apr-May;26(2):135-6. Remington R, Hultman T. Hypodermoclysis to treat dehydration: a review of the evidence. J Am Geriatr Soc. 2007 Dec;55(12):2051-5. Riker MW, Kennedy C, Winfrey BS, Yen K, Dowd MD. Validation and refinement of the difficult intravenous access score: a clinical prediction rule for identifying children with difficult intravenous access. Acad Emerg Med. 2011 Nov;18(11):1129-34. Rouhani S, Meloney L, Ahn R, Nelson BD, Burke TF. Alternative rehydration methods: a systematic review and lessons for resource-limited care. Pediatrics. 2011 Mar;127(3):e748-57. Smith LS. Hypodermoclysis with older adults. Nursing. 2014 Dec;44(12):66. Spandorfer PR. Subcutaneous rehydration: updating a traditional technique. Pediatr Emerg Care. 2011;27(3):230-6. Thomas JR, Yocum RC, Haller MF, von Gunten CF. Assessing the role of human recombinant hyaluronidase in gravity-driven subcutaneous hydration: the INFUSE-LR study. J Palliat Med. 2007 Dec;10(6):1312-20. Vacha ME et al. The Role of Subcutaneous Ketorolac for Pain Management. Hosp Pharm. 2015 Feb; 50(2): 108–112. Zaloga GP, Pontes-Arruda A, Dardaine-Giraud V, Constans T; Clinimix Subcutaneous Study Group. Safety and Efficacy of Subcutaneous Parenteral Nutrition in Older Patients: A Prospective Randomized Multicenter Clinical Trial. J Parenter Enteral Nutr. 2016 Feb 17. pii: 0148607116629790. [Epub ahead of print]   This post and podcast are dedicated to Christina L. Shenvi, MD, PhD, for her dedication to excellence in patient care and enthusiasm in #FOAMed, Emergency Medicine, and Geriatric Emergency Medicine.  There are many shared lessons learned in the care of children, elders, and families.  Thank you. Catch Dr Shenvi on the innovative GEMcast. Subcutaneous Infusion Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP

In this episode Dr. Don Melady, Canada's leading educator in Geriatric Emergency Medicine (Geri-EM) & Dr. Jaques Lee, one of Canada's leading researchers in Geri-EM, discuss the common yet challenging Geriatric Emergencies: a practical approach to geriatric Delirium, best practice for managing agitation and pain in the older patient, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, atypical presentations of common life threatening emergencies including ACS and surgical abdomen, key drug interactions in the geriatric patient and more.. The post Episode 34: Geriatric Emergency Medicine appeared first on Emergency Medicine Cases.

In this episode Dr. Don Melady, Canada's leading educator in Geriatric Emergency Medicine (Geri-EM) & Dr. Jaques Lee, one of Canada's leading researchers in Geri-EM, discuss the common yet challenging Geriatric Emergencies: a practical approach to geriatric Delirium, best practice for managing agitation and pain in the older patient, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, atypical presentations of common life threatening emergencies including ACS and surgical abdomen, key drug interactions in the geriatric patient and more.. The post Episode 34: Geriatric Emergency Medicine appeared first on Emergency Medicine Cases.

As a bonus to Episode 34 on Geriatric Emergency Medicine, Dr. Don Melady, one of Canada's leading educators in Geriatric EM, tells us about his Best Case Ever in which a simple fall turns out to be a multi-facited complicated case with a simple solution. In the related Episode 34 on Geriatric Emergency Medicine Dr. Melady and Dr. Jacques Lee cover an approach to geriatric Delirium, managing agitation, indications for CT head in the delirious older person, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, key drug interactions, pain management, atypical ACS and pearls in Geriatric abdominal pain presentations. The post Best Case Ever 17: Geriatric Emergency Medicine appeared first on Emergency Medicine Cases.

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