Getting ED Specific with Medication Safety by Christina Shenvi

In today’s episode host Dr. Christina Shenvi is joined by Dr. Robert Sternberg, Ultrasound Director at Akron General to discuss ultrasound-guided nerve blocks for precise pain relief in older patients. Ultrasound-guided nerve blocks provide relief from one of the most common emergency department complaints: pain. In addition to their use in acute pain management, nerve blocks can help reduce the use of opioids, reduce hospital length of stay, and improve patient outcomes and experiences.

Using case examples, Dr. Sternberg talks through how to perform 4 common types of nerve blocks you may use in the emergency department with an elderly patient: Fascia Iliaca Compartment Block (FICB), Pericapsular Nerve Group (PENG) Block, Serratus Anterior Plane (SAP) Block and Erector Spinae Block (ESB). Tune in to hear indications, key anatomical landmarks, dosing, and techniques for each of the nerve blocks.

Postmenopausal Problems - Geriatric Gynecology in the ED by Christina Shenvi

In this episode learn about how the Generational Health Program at Sharp Memorial Hospital in San Diego was developed and expanded to create an extensive care program that provides specialised care for older adults. What started as a pilot program in 2019 is now a multidisciplinary age-friendly collaboration that begins right at admission.  

Host Christina Shenvi is joined by 3 experts from Sharp Memorial Hospital who provide insight into how this program operates to provide the highest level of care for older patients. Diane Wintz, MD, a trauma surgeon who was heavily involved in creating the Generational Health Program. Her goal was to change how traditional health care models approach elderly patients presenting to the ED. Kelly Wright, RN, trained as an oncology nurse and now serves as manager of the program, and Stacy Nilsen, PhD RN, who’s focus is on the feasibility, implementation, education and data assessment of the program. Together they discuss the creation and expansion of the program and highlight the most important aspects of what makes it a success.

Today’s episode provides an introduction and overview of the 5 domains of the CMS Age-Friendly Hospital Measure. Host Dr. Christina Shenvi is joined by Dr. Marcia Russell to help clarify what each of these domains entail and how they may be carried out in the ED. They also discuss concerns that may be brought about following the implementation of this measure on January 1, 2025, and how these issues might be addressed and minimised.

Dr. Marcia Russel is a colorectal surgeon and Associate Professor at UCLA. She has a special interest in the surgical care of older adults and has worked with ACS to improve geriatric surgery through the ACS Geriatric Surgery Verification Program.

With the upcoming implementation of the new CMS age-friendly hospital measure, hospitals will be required to attest that they review medications to identify potentially inappropriate medications (PIMS) for older adults. Dr. Martin Casey, MD, MPH is an Assistant Professor in the Department of Emergency Medicine at UNC School of Medicine. Dr. Caseys’ work has focused on the identifying PIMS and finding opportunities to reduce the use of, and deprescribe, potentially harmful medications in the emergency department.

In this episode, Dr. Christina Shenvi and Dr. Martin Casey will discuss strategies for ED physicians who face unique challenges when assessing older patients’ medications. Using case examples of deprescribing in practice, they illustrate how deprescribing is a nuanced skill and how to approach it.

Dr. Cristina Shenvi is joined today by a panel to explore Geriatric Emergency Medicine (GEM) from a global perspective. As the global population ages, the importance of GEM and its continued development as a subspecialty becomes increasingly evident. This episode will examine the unique challenges that arise as GEM evolves and how different healthcare systems are adapting to meet these challenges. The panel will also discuss innovative practices and solutions that have emerged in their respective countries to advance GEM and improve care for elderly patients.

The expert panel features three distinguished guests: Dr. Mohd Idzwan Zakaria (@prof_idzwan), a senior consultant and professor of Emergency Medicine at University Malaya in Malaysia, specializing in innovative approaches to managing older patients; Dr. Rosa McNamara (@rosaMcNamara), a consultant at St. Vincent’s University Hospital in Dublin, Ireland, and GEM Special Interest Group Chair for the International Federation for Emergency Medicine, with extensive expertise in GEM and medical education; and Dr. Rasha Buhumaid (@Rbuhamaid), an Emergency Physician in Dubai, UAE, President of the Emirates Society for Emergency Medicine, working in both public health and private practice, and an Assistant Professor at Mohammed Bin Rashid University of Medicine and Health Sciences.

Resuscitation of older adults in the emergency department poses unique challenges for physicians. Understanding the differences between a typical resuscitation process compared to a resuscitation of an older adult is essential to appropriately manage and treat this population. In this episode Dr. Cliff Reid joins Dr. Christina Shenvi to explore these differences and the associated challenges, and highlight some tools he uses in his own practice. Cliff Reid, MD, is an Emergency, Retrieval, and Critical Care Physician and educator in the greater Sydney area with a focus on resuscitation of adults and children.

Alzheimer's disease (AD) begins developing in the brain 20-30 years before symptoms start to present in patients. Recent evidence suggests that up to 40% of AD cases could potentially be prevented by addressing modifiable risk factors such as insufficient education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, excessive alcohol consumption, air pollution, and traumatic brain injury. 

Dr. Christina Shenvi is joined once again by Dr. Richard Isaacson, M.D., a Harvard-trained preventive neurologist and world-renowned researcher at the Institute for Neurodegenerative Diseases in Florida. In 2013, he founded the Alzheimer's Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian, the first of its kind in the United States. In this episode of GEMCast they focus on the importance of individualized intervention and prevention as the future of AD treatment.

In 2021 constipation related visits to the ED reached over 1 million.The prevalence of constipation in elderly individuals in the community is between 15-30% and for those living in nursing homes or long-term care facilities it ranges between 50-75%. While constipation itself is not usually life-threatening, it can be indicative of life-threatening diseases or disorders and therefore a comprehensive history and physical assessment of patients is essential to avoid missing a critical diagnosis.

Sarah Lee is an emergency physician at the University of Maryland. In this episode she joins Dr. Christina Shenvi to discuss the presentation, risk factors, assessment and management of constipation in geriatric patients in the ED.