GEMCAST

By Christina ShenviScience

GEMCAST episodes

March 01, 2016 Hip Fracture Management Pathways in Older Adults
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: https://www.youtube.com/watch?v=p6X0IiYolIk
Femoral Nerve Block video: https://www.youtube.com/watch?v=5ht_N8j2KL8
This is a description of guidelines from the UK on recommendations for hip fracture management.
Tinetti ME, Inouye SK, Gill TM, et al. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA 1995;273(3):1348–1353. PMID 7715059
Godoy Monzon, D., et al. (2007). “Single fascia iliaca compartment block for post-hip fracture pain relief.” Journal of Emergency Medicine 32(3): 257-262. PMID 17394987
Gottschalk, A., et al. (2015). “The Impact of Incident Postoperative Delirium on Survival of Elderly Patients After Surgery for Hip Fracture Repair.” Anesthesia and Analgesia. PMID 25590791
Hogh, A., et al. (2008). “Fascia iliaca compartment block performed by junior registrars as a supplement to pre-operative analgesia for patients with hip fracture.” Strategies Trauma Limb Reconstr 3(2): 65-70. PMID 18762870
Kates, S. L., et al. (2015). “Financial Implications of Hospital Readmission After Hip Fracture.” Geriatr Orthop Surg Rehabil 6(3): 140-146. PMID 26328226 http://www.ncbi.nlm.nih.gov/pubmed/26328226
Lees, D., et al. (2014). “Fascia iliaca compartment block for hip fractures: experience of integrating a new protocol across two hospital sites.” European Journal of Emergency Medicine. PMID 24949565
Marcantonio, E. R., et al. (2000). “Delirium is independently associated with poor functional recovery after hip fracture.” Journal of the American Geriatrics Society 48(6): 618-624. PMID 10855596
Mouzopoulos, G., et al. (2009). “Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study.” Journal of Orthopaedics and Traumatology 10(3): 127-133. PMID: 19690943
Mundi, S., et al. (2014). “Similar mortality rates in hip fracture patients over the past 31 years.” Acta Orthopaedica 85(1): 54-59. PMID 24397744
Stoneham, M., et al. (2014). “Emergency surgery: the big three–abdominal aortic aneurysm, laparotomy and hip fracture.” Anaesthesia 69 Suppl 1: 70-80. PMID 24303863
Sound credits: This podcast uses sounds from freesound.org by Jobro and HerbertBoland
Image credit: https://www.flickr.com/photos/mac_filko/5132451119
28 min
February 11, 2016 Geriatric Toxicology Part 3: Digoxin and Calcium Channel Blockers
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_Project.jpg
Sound credits: sounds from freesound.org by Jobro and HerbertBoland
38 min
January 11, 2016 Geriatric Toxicology and Acetaminophen
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
22 min
December 15, 2015 Geritric Toxicology and Salicylates
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 by Jobro and HerbertBoland
21 min
November 03, 2015 High Risk Medications and Adverse Drug Events
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 medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures. J Am Geriatr Soc. 2015.
3. Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079-2086.
4. Pretorius RW, Gataric G, Swedlund SK, Miller JR. Reducing the risk of adverse drug events in older adults. Am Fam Physician. 2013;87(5):331-336.
5. Passarelli MC, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population: Inappropriate prescription is a leading cause. Drugs Aging. 2005;22(9):767-777.
6. Saedder EA, Lisby M, Nielsen LP, Bonnerup DK, Brock B. Number of drugs most frequently found to be independent risk factors for serious adverse reactions: A systematic literature review. Br J Clin Pharmacol. 2015;80(4):808-817.
Image credit: https://pixabay.com/en/pill-capsule-medicine-medical-1884775/
Sound credits: sounds from freesound.org by Jobro and HerbertBoland
29 min
October 01, 2015 Dr. Tintinalli on End-of-Life Decisions
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 with a quality of life that would not be meaningful for them.
References:
1. Rosenberg M, Rosenberg L. Integrated model of palliative care in the emergency department. West J Emerg Med. 2013;14(6):633-636. PMID: 24381685
2. Rosenberg M, Lamba S, Misra S. Palliative medicine and geriatric emergency care: Challenges, opportunities, and basic principles. Clin Geriatr Med. 2013;29(1):1-29 PMID: 23177598
3. Grudzen CR, Richardson LD, Hopper SS, Ortiz JM, Whang C, Morrison RS. Does palliative care have a future in the emergency department? discussions with attending emergency physicians. J Pain Symptom Manage. 2012;43(1):1-9. PMID: 21802899
4. Grudzen CR, Richardson LD, Morrison M, Cho E, Morrison RS. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17(11):1253-1257. PMID: 21175525
5. Quest TE, Marco CA, Derse AR. Hospice and palliative medicine: New subspecialty, new opportunities. Ann Emerg Med. 2009;54(1):94-102. PMID: 19185393
6. Penrod JD, Deb P, Dellenbaugh C, et al. Hospital-based palliative care consultation: Effects on hospital cost. J Palliat Med. 2010;13(8):973-979. PMID: 20642361
7. Penrod JD, Deb P, Luhrs C, et al. Cost and utilization outcomes of patients receiving hospital-based palliative care consultation. J Palliat Med. 2006;9(4):855-860. PMID: 16910799
8. Beemath A, Zalenski RJ. Palliative emergency medicine: Resuscitating comfort care? Ann Emerg Med. 2009;54(1):103-105. PMID: 19346031
9. Ciemins EL, Blum L, Nunley M, Lasher A, Newman JM. The economic and clinical impact of an inpatient palliative care consultation service: A multifaceted approach. J Palliat Med. 2007;10(6):1347-1355. PMID: 18095814
10. Barbera L, Taylor C, Dudgeon D. Why do patients with cancer visit the emergency department near the end of life? CMAJ. 2010;182(6):563-568. PMID: 20231340
This podcast uses sounds from freesound.org by Jobro and HerbertBoland.
Image from: http://news.unchealthcare.org/som-vital-signs/2013/nov-7/2013-berryhill-lecture-video-available
21 min
September 03, 2015 Diagnosing and Managing Delirium in Older Adults
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 medicine: A comprehensive study guide. 8th ed. ; 2011. Accessed 07/23/2015.
2. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911-922. PMID: 23992774
3. Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults. Lancet Neurol. 2015;14(8):823-832. PMID: 26139023
4. Han JH, Eden S, Shintani A, et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med. 2011;18(5):451-457. PMID: 21521405
5. Han JH, Shintani A, Eden S, et al. Delirium in the emergency department: An independent predictor of death within 6 months. Ann Emerg Med. 2010;56(3):244-252.e1. PMID: 20363527
6. Han JH, Wilson A, Vasilevskis EE, et al. Diagnosing delirium in older emergency department patients: Validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med. 2013;62(5):457-465. PMID: 23916018
7. Marcantonio ER. Delirium. In: Pacal JT, Sullivan GM, eds. Geriatrics review syllabus: A core curriculum in geriatric medicine. 7th ed. New York, NY: American Geriatrics Society; 2010
This podcast uses sound 173181 from freesound.com by jobro
20 min

About GEMCAST

From the publisher's feed

Welcome to GEMCAST! Shownotes and more info are available on https://gedcollaborative.com/resources/?type=podcast. GEMCAST is a Geriatric Emergency Medicine Podcast created to help clinicians, nurses, or paramedics who take care of older adults, particularly in the Emergency Department setting. Welcome! I'm your host, Christina Shenvi. You can connect with me on twitter @clshenvi

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