GEMCAST

Zara Cooper is an acute care and trauma surgeon at the Brigham and Women's hospital. See www.gempodcast.com for full details and show notes. This podcast uses sounds from freesound.org by Jobro and HerbertBoland. Image is from: https://pixabay.com/en/heart-first-aid-medical-medicine-2730784/

Chris Carpenter discusses the new ACEP accreditation of Geriatric EDs and what your ED would need to do to become accredited. See www.gempodcast.com for full shownotes and more info or to leave a comment. Music credit: Bob Dylan, The Times They Are Changing, 1964, Columbia Records

David Silfen, an EMS provider describes a program he has helped initiate to intervene with older adults who have a high falls risk. See www.gempodcast.com for full details and show notes. This podcast uses sounds from freesound.org by Jobro and HerbertBoland. Image credit: https://pixabay.com/en/step-falling-tripping-danger-98822/

Dr. Alisha Benner discusses tips for palliative care in the ED. see www.gempodcast.com for show notes, references, information, and to leave comments! Follow @gempodcast on twitter. This podcast uses sounds from freesound.org by Jobro and HerbertBoland. Image credit: https://commons.wikimedia.org/wiki/File:Dante_Gabriel_Rossetti_-_Study_of_Dante_holding_the_hand_of_Love.jpg

Ophthalmologist Dr. Bryan Hong continues to discuss his approach to some of the common eye emergencies that bring older adults to the Emergency Department. see www.gempodcast.com for show notes and information and to leave comments. This podcast uses sounds from freesound.org by Jobro and HerbertBoland. Image credit: https://pixabay.com/en/eye-black-reds-female-red-color-1574829/

Ophthalmologist Dr. Bryan Hong talks about his approach to some of the common eye emergencies that bring older adults to the Emergency Department. see www.gempodcast.com for show notes and information and to leave comments. This podcast uses sounds from freesound.org by Jobro and HerbertBoland. Image credit: https://commons.wikimedia.org/wiki/File:A_selection_of_glass_eyes_from_an_opticians_glas_eye_case._Wellcome_L0036581.jpg

Leah Hatfield discusses the new oral anticoagulants, and how to reverse them in cases of life threatening bleeds. To leave a comment and for the shownotes, see https://gempodcast.com/2016/09/30/how-to-reverse-oral-anticoagulants/

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.

Amal Mattu talks about ACS presentations, workup, and management in older adults, and why the atypical is typical! For the full shownotes and references, and to leave a comment, see: https://gempodcast.com Chest pain is one of the most common reasons why people present to the ED. The chief complaint of Chest Pain typically triggers an automatic EKG, and potentially a workup for acute coronary syndrome. However, many patients who are having ACS do not present with chest pain. Instead, they may have dyspnea, diaphoresis, nausea, vomiting, abdominal pain, or other non-specific symptoms. Which patients are most likely to present this way? Older adults. And the older the patient, the more likely they are to be chest-pain free when they present with an NSTEMI or STEMI. So it is up to the medical provider to be vigilant, consider possible angina equivalents, and order the right workup. Dr. Mattu talks us through some of the statistics of how often MIs occur without chest pain with age, how EKG interpretation may differ, and how management should differ vs how it does differ. Patients presenting with atypical symptoms are less likely to receive an aspirin or thrombolytics/PCI, and their mortality is higher. Selected References: 1. Mattu A, Grossman SA, Rose PL. Geriatric emergencies - A discussion-based review. Wiley Blackwell; 2016. 2. Glickman SW, Shofer FS, Wu MC, et al. Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction. Am Heart J. 2012;163(3):372-382. http://www.ncbi.nlm.nih.gov/pubmed/22424007 3. Brieger D, Eagle KA, Goodman SG, et al. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: Insights from the global registry of acute coronary events. Chest. 2004;126(2):461-469. http://www.ncbi.nlm.nih.gov/pubmed/15302732 4. Cannon AR, Lin L, Lytle B, Peterson ED, Cairns CB, Glickman SW. Use of prehospital 12-lead electrocardiography and treatment times among ST-elevation myocardial infarction patients with atypical symptoms. Acad Emerg Med. 2014;21(8):892-898. http://www.ncbi.nlm.nih.gov/pubmed/25155289 5. Alexander KP, Newby LK, Cannon CP, et al. Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: A scientific statement for healthcare professionals from the american heart association council on clinical cardiology: In collaboration with the society of geriatric cardiology. Circulation. 2007;115(19):2549-2569. http://www.ncbi.nlm.nih.gov/pubmed/17502590 6. Canto JG, Rogers WJ, Goldberg RJ, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813-822. http://www.ncbi.nlm.nih.gov/pubmed/22357832 This podcast uses sounds from freesound.org by Jobro and HerbertBoland. Image credit: https://pixabay.com/en/pulse-trace-healthcare-medicine-163708/

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-hospital-near/ The full geriatric ED guidelines are available here: https://www.acep.org/geriedguidelines/ To learn more about many of the Geriatric EM ideas and concepts discussed here, check out the Geri-EM.com site, where you can also get free CME. For the references see: https://gempodcast.com/2016/06/29/5-ways-to-geriatricize-your-ed/ This podcast uses sounds from freesound.org by Jobro and HerbertBoland. Image from https://commons.wikimedia.org/wiki/File:Clock_Cogs.jpg