This document provides an overview of key considerations for emergency physicians in evaluating geriatric patients. It discusses how diseases often present atypically in older patients due to multiple organ system involvement. Common geriatric syndromes like falls, incontinence and delirium are described. The case study presented is of a 92-year-old woman who presents with increased sleeping; the initial impression is likely stroke or infection given her altered mental status and other chronic conditions. The document outlines the critical role of emergency physicians in caring for older patients and some common chief complaints like abdominal pain, confusion and electrolyte imbalances.
Theory lecture for first semester RN students about the special needs of older adults. We have a growing older adult population.. we need education patients and family members how to adapt to this aging changes.
Theory lecture for first semester RN students about the special needs of older adults. We have a growing older adult population.. we need education patients and family members how to adapt to this aging changes.
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up
Trauma In Special Populations: Geriatrics, Bariatrics, Pediatrics, and Pregna...Rommie Duckworth
Title: It Takes All Kinds: Trauma Care in Special Populations
Description: Caring for patients with severe traumatic injuries can be difficult enough but what do you do when your patient is very young, very old or very pregnant or very large? “Special populations” is the term we use to identify patients for whom we need new tools and different rules for trauma care. This program shows you how to ensure an informed size-up, systematic assessment and delivery of effective, prioritized trauma care for the most challenging patients that you’ll encounter.
Teaching Formats:
-Lecture
-Case Study
-Question and Answer
Learning Objectives: Students will learn:
- Current and emerging recommendations for prehospital trauma care for all patient popu-lations.
- The special considerations and dangers of traumatic injuries specific to pediatric, geriat-ric, bariatric and pregnant patient populations.
- Rapid identification, assessment, prioritization and care for traumatic injuries to pediat-ric, geriatric and pregnant patients.
Meets requirements of NREMT Core Content for Trauma
SEE MORE AT:
WWW.ROMDUCK.COM
WWW.RESCUEDIGEST.COM
learn about excellent case article published in NEJM regarding celiac disease,its rare presentation and approach for the same along with discussion ..we should always think about this rare presentations
Taking History and Physical Examination in Hematology.pptxAskin Kaplan
Medical history taking
Assessment of symptoms
Reviewing previous records
Understanding the onset or progression of illness
Personal medical history for other disorders that can cause blood count abnormalities
Hematologic manifestations secondary to other diseases occur more frequently than primary hematologic diseases
Person’s ethnicity or race
Exposures; drugs, chemicals, toxins, radiation, alcohol
Family history
Every disease has its own way of presenting it. Identification of early signs by the nurse and the public is necessary for initiation of early treatment.
Critical Appraisal of a Diagnostic Test Article.pptxMarc Evans Abat
How to critically appraise a journal article on accuracy of a diagnostic test. This presentation spans issues regarding directness, validity, applicability and individualization. Also included are how to process information on sensitivity, specificity, likelihood ratios, predictive values and decision thresholds
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. Age Does Matter: Critical Issues in the
ED Evaluation of Geriatric Patients
Marc Evans M. Abat, MD, FPCP, FPCGM
Section of Adult Medicine, Department of Medicine, PGH
Head, Center for Healthy Aging, The Medical City
3. • Came from Samar due to fever and
headaches
• Seen at another tertiary hospital in Manila
– Dx: viral upper respiratory tract infection
– DM medications adjusted due to high CBGs
• Increased sleeping started 2 days before
current consultation
4. • ROS: (+)memory lapses notable since 2
months prior to admission
• Physical examination at the ER
– BP 100/60 HR 84 RR 20 T 36.7°C
– Patient drowsy to stuporous, minimal eye
opening on name calling and tapping, groans
only with no distinct verbal output
– E/N findings for other organ systems including
neuro
5. What is your initial
impression?
A. Hypoglycemia
B. Infection
C. Electrolyte Imbalance
D. Stroke
E. Dehydration
6. Outline
• Critical Role of the Emergency Medicine
Physician
• Clinical Vignettes in the Care of the Older
Patient at the Emergency Department
• Common Presenting Complaints
10. Compared to ages 18-60, those > 60 years
• Adjusted OR for admission
– 1.7 (1.6-1.8, p<0.001)
• Adjusted OR for mortality
– 2.3 (2.0-2.5, p<0.001)
BMC Geriatrics 2013, 13:83
14. Geriatric syndromes
• refer to multifactorial health conditions that
occur when the accumulated effects of
impairments in multiple systems render an
older person vulnerable to situational
challenges
• Emphasizes multiple causation of a unified
manifestation
15. Syndromes in the young
population
Geriatric syndromes
a group of symptoms that do not
need to be highly prevalent
highly prevalent, mostly single
symptom states
a single pathogenetic pathway,
known or unknown, causes the
symptoms.
the leading symptom is linked to
a number of aetiological factors
or diseases in other organs.
separate entities, and there is no
overlap between aetiological
factors of different syndromes
large overlap between the
aetiological factors of different
geriatric syndromes.
in younger patients, one usually
finds a single syndrome in one
patient
A geriatric patient often suffers
from more than one geriatric
syndrome
16.
17. • Use of the terminology leads to special
considerations
– multiple risk factors and multiple organ systems are
often involved
– diagnostic strategies to identify the underlying causes
can sometimes be ineffective, burdensome,
dangerous, and costly
– therapeutic management of the clinical manifestations
can be helpful even in the absence of a firm diagnosis
or clarification of the underlying causes
18.
19. • Education Committee Writing Group
(ECWG) of the American Geriatrics
Society recommends that undergraduate
students should be trained profoundly in
the 13 most common geriatric syndromes
dementia inappropriate
prescribing of
medications
osteoporosis
depression incontinence sensory alterations
including hearing
and visual impairment
delirium iatrogenic problems immobility and
gait disturbances
falls failure to thrive
pressure ulcers sleep disorders
20. Paradigm shifts
• Diseases often present atypically
– Reflects organ system most restricted in homeostasis
– Confusion, increased somnolence, incontinence are
common manifestations of infection, hip fracture
• Aggressive medical attention is necessary to
prevent domino effect of illness
– Endpoint: multiple organ failure
• Law of parsimony does not hold
– Symptoms in elderly often due to multiple causes
22. Acute Myocardial
Infarction
• “Silent” MI more
common
• Dyspnea only
• May present with
signs, symptoms of
acute abdomen--
including
tenderness, rigidity
24. Congestive Heart Failure
• Nocturnal confusion
• Bed-ridden patients may have
fluid over sacral areas rather
than feet, legs
• Without orthopnea or
paroxysmal nocturnal dyspnea
in earlier stages
• “Visceral” or pulmonary
congestion without peripheral
edema
25. Acute Arterial Occlusion
• May be painless and
easily missed
• May manifest only with
a cyanotic, pulseless
and cold extremity
• Unpredictable and may
follow any acute
disease
26. Pulmonary Edema
• May be tricky to differentiate
from other causes of
crackles
– Pneumonia
– Bronchiectasis
• Need to use other modalities
– Hepatojugular reflux
– labs (e.g. BNP)
27. Pulmonary Embolism
• Suspect in any patient with sudden onset
of dyspnea when cause cannot be quickly
identified
– D-dimer??
– DVT screening??
– Venous duplex scanning??
28. Pneumonia
• Possibly atypical
presentations
– Absence of cough, fever
– Loss of appetite and
difficulty sleeping
– Abdominal rather than
chest pain
– Altered mental status
– Falls
29. Chronic Obstructive Pulmonary
Disease
• Usually causes a progressive
degree of dyspnea and
coughing over a long period of
time, with episodes of acute
exacerbation
• May co-exist with other acute
problems (e.g. MI, pneumonia)
30. Constipation
• May acutely present as
– Delirium
– BP spikes
– Gastric retention
31. Diarrhea and Dehydration
• Dehydration may be
difficult to assess in the
elderly due to preexistent
– Xerostomia
– Loss of subcutaneous
tissues
32. • Manifests as
– Delirium
– Decreasing blood
pressure
– Loss of urine
output
– Tachycardia
– hypotension
33. Acute abdominal pain
• Numerous etiologies
– Pneumonia
– Myocardial infarction
– Gastroenteritis
– Malabsorption
syndromes
– Mesenteric disease
– Acute appendicitis
– Malignancy
• May be accompanied by
abdominal rigidity
despite the absence of
peritonitis
34. GI Bleeding
• Manifest with
progressive pallor and
weakness, loss of
appetite, body malaise
• May also present with
progressive abdominal
enlargement with initial
constipation
35. Urinary Tract Infection
• Patient may not complain of painful
urination or frequency or urgency
• May manifest with acute incontinence,
delirium or loss of appetite
• In cases of pyelonephritis, there may be
absence of costovertebral tenderness and
fever
36. Uremia
• Symptoms related to the inability of the
kidney to remove toxins
• May present with delirium, persistent
nausea and vomiting, tachypnea
• May present atypically with body malaise,
poor appetite, weakness
37. Hypoglycemia
• Patient may not
complain of hunger,
tremors, sweating
and other signs seen
in the young
• May just present with
loss of
consciousness or
seizures
38. Hyperglycemia
• Symptoms are attributable to the
underlying disorder
– Diabetic ketoacidosis
– Hyperosmolar, hyperglycemic state
• Include delirium, loss of urine output,
tachypnea, diarrhea, coma
39. Electrolyte disorders
• Hyponatremia
– Weakness, sleepiness, difficulty walking or
ambulating, delirium
• Hypernatremia
– Delirium, seizures, coma
• Hyperkalemia
– Sudden cardiac death
• Hypokalemia
– Muscle weakness, sudden cardiac death
40. Dementia vs. Delirium
• Stable and progressive vs waxing and waning
• chronic onset vs acute onset
• The former has more prominent cognitive
impairment, the latter has sensorium as
dominant impairment
• Never assume acute dementia or altered mental
status is due to “senility”
• Ask relatives, other caregivers what the patient’s
baseline mental status is
41. Possible Causes of Delirium
• Head injury with
subdural hematoma
• Alcohol, drug
intoxication, withdrawal
• Tumor
• CNS Infections
• Electrolyte imbalances
• Cardiac failure
• Hypoglycemia
• Hypoxia
• Drug interactions
42. Cerebrovascular Accident
• signs often subtle—dizziness,
behavioral change, altered
affect
• Headache, especially if
localized, is significant
• Stroke-like symptoms may be
delayed effect of head trauma
43. Seizures
• All first time seizures in elderly are
dangerous
• Possible causes
CVA
Arrhythmias
Infection
Alcohol, drug
withdrawal
Tumors
Head trauma
Hypoglycemia
Electrolyte
imbalance
45. Depression
• Common problem
• May account for symptoms of “senility”
• Persons >65 account for 25% of all
suicides
• Treat as possibly life threatening
46. Head Injury
• More likely, even with minor trauma
• Signs of increased ICP develop slowly
• Patient may have forgotten injury, delayed
presentation may be mistaken for CVA
47. Cervical Injury
• Osteoporosis, narrow
spinal canal increase
injury risk from trivial
forces
• Sudden neck
movements may cause
cord injury without
fracture
• Decreased pain
sensation may mask
pain of fracture
48. Hypovolemia & Shock
• Decreased ability to compensate
• Progress to irreversible shock rapidly
• Tolerate hypoperfusion poorly, even for
short periods
49. Hypovolemia & Shock
• Hypoperfusion may occur at “normal” pressures
• Medications (beta blockers) may mask signs of
shock
50. Geriatric Abuse & Neglect
• Physical, psychological injury of older
person by their children or care providers
• Knows no socioeconomic bounds
51. Geriatric Abuse & Neglect
• Contributing factors
– Advanced age: average mid-80s
– Multiple chronic diseases
– Patient lacks total dependence
– Sleep pattern disturbances leading to
nocturnal wandering, shouting
– Family has difficulty upholding commitments
52. Geriatric Abuse & Neglect
• Primary findings
– Trauma inconsistent with history
– History that changes with multiple tellings
54. General Management
Guides
• No enormous change
• “Start Low, Go Slow, But Keep on Going”
• Be wary of Drug Adverse Reactions!
55. Additional
• Geriatric Emergency Department
Guidelines (2014)
– American College of Emergency Physicians
– American Geriatrics Society
– Emergency Nurses Association
– Society for Academic Emergency Medicine
57. Summary
• The Emergency Physician plays a vital
role in the initial management of the
Geriatric patient
• Symptoms of the Geriatric ED patient are
often multiple, overlapping, and atypical,
complicated by existing diseases,
medications and age-related changes