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Contributors
AMAL MATTU, MD (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 14, 2021 Category: Emergency Medicine Source Type: research

Contents
Amal Mattu (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 14, 2021 Category: Emergency Medicine Source Type: research

Forthcoming Issues
Pediatric Emergency Medicine (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 14, 2021 Category: Emergency Medicine Source Type: research

Applying Geriatric Principles to Transitions of Care in the Emergency Department
Each emergency department (ED) visit represents a crucial transition of care for older adults. Systems, provider, and patient factors are barriers to safe transitions and can contribute to morbidity and mortality in older adults. Safe transitions from ED to inpatient, ED to skilled nursing facility, or ED back to the community require a holistic approach, such as the 4-Ms model —what matters (patient goals of care), medication, mentation, and mobility—along with safety and social support. Clear written and verbal communication with patients, caregivers, and other members of the interdisciplinary team is paramount in en...
Source: Emergency Medicine Clinics of North America - March 17, 2021 Category: Emergency Medicine Authors: Kimberly Bambach, Lauren T. Southerland Source Type: research

Trends in Geriatric Emergency Medicine
This article educates emergency medicine practitioners and highlights high-value care practice trends to inform and prioritize decision-making for this u nique patient population. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 16, 2021 Category: Emergency Medicine Authors: Phillip D. Magidson, Christopher R. Carpenter Source Type: research

Infections in Older Adults
Infections in elderly patients can prove diagnostically challenging. Age-related factors affecting the immune system in older individuals contribute to nonspecific presentations. Other age-related factors and chronic conditions have symptoms that may or may not point to an infectious diagnosis. Delay in administration of antimicrobials can lead to poor outcomes; however, unnecessary administration of antimicrobials can lead to increased morbidity and contribute to the emergence of multidrug-resistant organisms. Careful clinical assessment and consideration of patient history and risk factors is crucial. When necessary, ant...
Source: Emergency Medicine Clinics of North America - March 16, 2021 Category: Emergency Medicine Authors: Mary Morgan Scott, Stephen Y. Liang Source Type: research

Physical Therapy, Occupational Therapy, and Speech Language Pathology in the Emergency Department
The rehab services of Physical Therapy, Occupational Therapy, and Speech Language Pathology (PT/OT/SLP) are areas of emerging practice in the emergency department (ED). These specialty consult services can provide ED physicians with valuable, nuanced assessments for the older adults that will assist in determining a safe discharge plan. PT and OT interventions in the ED have been shown to decrease hospital admissions and readmissions, increase patient satisfaction, and decrease cost. Rehab specialists provide physicians with an expanded scope of management options that can greatly enhance the care of patients in the ED. (S...
Source: Emergency Medicine Clinics of North America - March 16, 2021 Category: Emergency Medicine Authors: Elizabeth A. Pontius, Robert S. Anderson Source Type: research

Clinical Relevance and Considerations of Palliative Care in Older Adults
The incorporation of palliative care to address the needs of the older adult is a vital part of emergency medicine. Recognizing the trajectory of chronic diseases in older adults and the myriad of medical diseases amenable to palliative care is paramount. Early involvement of palliative care should be considered the cornerstone to overarching management of the older adult presenting to the emergency department. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 16, 2021 Category: Emergency Medicine Authors: Leah Bright, Bonnie Marr Source Type: research

Elder Abuse —A Guide to Diagnosis and Management in the Emergency Department
Elder abuse affects many older adults and can be life threatening. Older adults both in the community and long-term care facilities are at risk. An emergency department visit is an opportunity for an abuse victim to seek help. Emergency clinicians should be able to recognize the signs of abuse, including patterns of injury consistent with mistreatment. Screening tools can assist clinicians in the diagnosis of abuse. Physicians can help victims of mistreatment by reporting the abuse to the appropriate investigative agency and by developing a treatment plan with a multidisciplinary team to include a safe discharge plan and c...
Source: Emergency Medicine Clinics of North America - March 16, 2021 Category: Emergency Medicine Authors: Nicole Cimino-Fiallos, Tony Rosen Source Type: research

Resuscitation of the Critically Ill Older Adult
In 30 years, adults 65 and older will represent 20% of the US population, with increased medical comorbidities leading to higher rates of critical illness and mortality. Despite significant acute illness, presenting symptoms and vital sign abnormalities may be subtle. Resuscitative guidelines are a helpful starting point but appropriate diagnostics, bedside ultrasound, and frequent reassessments are needed to avoid procrustean care that may worsen outcomes. Baseline functional status is as important as underlying comorbid conditions when prognosticating, and the patient ’s personal wishes should be sought early and throu...
Source: Emergency Medicine Clinics of North America - March 11, 2021 Category: Emergency Medicine Authors: Kami M. Hu, Robert M. Brown Source Type: research

Rapid Fire
Delirium is common in older emergency department (ED) patients. Although associated with significant morbidity and mortality, it often goes unrecognized. A consistent approach to evaluation of mental status, including use of validated tools, is key to diagnosing delirium. Identification of the precipitating event requires thorough evaluation, including detailed history, medication reconciliation, physical examination, and medical work-up, for causes of delirium. Management is aimed at identifying and treating the underlying cause. Meaningful improvements in delirium care can be achieved when prevention, identification, and...
Source: Emergency Medicine Clinics of North America - March 11, 2021 Category: Emergency Medicine Authors: Debra Eagles, Danya Khoujah Source Type: research

Identification of Acute Coronary Syndrome in the Elderly
This article aims to outline presentation, outcomes, and potential solutions of underrecognition of ACS in the older adult population. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 11, 2021 Category: Emergency Medicine Authors: Michael McGarry, Christina L. Shenvi Source Type: research

Rapid Fire
Increasing prescription drug use trends in the United States affects patients across all ages, but especially the geriatric patient. As patients age, they are at increased risk for adverse events owing to natural changes in body composition and organ function, increased sensitivity to medications, and a higher chance of adverse events from drug –drug interactions and polypharmacy. Falls are common and can increase morbidity and mortality. To mitigate falls, it is imperative to have a comprehensive approach to screening home medication lists, be aware of and avoid high-risk medications, and deprescribe agents that are pot...
Source: Emergency Medicine Clinics of North America - March 11, 2021 Category: Emergency Medicine Authors: Ashley N. Martinelli Source Type: research

Genitourinary Emergencies in Older Adults
Older adults are frequently seen in the emergency department for genitourinary complaints, necessitating that emergency physicians are adept at managing a myriad of genitourinary emergencies. Geriatric patients may present with acute kidney injury, hematuria, or a urinary infection and aspects of how managing these presentations differs from their younger counterparts is emphasized. Older adults may also present with acute urinary retention or urinary incontinence as a result of genitourinary pathology or other systemic etiologies. Finally, genital complaints as they pertain to older adults are briefly highlighted with emp...
Source: Emergency Medicine Clinics of North America - March 11, 2021 Category: Emergency Medicine Authors: Nicole Soria, Danya Khoujah Source Type: research

Emergencies in the Geriatric Patient
Any clinician who has spent time working in the emergency department (ED) in recent years knows that our patients are getting older. During my last shift, 11 out of the 25 patients I cared for were over the age of 65, three of whom were over the age of 75, and one of the patients was over the age of 90. Care of these patients was challenging: each of them brought with them a host of prior medical problems, significant risks for polypharmacy, and sometimes vague complaints. Evaluations were sometimes further confounded by hearing problems, memory issues, and altered mental status. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - March 11, 2021 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research