Emerg Med Clin North Am
· 2025 May · PMID 40210350
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Older adult patients (age ≥ 65 years) frequently present to the emergency department with dyspnea, and the most common cause is pulmonary disease. Clinical presentation, examination findings, and existing diagnostic test...Older adult patients (age ≥ 65 years) frequently present to the emergency department with dyspnea, and the most common cause is pulmonary disease. Clinical presentation, examination findings, and existing diagnostic tests can be affected by the pathophysiological changes associated with aging and other comorbidities. As a result, to provide the highest quality care to older adult patients with pulmonary disease, physicians should understand these changes and their implications.
Emerg Med Clin North Am
· 2025 May · PMID 40210349
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Capacity refers to the ability of an individual to make a decision about their medical care based on informed understanding of the medical scenario, treatment options, and potential outcomes. Determining patient capacity...Capacity refers to the ability of an individual to make a decision about their medical care based on informed understanding of the medical scenario, treatment options, and potential outcomes. Determining patient capacity for a decision requires probing each of these components. In this article, the authors describe a structure for assessing capacity as well as identifying and supporting surrogate decision-makers when patients lack the capacity for a decision.
Emerg Med Clin North Am
· 2025 May · PMID 40210348
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Older adults with acute mental health concerns represent a large and growing population presenting to emergency departments (EDs). An organized approach to seniors experiencing a mental health crisis, grounded in a life...Older adults with acute mental health concerns represent a large and growing population presenting to emergency departments (EDs). An organized approach to seniors experiencing a mental health crisis, grounded in a life course perspective, is essential. A structured approach to suicide risk assessment is a key part of ED practice. Mania, psychosis, anxiety, trauma, substance use, and the neuropsychiatric complications of Parkinson's disease are described in this article.
Emerg Med Clin North Am
· 2025 May · PMID 40210347
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Social factors and determinants have an immense impact on health. These "social drivers of health" have been broadly defined as economic and social conditions that influence the health of people and communities. Unmet so...Social factors and determinants have an immense impact on health. These "social drivers of health" have been broadly defined as economic and social conditions that influence the health of people and communities. Unmet social needs contribute to poor health outcomes, particularly for patients with poor access to outpatient care. Emergency departments (EDs) play a critical role in providing health care to vulnerable populations with these needs, and delivering this care is a central component of emergency medicine's public health mission. Here, the authors describe the major unmet social needs that may impact geriatric patients' care in the ED and provide some ways to address them.
Emerg Med Clin North Am
· 2025 May · PMID 40210346
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Identifying and managing critically unwell older patients in emergency departments are challenging for all clinicians. Physiologic changes, multiple comorbidities, and medications often mask or confound serious condition...Identifying and managing critically unwell older patients in emergency departments are challenging for all clinicians. Physiologic changes, multiple comorbidities, and medications often mask or confound serious conditions in older people, and vital signs can be misleading. Because standard triage methods may be inadequate for this population, enhanced triage systems that incorporate frailty assessments and tailored scoring systems are useful. Serial assessments tailored to the patient, biomarkers, and advanced imaging are also important to better detect and manage critical illness in older adults and improve outcomes. Here, the authors discuss diagnosis and management of critically ill older adults.
Emerg Med Clin North Am
· 2025 May · PMID 40210345
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Full text
Delirium, acute brain dysfunction, is present in 10% to 35% of older adults in the emergency department (ED) but unrecognized in ∼80% of cases leading to significant adverse outcomes. Thus, routine screening for delirium...Delirium, acute brain dysfunction, is present in 10% to 35% of older adults in the emergency department (ED) but unrecognized in ∼80% of cases leading to significant adverse outcomes. Thus, routine screening for delirium is vital to improve prevention and management in the ED. The treatment of delirium focuses on addressing the underlying cause. For agitation, nonpharmacologic measures using the Tolerate, Anticipate, and Don't Agitate (TADA) approach and the Assess, Diagnose, Evaluate, Prevent, and Treat (ADEPT) tool are prioritized for management. If unsuccessful, only the lowest effective dose of pharmacologic agents (atypical antipsychotics) should be used for severe symptom control.
Emerg Med Clin North Am
· 2025 May · PMID 40210344
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Assessments are available which can help to identify emergency department (ED) patients who may have dementia. Persons living with dementia (PLWD) have unique emergency care needs such as difficulties with activities of...Assessments are available which can help to identify emergency department (ED) patients who may have dementia. Persons living with dementia (PLWD) have unique emergency care needs such as difficulties with activities of daily living and behavioral and psychological symptoms of dementia. Multiple emergency care practices have shown improved outcomes for PLWD. Communication between clinicians and PLWD requires additional attention and should include care partners and other clinicians when possible. Transitions of care from the ED for PLWD are often problematic with poor outcomes. Interventions like community paramedicine follow up may improve the transition from the ED to the community.
Emerg Med Clin North Am
· 2025 May · PMID 40210343
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Treating older adults with acute pain in the emergency department is complicated. Undertreated pain can lead to delirium and functional decline. Conversely, common analgesics pose risks of serious drug-drug interactions...Treating older adults with acute pain in the emergency department is complicated. Undertreated pain can lead to delirium and functional decline. Conversely, common analgesics pose risks of serious drug-drug interactions and adverse drug events. In this review, we discuss issues essential to pain management in older adults including (1) assessing pain in the cognitively impaired, (2) review of analgesic medication classes, (3) principles of geriatric pharmacology, and (4) selecting an analgesic for an older adult with acute pain.
Emerg Med Clin North Am
· 2025 May · PMID 40210342
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This review summarizes the latest evidence in the evaluation of older adults presenting to the emergency department following head injury. The incidence of traumatic intracranial bleeding in older adults is rising. It is...This review summarizes the latest evidence in the evaluation of older adults presenting to the emergency department following head injury. The incidence of traumatic intracranial bleeding in older adults is rising. It is associated with significant morbidity and mortality. Early identification is critical to facilitate appropriate medical care. Evaluation of the older adult can be challenging due to frailty, delirium, and baseline cognitive and neurologic abnormalities. Clinical decision rules are helpful to identify patients who require advanced imaging. Warfarin slightly increases the risk of traumatic intracranial bleeding, and antiplatelet medications may also increase the risk.
Emerg Med Clin North Am
· 2025 May · PMID 40210341
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Older adults living with frailty are a growing population that will increasingly present to the emergency department (ED). This is a population that is at increased risk of adverse health outcomes and most EDs are not de...Older adults living with frailty are a growing population that will increasingly present to the emergency department (ED). This is a population that is at increased risk of adverse health outcomes and most EDs are not designed with their needs in mind. Instead of characterizing patients based on chronologic age or existing triage tools, frailty assessment offers an accurate, feasible, and patient-centered approach to improving care, and should be performed in the ED.
Emerg Med Clin North Am
· 2025 May · PMID 40210340
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Falls are an important source of morbidity and mortality for older adults. The emergency department (ED) evaluation of an older patient who presents after a fall should include an assessment of events contributing to the...Falls are an important source of morbidity and mortality for older adults. The emergency department (ED) evaluation of an older patient who presents after a fall should include an assessment of events contributing to the acute fall, injuries sustained from it, as well as an underlying falls syndrome. ED measures and referrals to appropriate outpatient services on discharge can help ensure patients receive care and services that can help reduce future falls.
Emerg Med Clin North Am
· 2025 May · PMID 40210339
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In the evolving landscape of emergency departments (EDs), the increasing number of older patients necessitates a paradigm shift. It is important for clinicians to have a working knowledge of geriatric syndromes, goals of...In the evolving landscape of emergency departments (EDs), the increasing number of older patients necessitates a paradigm shift. It is important for clinicians to have a working knowledge of geriatric syndromes, goals of care discussions, the importance of gathering collateral history, involving caregivers, assessing medication use, conducting a thorough physical examination, integrating an interdisciplinary team, ensuring basic equipment availability, and coordinating seamless transitions of care. Though nuanced, these strategies promise to enhance the quality of care for older adults in EDs.
Emerg Med Clin North Am
· 2025 Feb · PMID 39515947
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Abdominal pain accounts for approximately 10% of emergency department visits and 4% to 6% of litigation. Clinical history and examination are important, as all diagnostic testing has limitations. Specific pathologies, su...Abdominal pain accounts for approximately 10% of emergency department visits and 4% to 6% of litigation. Clinical history and examination are important, as all diagnostic testing has limitations. Specific pathologies, such as appendicitis, warrant a review of factors increasing risk. In all cases, documentation of prompt communication with consultants can be protective in the event of any unforeseen delays in care. Careful attention should be paid to special populations including patients with cancer, diabetes, and patients with postsurgical, geriatric, and bariatric surgery.
Emerg Med Clin North Am
· 2025 Feb · PMID 39515946
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The balance between risk of missing serious disease and potential harms from over testing involves knowledge of the literature, familiarity of clinical guidelines, incorporation of clinical decision tools where appropria...The balance between risk of missing serious disease and potential harms from over testing involves knowledge of the literature, familiarity of clinical guidelines, incorporation of clinical decision tools where appropriate, use of metacognition to be aware of cognitive decisions to respond and use of shared decision-making in the context of a patient's presentation and with the guidance of the clinician.
Emerg Med Clin North Am
· 2025 Feb · PMID 39515945
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Misdiagnosis in Emergency Medicine can be associated with patient harm, with neurologic diagnoses among the most common conditions to confound physicians. These are often complex, time-sensitive and nuanced, offering opp...Misdiagnosis in Emergency Medicine can be associated with patient harm, with neurologic diagnoses among the most common conditions to confound physicians. These are often complex, time-sensitive and nuanced, offering opportunity for mimics and chameleons to make assessment, diagnosis and treatment challenging. This article discusses the legal considerations pertinent to neurologic diagnoses for the emergency physician, including assessment, diagnosis, treatment, transfer and documentation in order to ensure excellent patient care as well as protection from liability.
Emerg Med Clin North Am
· 2025 Feb · PMID 39515944
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Headache is a common complaint of patients in the emergency department. The large majority of them have self-limited causes but some have life, limb, brain, or vision-threatening secondary causes. The job of the emergenc...Headache is a common complaint of patients in the emergency department. The large majority of them have self-limited causes but some have life, limb, brain, or vision-threatening secondary causes. The job of the emergency physicians is to distinguish the 2 groups. This article focuses on clinical tips to avoid or at least mitigate medico-legal risk in patients with headache. Each process of care-history, physical examination, laboratory testing, brain imaging, spinal fluid analysis, specialist consultation, and documentation-will be considered.
Emerg Med Clin North Am
· 2025 Feb · PMID 39515943
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Chest pain is a common chief complaint in the emergency department. When looking at patients with chest pain cases of acute coronary syndrome, pulmonary embolism and aortic dissection account for the majority of cases th...Chest pain is a common chief complaint in the emergency department. When looking at patients with chest pain cases of acute coronary syndrome, pulmonary embolism and aortic dissection account for the majority of cases that involve an allegation of malpractice. While it is likely impossible to catch all these cases having a structured approach to these patients may improve outcomes for both patients and clinicians.
Emerg Med Clin North Am
· 2025 Feb · PMID 39515942
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Meningitis, appendicitis, and testicular torsion are among the most common conditions resulting in malpractice litigation in Pediatric Emergency Medicine. With meningitis, most litigation claims involved patients <2 year...Meningitis, appendicitis, and testicular torsion are among the most common conditions resulting in malpractice litigation in Pediatric Emergency Medicine. With meningitis, most litigation claims involved patients <2 years old. Notably, 25% of patients had no fever and many lacked classic signs of meningitis. For appendicitis, nearly 3/4 of litigated cases claimed delayed/missed diagnosis. A non-diagnostic ultrasound (eg, no appendix visualized) has a negative predictive value of only 86%. Finally, testicular torsion carries a 34-42% testicular loss rate and 10% of patients with torsion only present with isolated abdominal pain. Atypical presentations must be considered and clear return precautions are imperative.