We explore the expanding field of Geriatric Emergency Medicine.

Hosts:
Ula Hwang, MD
Brian Gilberti, MD

• Importance and impact of geriatric emergency departments.
• Optimizing care strategies for geriatric patients in ED settings.
• Practical approaches for non-geriatric-specific EDs.

• Geriatric patients often present with:
  • Multiple chronic conditions
  • Polypharmacy
  • Functional decline (mobility issues, cognitive impairments, social isolation)

• Core objective remains acute issue diagnosis and treatment.
• Additional considerations for geriatric patients:
  • Review and caution with medications to prevent adverse reactions.
  • Address functional limitations and cognitive impairments.
  • Emphasize safe discharge and care transitions to prevent unnecessary hospitalization.

• Screening tools:
  • Identification of Seniors at Risk (ISAR)
  • Frailty screens
• Alignment with the “Age-Friendly Health Systems” initiative focusing on:
  • Mentation
  • Mobility
  • Medications
  • Patient preferences (what matters most)
  • Mistreatment (elder abuse awareness)

We discuss the injuries sustained from smoke inhalation.

Hosts:
Sarah Fetterolf, MD
Brian Gilberti, MD

00:37 – Overview of Smoke Inhalation Injury

00:55 – Three Key Pathophysiologic Processes

01:41 – Physical Exam Findings to Watch For

02:12 – Airway Management and Early Intervention

03:23 – Carbon Monoxide Toxicity

04:24 – Workup and Initial Treatment of CO Poisoning

06:14 – Cyanide Toxicity

07:19 – Treatment Options for Cyanide Poisoning

09:12 – Take-Home Points and Clinical Pearls

• Thermal Injury:
  • Direct upper airway damage from heated air or steam.
  • Leads to swelling, inflammation, and possible airway obstruction.
• Chemical Irritation:
  • Causes bronchospasm, mucus plugging, and inflammation in the lower airways.
  • Increases capillary permeability, potentially causing pulmonary edema.
• Systemic Toxicity:
  • Primarily involves carbon monoxide and cyanide poisoning.

We discuss the evaluation of and treatment options for acute back pain.

Hosts:
Benjamin Friedman, MD
Brian Gilberti, MD

• Primary Goal: Distinguish benign musculoskeletal pain from serious pathology.
• Red Flags: Look for indicators of spinal infection, spinal bleed, or space-occupying lesions (e.g., tumors, large herniated discs).
• Assessment: A thorough history and neurological exam (strength testing, gait) is essential.
• Additional Tools: Use bedside ultrasound for post-void residual assessment in suspected cauda equina syndrome

• Routine Imaging: Generally not indicated for young, healthy patients without red flags.
• ACEP Recommendations: Avoid lumbar X-rays in patients under 50 without risk factors, as they do not change management and may increase costs and ED time.
• Advanced Imaging: Reserve MRI for patients with red flags, neurological deficits, or suspected cauda equina syndrome; CRP may be a part of your calculus when evaluating for infectious causes of back pain

• Evidence-Based First-Line:
  • NSAIDs offer modest benefit.