Geriatric Emergencies

Cover\nTitle Page\nCopyright\nContents\nPreface\nAcknowledgements\nList of Abbreviations\nChapter 1 Introduction to geriatric emergency medicine\n	Demographics\n	Emergency presentations\n	Frailty at the front door\n	Comprehensive geriatric assessment (CGA)\n	Pathways in geriatric emergency care\n	References\nChapter 2 Essentials of assessment and management in geriatric emergency medicine\n	Introduction\n	Triage and initial assessment\n	Communication with older patients\n		Positioning and body language\n		Vision and hearing\n		Communicating with the cognitively impaired\n	Initial cognitive assessment\n	History of presenting complaint\n		Chronic versus acute symptoms\n		Cognitive impairment\n	Collateral history\n		What to ask\n		Whom to ask\n	Systematic enquiry\n	Social and functional history\n	Medications and polypharmacy\n	Examination\n		General examination\n		Specific areas of focus on examination\n	Investigations\n		Computed tomography (CT) scans in older patients\n		When not to investigate\n	Management\n	How to make a problem list\n		Active problems\n		Inactive problems\n	Discharging a patient from hospital\n		Transitions of care\n	References\nChapter 3 Special skills in geriatric emergency medicine\n	Pain in the older patient\n		Pain assessment\n		Management of acute pain\n		Chronic pain management\n	Palliative care in the acute setting\n		Definition\n		Background\n		Identifying patients requiring palliative care\n		General approach to the patient with palliative care needs\n		Palliative care emergencies\n		Addressing symptom management\n		Communication with patient, carers and family\n		Managing the dying patient in the emergency department\n	Decision-making capacity\n		When the patient lacks decision-making capacity\n	Advance directives\n	Cardiopulmonary resuscitation (CPR)\n		Resuscitation decisions\n		How to discuss resuscitation decisions\n	Ceilings of care\n	Critical care referral\n	Take home messages\n	References\nChapter 4 Vulnerable adults and elder abuse\n	Introduction\n		Definition\n		Background\n	History\n		Think about it\n		Ask about it\n	Examination\n		Physical examination\n		Specific areas of focus\n	Investigation\n		Initial investigations\n	Management\n		Documentation\n		Referral\n	Overview of an approach to patients where abuse is a concern\n	Take home messages\n	Useful links and resources\n		UK (general)\n		England\n		Northern Ireland\n		Scotland\n		Wales\n	USA\n	Case Studies\n	References\nChapter 5 Chest pain and atrial fibrillation\n	Part 1: Chest pain\n		Introduction\n		Background\n	History\n		Particular challenges in taking a history from patients with:\n	Examination\n		Physical examination: general\n		Specific areas of focus on examination\n	Investigations\n		Initial investigations\n		Further investigation\n	Management\n		General management\n		Acute coronary syndrome\n		Pulmonary embolus\n		Aortic dissection\n	Overview of an approach to a patient presenting with chest pain\n	Part 2: Atrial fibrillation\n		Atrial fibrillation\n		Background\n	Initial assessment\n	History and examination\n	Investigations\n	Management\n		1. Haemodynamic compromise\n		2. Identify and treat precipitating causes\n		3. Improve cardiac function by rhythm or rate control\n		Rate control\n		Rhythm control\n		4. Preventing thromboembolism\n	Further management\n	Take home messages\n	References\nChapter 6 Dyspnoea\n	Introduction\n	Definition\n	Background\n	Initial assessment\n	History\n		Onset\n		Comparison with baseline symptoms\n		Associated symptoms\n		Previous episodes\n		Past medical history\n		Drug history\n		Social history\n		Systemic enquiry\n	Asthma in older patients\n	COPD in older patients\n	Cardiac failure\n	Examination\n		General examination\n		Specific areas of focus on examination\n	Investigations\n		Initial investigations\n		Further investigations If cardiac failure is suspected\n		If an exacerbation of asthma or COPD is suspected\n	Management\n		Oxygen\n		Type 2 respiratory failure in older patients\n		Non-invasive ventilation (NIV)\n		Invasive ventilation\n		Recurrent presentations with COPD ‘the revolving door patient’\n		Discharging older patients with COPD\n		Management of end-stage lung disease\n		Management of cardiac failure\n		Acute pulmonary oedema\n		Cardiac failure with acute or chronic kidney injury\n		Prognosis\n	Take home messages\n	References\nChapter 7 Infection and sepsis\n	Introduction\n	Background\n		Specific causes of infection\n		Urinary tract infection (UTI)\n		Respiratory tract infections\n		Cellulitis\n	Initial assessment\n	History\n		In suspected urinary tract infection\n		In suspected pneumonia\n		In suspected cellulitis\n	Examination\n		In suspected urinary tract infection\n		In suspected pneumonia\n		In suspected cellulitis\n	Investigations\n		In suspected urinary tract infection\n		In suspected pneumonia\n		In suspected cellulitis\n	Management\n		General management of the septic older patient\n		Antibiotic therapy\n		Admission\n		Critical care referral\n		Management of specific infections Urinary tract infection\n		Respiratory tract infections\n	Take home messages\n	References\nChapter 8 Falls and immobility\n	Part 1: Falls\n		Introduction\n	History\n	Examination\n		General\n		Specific areas of focus on examination\n	Investigations\n		Initial investigations\n		Further investigations\n	Management\n		General\n	Specific management considerations in older patients\n		Soft tissue injury\n		Fractures\n		Head injury\n		Prolonged immobility\n		Overview of an approach to a patient with a fall\n	Part 2: Immobility\n		Introduction\n		Background\n	History\n	Examination\n		General examination\n		Examining pressure ulcers\n	Investigations\n		Initial investigations\n		Further investigations\n	Management\n		General management\n		Pressure ulcers in older patients\n		Patients with Parkinson’s disease\n		Complications of a ‘long lie’\n		Hypothermia\n	Take home messages\n	References\nChapter 9 Syncope\n	Introduction\n		Definition\n		Background\n	History\n	Examination\n		General examination\n		Specific areas of focus on examination\n	Investigations\n		Initial investigation\n		Further investigation\n	Management\n		General management\n		Specific management considerations in older patients\n	Overview of an approach to a patient presenting with syncope\n	Take home messages\n	References\nChapter 10 Dizziness\n	Introduction\n		Definition\n		Background\n	History\n		What is the nature of the dizziness?\n		Precipitants of the dizziness\n		Timescale\n		Frequency of attacks\n		Past medical history\n		Medication and alcohol history\n	Examination\n		General examination\n		Specific areas of focus on examination\n	Investigations\n		Initial investigations\n		Further investigations\n	Management\n		General management\n		Specific management considerations in older patients\n	Criteria for admission of a dizzy patient\n	Take home messages\n	References\nChapter 11 Major trauma\n	Introduction\n	Definition\n	Background\n	Initial Approach\n		Airway and cervical spine immobilisation\n		Breathing\n		Circulation with haemorrhage control\n		Disability\n		Exposure and environmental control\n	History\n	Investigations\n	General management\n	Secondary survey and tertiary survey\n	Rib fractures\n	Cervical spine injuries\n		Initial assessment\n		Odontoid peg fractures\n		Central cord syndrome\n	Take home messages\n	References\nChapter 12 Fractures and back pain\n	Fractures\n		Introduction\n		Definition and background\n		Initial assessment\n		Hip fractures\n		History and examination\n		Investigations\n		Management\n		Fascia iliaca compartment block (FICB)\n		Facilitating surgery\n		Ongoing care\n		Pelvic insufficiency fractures\n		History, examination and investigations\n		Distal radial fractures\n	Back pain in the older adult\n		Immediate assessment\n		Differential diagnosis\n		History\n		Examination\n		Investigations\n		Vertebral insufficiency fracture\n		Diagnosis and classification\n		Management\n		Spinal cord compression and cauda equina syndrome\n		History and examination\n		Management\n		Procedural sedation in the older patient\n	Take home messages\n	References\nChapter 13 Skin trauma\n	Introduction\n	Background\n	History and examination\n		Tetanus status\n	Specific injuries\n		Skin tears\n		Scalp and face lacerations\n		Pre-tibial lacerations\n	Burns\n		Background\n		Initial assessment\n		Examination\n		Management\n	Take home messages\n	References\nChapter 14 Head injury\n	Introduction\n	Initial assessment\n		Airway and cervical spine immobilisation\n		Breathing\n		Circulation with haemorrhage control\n		Disability\n		Exposure and environmental control\n	History\n	Examination\n	Investigations\n		Initial investigations\n		Computed tomography (CT) head\n		Computed tomography (CT) cervical spine\n	Management\n		Managing a head injured patient on anticoagulants\n		Discharging patients with head injuries\n	Take home messages\n	References\nChapter 15 Abdominal emergencies\n	Introduction\n	Background\n	Initial assessment\n	History\n	Examination\n	Investigations\n	Specific causes of abdominal pain in the older adult\n		Abdominal aortic aneurysm (AAA)\n		Biliary disease\n		Pancreatitis\n		Biliary disease\n		Pancreatitis\n		Peptic ulcer disease\n		Gastrointestinal haemorrhage\n		Small bowel obstruction\n		Large bowel obstruction\n		Non-mechanical causes of bowel obstruction\n		Constipation and faecal impaction\n		Mesenteric ischaemia\n		Appendicitis\n		Diverticular disease\n		Genitourinary causes\n		Non-surgical or extra-abdominal causes of abdominal pain\n		Non-specific abdominal pain\n	Take home messages\n	References\nChapter 16 Diabetic and environmental emergencies\n	Part 1: Diabetic emergencies\n		Introduction\n	Hypoglycaemia\n	Hyperglycaemic hyperosmolar syndrome\n		Diagnosis\n		Management\n	Part 2: Temperature homeostasis\n		Introduction\n	Hypothermia\n		Definition\n		Background\n		Initial assessment\n		History and examination\n		Investigations\n		Management\n	Hyperthermia and heat illness\n		Management\n	Take home messages\n	References\nChapter 17 Acute kidney injury and metabolic emergencies\n	Acute kidney injury\n		Definition\n		Background\n		Initial assessment\n		History and examination\n		Investigations\n		Management\n		Complications\n		Prevention of acute kidney injury\n	Hyponatraemia\n		Definition\n		Background\n		History and Examination\n		Investigations\n		Management\n	Hypernatraemia\n	Hypercalcaemia\n		History and examination\n		Management\n	Take home messages\n		Recommended resources\n	References\nChapter 18 Delirium\n	Introduction\n		Definition\n		Background\n	History\n		Differential diagnosis\n	Examination\n		Physical examination: general\n		Specific areas of focus on examination\n		Assessing for and documenting delirium\n	Investigations\n		Initial investigations\n		Further investigations\n	Management\n		General management\n		Specific management considerations in older patients\n	Legislation and delirious patients\n		Medical treatments and other healthcare interventions\n		Covert medication\n		Wandering\n		Absconding and restraint\n		Restriction or deprivation of liberty (DOLS)\n	Prevention of delirium\n	Take home messages\n	References\nChapter 19 Stroke and transient ischaemic attack\n	Introduction\n		Definition\n		Background\n		Stroke categorisation\n	Initial assessment of patients with acute stroke in the ED\n		The FAST test\n		Time of onset\n		Past medical history\n		Functional status\n		Medications\n	Examination\n		General examination\n		The national institute of health stroke scale\n		Recommended resources\n		Higher function assessment\n	Investigations\n		Initial investigations\n		Further investigations\n	Management\n		General management of acute ischaemic stroke in the ED\n		Specific management considerations in the older patients\n		Further management of acute stroke\n		Transient ischaemic attack\n	Intracranial haemorrhage\n		Background\n		Management\n	Take home messages\n	References\nIndex