Abstract:
:Older patients account for up to a quarter of all emergency department (ED) visits. Atypical clinical presentation of illness, a high prevalence of cognitive disorders, and the presence of multiple comorbidities complicate their evaluation and management. Increased frailty, delayed diagnosis, and greater illness severity contribute to a higher risk of adverse outcomes. This article will review the most common conditions encountered in older patients, including delirium, dementia, falls, and polypharmacy, and suggest simple and efficient strategies for their evaluation and management. It will discuss age-related changes in the signs and symptoms of acute coronary events, abdominal pain, and infection, examine the yield of different diagnostic approaches in this population, and list the underlying medical problems present in half of all "social" admission cases. Complete geriatric assessments are time consuming and beyond the scope of most EDs. We propose a strategy based on the targeting of high-risk patients and provide examples of simple and efficient tools that are appropriate for ED use.
journal_name
Ann Emerg Medjournal_title
Annals of emergency medicineauthors
Samaras N,Chevalley T,Samaras D,Gold Gdoi
10.1016/j.annemergmed.2010.04.015subject
Has Abstractpub_date
2010-09-01 00:00:00pages
261-9issue
3eissn
0196-0644issn
1097-6760pii
S0196-0644(10)00385-9journal_volume
56pub_type
杂志文章,评审abstract::Gifts to physicians by the pharmaceutical industry pose numerous ethical questions. Although individual patients and physicians may benefit financially and educationally from certain gifts, the risk of bias resulting from such gifts makes them ethically challenging. After a brief description of the nature and scope of...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.12.013
更新日期:2006-11-01 00:00:00
abstract:STUDY HYPOTHESIS:To determine the prevalence of antibody to human immunodeficiency virus (HIV) in trauma and nontrauma patients not identified as having known HIV infection in a noninner-city university teaching hospital emergency department, and to determine the frequency with which treating emergency physicians are k...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)80842-x
更新日期:1991-07-01 00:00:00
abstract:STUDY OBJECTIVE:This study was conducted to compare the clinical and spirometric effects of continuous and intermittent nebulization of salbutamol in acute severe asthma. METHODS:Forty-two consecutive patients presenting to the emergency department for acute severe asthma (peak expiratory flow [PEF] mean+/-SD, 24%+/-1...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mem.2000.109169
更新日期:2000-09-01 00:00:00
abstract::Epiglottitis in adults, while uncommon, is certainly not rare. Despite the increasing reports of the disorder in the literature, it continues to be misdiagnosed in emergency departments. The first step in the diagnosis of acute epiglottitis is for the emergency physician to think of it. The literature concerning the e...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80463-5
更新日期:1981-01-01 00:00:00
abstract::The insurance market is evolving, with increased emphasis on plans with high deductibles and a large degree of coinsurance. This article serves as an introduction to the defining characteristics of consumer-driven health care plans and their associated health savings accounts. We discuss the most recent evidence on th...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.05.013
更新日期:2005-12-01 00:00:00
abstract:STUDY OBJECTIVE:The benefit of epinephrine in cardiac arrest is controversial and has not been conclusively shown in any human clinical study. We seek to assess the effect of introducing intravenous epinephrine on the survival outcomes of out-of-hospital cardiac arrest patients in an emergency medical services (EMS) sy...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2007.03.028
更新日期:2007-12-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate clinical and cellular changes of bone through the rapid growth phase of development after intraosseous infusion of hypertonic or isotonic solutions at slow or fast infusion rates in a pig model. METHODS:This was a prospective, randomized, partially blinded, comparative study using a porcine...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(96)70010-0
更新日期:1996-10-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the effectiveness of magnetic resonance imaging in detecting early myocardial infarction in vivo after coronary artery occlusion. DESIGN:A prospective, controlled canine study using a left anterior descending coronary artery ligation model. INTERVENTIONS:After thiopental anesthesia, nine ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81982-1
更新日期:1993-09-01 00:00:00
abstract::This clinical policy focuses on critical issues in the evaluation and management of adult patients with seizures. The medical literature was reviewed for articles that pertained to the critical questions posed. Subcommittee members and expert peer reviewers also supplied articles with direct bearing on this policy. Th...
journal_title:Annals of emergency medicine
pub_type: 指南,杂志文章,实务指引
doi:10.1016/S019606440400068X
更新日期:2004-05-01 00:00:00
abstract::Although a number of studies have described endotracheal intubation of adult patients in the prehospital setting, there are few studies on prehospital endotracheal intubation of pediatric patients. The purposes of our study were to determine how frequently prehospital endotracheal intubation was used in pediatric card...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(89)80830-3
更新日期:1989-05-01 00:00:00
abstract:STUDY OBJECTIVES:To demonstrate the degree to which pulse oximetry overestimates actual oxyhemoglobin (O2Hb) saturation in patients with carbon monoxide (CO) poisoning. This phenomenon has been reported in fewer than 20 humans in the English medical literature. METHODS:A retrospective chart review of 191 patients eval...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(97)70077-5
更新日期:1997-11-01 00:00:00
abstract:STUDY OBJECTIVES:To examine trends in legal handgun purchases from federally licensed dealers and specifically to describe recent changes in age and gender of purchaser and caliber of handguns purchased. METHODS:A cohort study was performed of the adult population of Washington state from 1950 through 1992 using a sta...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(98)70100-3
更新日期:1998-07-01 00:00:00
abstract::During a 3-month period, a 33-year-old man presented to the emergency department on 4 occasions with dyspnea, palpitations, and syncope. His initial presentation was accompanied by acute myocardial injury and ventricular fibrillation. An extensive evaluation spanned the 3 months and included echocardiography, cardiac ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2005.02.002
更新日期:2005-06-01 00:00:00
abstract:STUDY OBJECTIVE:Stress is an emergent occupational problem in modern societies. Among workers, medical practitioners are particularly exposed. However, data objectifying stress levels during work time are scarce. The aim of this study was to establish diurnal salivary cortisol levels in a highly stressful work environm...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2003.109
更新日期:2003-04-01 00:00:00
abstract::Acoustic otoscopy detects middle ear pathology by measuring the ability of the tympanic membrane to reflect sound. Fluid or thickening of the tympanic membrane increases sound reflection. We conducted a study to compare acoustic otoscopy with pneumatic otoscopy in identifying middle ear pathology in 80 children (160 e...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章
doi:10.1016/s0196-0644(89)80578-5
更新日期:1989-04-01 00:00:00
abstract::The ability of military anti-shock trousers (MAST) to increase central venous pressure and improve cardiac filling pressure suggests that they might be useful in the prehospital treatment of pericardial tamponade. This study utilizes a canine model to examine the hemodynamic effects of MAST inflation on experimentally...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(81)80158-8
更新日期:1981-04-01 00:00:00
abstract:STUDY OBJECTIVE:Medication history is an essential part of patient assessment in emergency care. Patient-reported medication history can be incomplete. We study whether an electronic pharmacy-sourced prescription record can supplement the patient-reported history. METHODS:In a community hospital, we compared the patie...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2013.04.014
更新日期:2013-09-01 00:00:00
abstract::The World Health Assembly 2007 Resolution 60.22 tasked the global health community to address the lack of emergency care in low- and middle-income countries. Little progress has yet been made in integrating emergency care into most low- and middle-income-country health systems. At a rural Ugandan district hospital, ho...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2014.01.035
更新日期:2014-11-01 00:00:00
abstract:STUDY OBJECTIVE:The study was designed to determine if open peritoneal lavage is superior to closed peritoneal lavage. DESIGN AND PARTICIPANTS:Patients who were admitted to a trauma center and needed peritoneal lavage were assigned to alternate trauma teams. Team 1 performed only open lavages one month and then switch...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0196-0644(05)81067-4
更新日期:1991-12-01 00:00:00
abstract::We present the case of a 21-year-old man who presented to the emergency department with an episode of profound weakness due to thyrotoxic periodic paralysis, a syndrome of muscular weakness occurring in patients with hyperthyroidism. Prior to the diagnosis, the patient was treated with a parenteral tranquilizer. When ...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(88)80568-7
更新日期:1988-08-01 00:00:00
abstract:STUDY OBJECTIVE:To compare patient and practitioner assessments of pain associated with commonly performed emergency department procedures and use of anesthetics before these procedures. METHODS:This was a prospective, observational, cross-sectional study conducted at a university-based ED with a convenience sample of...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:
更新日期:1999-06-01 00:00:00
abstract::Severe sepsis and septic shock are as common and lethal as other acute life-threatening conditions that emergency physicians routinely confront such as acute myocardial infarction, stroke, and trauma. Recent studies have led to a better understanding of the pathogenic mechanisms and the development of new or newly app...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2006.02.015
更新日期:2006-07-01 00:00:00
abstract::The sudden emergence of 2009 H1N1 influenza in the spring of that year sparked a surge in visits to emergency departments in New York City and other communities. A larger, second wave of cases was anticipated the following autumn. To reduce a potential surge of health system utilization without denying needed care, we...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/j.annemergmed.2010.04.005
更新日期:2010-09-01 00:00:00
abstract::Decisions about medical resource triage during disasters require a planned structured approach, with foundational elements of goals, ethical principles, concepts of operations for reactive and proactive triage, and decision tools understood by the physicians and staff before an incident. Though emergency physicians ar...
journal_title:Annals of emergency medicine
pub_type: 杂志文章,评审
doi:10.1016/j.annemergmed.2011.06.012
更新日期:2012-03-01 00:00:00
abstract:STUDY PURPOSE:To evaluate the efficacy of adenosine in the treatment of emergency department patients with unstable paroxysmal supraventricular tachycardia (PSVT). DESIGN:A retrospective chart review conducted over two years. SETTING:A university-affiliated hospital ED. PARTICIPANTS:Patients with unstable PSVT (syst...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)81853-0
更新日期:1993-04-01 00:00:00
abstract:STUDY OBJECTIVE:We evaluate the safety and efficacy of a single dose of hyoscyamine sulfate in combination with ketorolac tromethamine for the reduction of pain in emergency department patients with ureteral colic. METHODS:We conducted a prospective, randomized, double-blind study at 2 EDs with residency programs in e...
journal_title:Annals of emergency medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mem.2001.113133
更新日期:2001-02-01 00:00:00
abstract:STUDY OBJECTIVES:To determine the sensitivity, specificity, and predictive values of a new rapid creatine kinase-MB (R-CK-MB) assay compared with a standard CK-MB (S-CK-MB) assay and to determine its potential use in the evaluation of emergency department patients with possible myocardial infarction. DESIGN:Retrospect...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(05)82971-3
更新日期:1991-09-01 00:00:00
abstract:STUDY OBJECTIVE:We estimate the occupational fatality rate among emergency medical services (EMS) personnel in the United States. METHODS:We undertook descriptive epidemiology of occupational fatalities among EMS providers. Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1067/mem.2002.128681
更新日期:2002-12-01 00:00:00
abstract::Our study was conducted to determine the appropriate dose of lidocaine using the larynx and to characterize the onset and duration of therapeutic serum levels. A mean dose of 5.67 +/- 1.2 mg/kg was topically administered to the subglottic region of seven comatose patients through a cricothyroid membrane puncture. Seri...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(82)80062-0
更新日期:1982-09-01 00:00:00
abstract::Many studies of prehospital resuscitation report on selected populations. We examined a series of 445 unselected nontraumatic cardiac arrests. Emergency cardiac care (ECC) was not initiated in 126 (28%). ECC was begun in 319 (78%), but was terminated in 132 (33%). Ninety-four (21%) were admitted to the hospital with p...
journal_title:Annals of emergency medicine
pub_type: 杂志文章
doi:10.1016/s0196-0644(86)80185-8
更新日期:1986-04-01 00:00:00