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Geriatric Emergencies
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Current Topics
in Emergency Medicine
Series editor-in-chief, Peter L. Rosen
Associate series editor-in-chief, Shamai A. Grossman
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Geriatric Emergencies
A discussion-based review
Edited by
Amal Mattu
UniversityofMarylandSchoolofMedicine,DepartmentofEmergencyMedicine,USA
Shamai A. Grossman
HarvardMedicalSchool,USA
BethIsraelDeaconessMedicalCenter,BostonMassachusetts,USA
Peter L. Rosen
HarvardMedicalSchool,USA
BethIsraelDeaconessMedicalCenter,BostonMassachusetts,USA
(cid:2) Associate Editors (cid:2)
Robert Anderson, MD
Christopher Carpenter, MD, MSC
Andrew Chang, MD, MS
Jon Mark Hirshon, MD, MPH, PhD
Ula Hwang, MD, MPH
Maura Kennedy, MD, MPH
Don Melady, MD, MSC(Ed)
Vaishal Tolia, MD, MPH
Scott Wilber, MD, MPH
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Contents
ListofContributors,vii
1 Generalassessmentoftheelderlypatient,1
AlisonSouthern&ScottWilber
2 Physiologicchangeswithaging,13
KateD.Zimmerman&RobertS.Anderson,Jr.
3 Functionalassessmentoftheelderly,28
KirkA.Stiffler
4 Pharmacologicalissuesintheelderly,43
RubenOlmedo&DeniseNassisi
5 Alteredmentalstatusintheelderly,58
JoshJoseph&MauraKennedy
6 Geriatricpsychiatricemergencies,71
JoshJoseph&MauraKennedy
7 Acuteabdominalpainintheelderly:Surgicalcauses,83
KatrenTyler&MauraKennedy
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8 Nonsurgicalabdominalpainintheelderly,99
KatrenTyler&MauraKennedy
9 Backpain,110
NicholasSantavicca&MichaelE.Winters
10 Headache,123
BenjaminW.Friedman&RebeccaNerenberg
11 Dyspneaintheelderly,139
MercedesTorres&SiamakMoayedi
12 Acutechestpaininthegeriatricpatient,152
MarianneHaughey
13 Acutecardiacdiseaseinelderpatients,168
SusanneDeMeester
14 SyncopeinGeriatrics,191
TimothyCPeck,NissaJAli&ShamaiAGrossman
15 Stroke,203
JulieWatkins-Torrey,RoxannaSadri&KamaGuluma
16 Infections,218
JasonOndrejka&ScottWilber
17 Dizzinessandvertigointhegeriatricpopulation,234
JonathanEdlow&AlessandroCancelliere
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CONTENTS
18 Weaknessandfunctionaldecline,252
ColleenMMcQuown
19 Emergencydepartmentevaluationoffallsintheelderly,264
TaniaD.Strout&RobertS.Anderson
20 Traumainthegeriatricpatient,280
ChristopherR.Carpenter&PeterL.Rosen
21 Surgicalconsiderationsintheelderly,304
CharlesW.O’Connell,DavutSavaser&ColleenCampbell
22 Oncologicemergencies,321
GabrielWardi,AlexanderBromfield&LeslieC.Oyama
23 Elderabuseandneglect,351
MichaelC.Bond&KennethH.Butler
24 Geriatricemergencypainmanagementcase,363
TeresitaMHogan&AlexandraWong
25 Ethicalissuesandend-of-lifecare,386
PhillipD.Magidson&JonMarkHirshon
26 Geriatricdispositionsandtransitionsofcare,394
BarbaraMorano,CarmenMorano,KevinBiese,EricA.Coleman&UlaHwang
27 ThegeriatricED,407
PhillipD.Magidson,JohnG.Schumacher&ElizabethA.Couser
(cid:2) Index,417 (cid:2)
vi
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List of Contributors
Nissa J. Ali,MD Colleen Campbell,MD
BethIsraelDeaconessMedicalCenter AssociateClinicalProfessor
HarvardAffiliatedEmergencyMedicineResidency DepartmentofEmergencyMedicine
DepartmentofEmergencyMedicine DivisionofEmergencyUltrasound
WestCampusClinicalCenter UniversityofCalifornia
Boston,MA,USA SanDiegoHealthSystem
SanDiego,CA,USA
Robert S. Anderson, Jr.,MD
AssistantProfessor Alessandro Cancelliere,MDPhD
TuftsUniversitySchoolofMedicine
AssistantProfessor
DepartmentsofEmergencyMedicineandInternal
DepartmentofEmergencyMedicine
MedicineandDivisionofGeriatricMedicine
UniversityofMassachusettsMedicalSchool
MaineMedicalCenter
Worcester,MA,USA
Portland,ME,USA
Kevin Biese,MD,MAT Christopher R. Carpenter,MD,MSC
ViceChairofAcademicAffairs AssociateProfessor
DepartmentofEmergencyMedicine DivisionofEmergencyMedicine
UniversityofNorthCarolinaatChapelHillChapel WashingtonUniversityinSt.LouisSchoolof
(cid:2) Hill,NC,USA Medicine (cid:2)
St.Louis,MO,USA
Michael C. Bond,MD
AssociateProfessor,ResidencyProgramDirector Andrew K. Chang,MD,MS
DepartmentofEmergencyMedicine VincentP.VerdileViceChairforResearchand
UniversityofMarylandSchoolofMedicine AcademicAffairs
Baltimore,MD,USA ProfessorofEmergencyMedicine
AlbanyMedicalCollege
Alexander Bromfield,MD AttendingPhysician
ClinicalInstructor,DepartmentofEmergency AlbanyMedicalCenter
Medicine Albany,NewYork
UniversityofCaliforniaSanDiegoHealthSystem
SanDiego,CA,USA Eric A. Coleman,MD,MPH
ProfessorofMedicineandHead,DivisionofHealth
Kenneth H. Butler,DO CarePolicyandResearch
AssociateProfessor,AssociateResidencyProgram Director
Director CareTransitionsProgramUniversityofColorado
DepartmentofEmergencyMedicine Denver
UniversityofMarylandSchoolofMedicine AnschutzMedicalCampus
Baltimore,MD,USA Aurora,CO,USA
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LIST OF CONTRIBUTORS
Elizabeth Couser,MSW Bryan Hayes,PharmD
GerontologyPhDCandidate ClinicalAssociateProfessor
DoctoralPrograminGerontology DepartmentofEmergencyMedicine
UniversityofMaryland UniversityofMarylandSchoolofMedicine
Baltimore,MD,USA Baltimore,MD,USA
Susanne DeMeester,MD Jon Mark Hirshon,MD,MPH,PhD
AttendingPhysicianandDirectorEmergency Professor
ObservationCenter DepartmentsofEmergencyMedicineandof
StJosephMercyHospital EpidemiologyandPublicHealth
AnnArbor,MI,USA UniversityofMarylandSchoolofMedicine
Baltimore,MD,USA
Jonathan Edlow,MD
Vice-Chair,DepartmentofEmergencyMedicine Teresita M. Hogan,MD
BethIsraelDeaconessMedicalCenter DirectorofGeriatricEmergencyMedicine
ProfessorofMedicineandEmergencyMedicine DepartmentofMedicine
HarvardMedicalSchool SectionsofEmergencyMedicineandGeriatrics&
Boston,MA,USA PalliativeCare
TheUniversityofChicago
Benjamin W. Friedman,MD,MS Chicago,IL,USA
AssociateProfessorofEmergencyMedicine
AlbertEinsteinCollegeofMedicine Ula Hwang,MD,MPH
MontefioreMedicalCenter AssociateProfessor
Bronx,NY,USA DepartmentofEmergencyMedicine
BrookdaleDepartmentofGeriatricsandPalliative
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Shamai A. Grossman,MD Medicine
AssociateProfessorofMedicineandEmergency IcahnSchoolofMedicineatMountSinai
Medicine NewYork,NY
HarvardMedicalSchool GeriatricResearch,EducationandClinicalCenter
ViceChairforHealthCareQuality JamesJ.PetersVAMC
Director Bronx,NY,USA
ObservationMedicine
DepartmentofEmergencyMedicine Joshua W. Joseph,MD
BethIsraelDeaconessMedicalCenter FellowinClinicalInformatics
Boston,MA,USA DepartmentofEmergencyMedicine
BethIsraelDeaconessMedicalCenter
Kama Guluma,MD ClinicalFellowinEmergencyMedicine
ClinicalProfessor HarvardMedicalSchool,Boston,MA,USA
DepartmentofEmergencyMedicine
UniversityofCaliforniaSanDiegoHealthSystem Maura Kennedy,MD,MPH
SanDiego,CA,USA AssociateDirectorforEmergency
MedicineResearch
Marianne Haughey,MD DepartmentofEmergencyMedicine
AssociateProfessorofEmergencyMedicine BethIsraelDeaconessMedicalCenter
AlbertEinsteinCollegeofMedicine AssistantProfessorofEmergencyMedicine
JacobiMedicalCenter HarvardMedicalSchool
Bronx,NewYork,NY,USA Boston,MA,USA
viii
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