60% ED cases are surgical, 20% go directly to the OR
Have a lower threshold
- Relying on normal lab results
- Misdiagnosing mesenteric ischemia as gastroenteritis
- Relying too heavily on classic presentations of common illnesses
- Over-reliance on positive UA as indicating cause of acute abdominal pain
- Relying on classic findings and history to rule out appendicitis
- Expecting abdominal rigidity when considering a visceral perforation
- SMA embolus - pain out of proportion, nausea, vomiting, diarrhea. Seen in atrial fibrillation, valvular disease, cardiomyopathy.
- SMA thrombosis - "Intestinal angina." Seen in atherosclerosis, smokers.
- SMV thrombosis - less severe pain than arterial disease. Seen in OCP use, hypercoagulable state.
- Non-occlusive mesenteric ischemia - nonreproducible abdominal pain, unexplained GI bleeding in ICU patients, abdominal pain after dialysis.
- Higher prevalence of cervical spine injuries. About 50% due to ground level falls
- Higher incidence of higher level cervical spine injuries. 45% C2, 15% C1 injuries
- Blunted/absent fever response in 30%
- 89% have infection when fever is present
- High incidence of asymptomatic bacteriuria. Reconsider antibiotics for these patients.
- One, et al. Detection of cervical spine injuries in alert, asymptomatic geriatric blunt trauma patients: who benefits from radiologic imaging? American Surgeon.2006.
- Chen P. Emergency rooms are no place for the elderly. The New York Times. 2014.
- American Geriatric Society
- US Department of Health and Human Resources
- Lee J. Growth of senior specific EDs holds quality promise but raises cost issues. Modern Heatlhcare. 2014.
- Wang et al. Geriatric trauma patinets with cervical spine fractures due to ground level fall. Journal of Clinical Medical Research. 2013.
- Lamoschitz. Cervical spine injuries in patients 65 years old and older. American Journal of Roentgenology. 2002.
- Spaniolas, et al. Ground level falls are associated with signfiicant mortality in elderly patients. The Journal of Trauma Injury, Infection and Critical Care. 2010.
- Parker, Simon and Arash Afsharpad. Ground-level geriatric falls: a not so minor mechanism of injury. Case Reports in Orthopedics. 2014.
- Platts-Mills, et al. A modern day purgatory: older emergency department patients with non-operative injuries. Journal of American Geriatric Society.
- Row and Juthani-Mehta. Diagnosis and management of urinary tract infections in older adults. Infectious Disease Clinics of North America. 2014.
Submitted by Dr. Kristina Morgan, PGY-3