Emergency medicine clinics of North America
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The bones of elderly individuals fracture easily. The fractures in osteoporotic bones may not be easily identified on plain films. A high level of suspicion will result in more accurate diagnosis and appropriate referral and treatment of these patients.
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Psychiatric disorders are best managed by interdisciplinary teams of psychiatrists, psychiatric nurses, social workers, and psychologists. Some Emergency Departments have access to such psychiatric services either in the hospital or in associated clinics or community mental health centers. Unfortunately, many are not staffed with mental health professionals or such expertise is available only on a limited basis, particularly on evenings and weekends. ⋯ We have reviewed the format for conducting a psychiatric history and mental status examination and have discussed the most common emergency psychiatric disorders of the elderly and their management in the Emergency Department. In order to assess and treat elderly psychiatric patients properly, emergency personnel must be aware of the medical disorders associated with psychiatric illness and must be prepared to initiate treatment quickly and appropriately. For most patients, emergency intervention is the first step in ensuring that a correct diagnosis is made and that ongoing psychiatric treatment is arranged through timely consultation and referral.
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An examination of the social concerns of the elderly reinforces the importance of a thorough social assessment and the availability of skilled staff in an Emergency Department to make appropriate community referrals. The resolution of disposition problems brought about through caregiver exhaustion, patients no longer able to care for themselves in the community, and abandonment by individuals and institutions require a complex array of skills. The serious problem of drug and alcohol abuse among the elderly must be recognized by Emergency Department staff. ⋯ Communities with a geriatric treatment center provide a valuable resource for patients identified through Emergency Department visits. The Emergency Department must play an active role in assisting hospitals, area agencies on aging, and other concerned members of the community plan programs for elderly patients with physical and social concerns. While these changes are implemented, the Emergency Department will continue to remain responsive to the social concerns of the elderly through deliberate organizational efforts designed to maintain a high quality of care for elderly patients.
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Emerg. Med. Clin. North Am. · Feb 1990
ReviewMass casualty incident. Integration with prehospital care.
Mass casualty incident involves the use of limited resources for multiple casualties. The emergency physician must be familiar with both prehospital and hospital plans for mass casualty care in order to facilitate optimal care and to maintain the continuum from field care to definitive treatment. ⋯ Emergency physicians involved in prehospital care should be certain that the local EMS system has adequate training and chances to update their skills and knowledge. Disaster drills of the EMS system are excellent ways to practice, to identify weaknesses, and for preplanning to enhance disaster medical care.
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All patient care aspects of prehospital health care delivery must be physician directed. This process of medical accountability seeks to assure quality EMS patient care. Emphasis in this chapter is on the two main configurations of EMS medical accountability, off-line medical direction and on-line medical control. Topics include EMS physician qualifications, responsibilities, and authority; the role of protocols and standing orders; medical control configurations; and others.