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EMERGENCY ROOM
VISITS
An emergency room can be frightening and agitating
for anyone, let alone for individuals with dementia.
They almost always become more confused when they
are brought to a new location, especially one as
chaotic as an emergency department.
Here are some points that can help:
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If at all possible, a caregiver should discuss
the need for an emergency department visit with
the individual's visiting nurse or primary
physician first before going to the hospital.
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A physician should evaluate any individual with
an acute change in functioning—either cognitive
or psychomotor. It is not always necessary for
the person to visit the ER for this evaluation.
However, if X-rays, blood testing, or other
treatment and diagnostic modalities are
necessary that are not usually available in a
physician's office, an ER is the only choice.
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In transporting someone with dementia to the ER,
it is safer to use an ambulance, rather than
one's car, because they can be strapped onto a
stretcher and monitored. Cars pose a risk since
the person may open the car door while it is
moving or fall during transfer in and out of the
car.
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It is critical for one responsible caregiver or
relative to remain with the person with dementia
at all times. This is to help with the
individual's orientation, and to provide a
measure of support and safety.
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The accompanying caregiver has a major role in
providing critical information to the physician.
They should be prepared to give vital
information about the individual, help the
physician and staff position the person for the
examination if they are able to do so, and
minimize unnecessary interactions with the fully
occupied staff members.
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At the initial encounter with the treating
physician and nurse, caregivers should present
their "credentials." They should inform the
physician and nurse about their background,
experience, continuity, insights, and vantage
points they may have concerning the individual.
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Caregivers should pack an ER kit and have it
ready to go. It should include 1) A preprinted
summary containing the individual's medical
history; key contact numbers such as family and
friends, and health insurance provider; list of
problems; allergies; and medications, including
prescription drugs, over-the-counter and
vitamins 2) Health insurance cards 3) Copies of
legal documents, such as advance directive,
do-not-resuscitate order, health care proxy,
power of attorney and living will 4) Item of
comfort, such as a family photo 5) Change of
clothing, including adult briefs, if necessary.
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ER physicians will do a mental status
examination on the individual with dementia to
decide how to use the information they present.
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It is always advantageous to have a team
approach to evaluate individuals with dementia.
A gerontologist is a key member of this team.
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ER rooms triage priority cases in the following
way: Each presenting complaint, vital signs and
history at triage provide an Emergency Severity
Index (ESI) level. Hospitals use a five level
system, with number one representing the sickest
clients. Within each level, the frail elderly,
including the geriatric person with dementia,
would come first.
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If an individual is stable and waiting for test
results, consultation or perhaps, in some
situations, an in-patient bed, it is best for
caregivers to take them out of the main
emergency department to a quieter place.
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The caregiver is entitled to a complete
debriefing about the individual's condition. But
be patient. Until all of the information has
been obtained and evaluated physicians prefer
not to have to stop what they are doing to
answer questions that will be covered more
comprehensively once the evaluation is
completed.
Based on an interview with Sheldon Jacobson, M.D.,
chairman of the Department of Emergency Medicine at
the Mount Sinai School of Medicine in New York City,
and one of the founders of New York City's first
emergency medicine and paramedic training programs.
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