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Alex 01:27 We’re delighted to welcome back Tim F a rrell, who’s a geriatrician, associate chief for Age Friendly care at the University of Utah and chair of the American Geriatric Society Ethics Committee. All right, and finally we have Yael Zweig, who is a geriatric nurse practitioner at NYU. Tim, welcome back to GeriPal.
This idea that for critically ill patients in the ICU, geriatric conditions like disability, frailty, multimorbidity, and dementia should be viewed through a wider lens of what patients are like before and after the ICU event was transformative for our two guests today. I’m going to turn to you Lauren.
Alex: Also returning Rebecca Sudore, who is professor of medicine at the UCSF in the division of geriatrics, and is a geriatric and palliative care doctor. I don’t need a checkbox form, I don’t need to know about CPR or mechanical ventilation. Welcome back, Rebecca. Rebecca: Thanks for having us. Who are they?
And now ICU care has flourished, and we can keep people alive in the sense that their heart is beating and we can sustain their ventilation and circulation. For example, I had another patient in the ICU who she was on a ventilator. They didn’t come up in geriatrics very much. And we see that too in geriatrics.
And that helped them focus on that instead of, say, the blood pressure, the vasopressors or the ventilator settings that day. And then they had to be receiving 48 hours of continuous mechanical ventilation at a minimum and be an adult. Eric: And how did you do that? There were nine disease categories. Eric: Okay.
I’d be willing to take some time on a mechanical ventilation machine to live longer.” And so the idea that patients are walking around with these on their shoulder like, “Hey, I got the mechanical ventilation preference, just want to make sure.” ” Because I’m like, “Yeah, to what end?
In the US, geriatrics “grew up” as an academic profession with a heavy research base. Clinical growth of geriatrics programs has lagged academic research, despite the rapid aging of the population. . And instead of only being focused on the mechanical ventilation parameters that day, we force them to focus on prognosis.
Their oxygenation, while important, whether or not we can take them off the ventilator, probably has nothing to do with the big picture, oh, and they’re dying of metastatic pancreatic cancer. ” Don: It was part of the palliative care fellowship, a study of linguistics and communication.
Interested in your thoughts on revising this framework at a national level, the NIH framework versus clinicians making individual choices about who to allocate this, a scarce treatment to whether it’s Paxlovid or an ICU bed or a ventilator or a dialysis compounds. Emily: Yeah.
I can on one hand count the patients I’ve cared for who didn’t want mechanical ventilation. I can correspondingly count on one hand the number of patients I’ve cared for who said I want to be on mechanical ventilation at all costs, even if it means I will never come off.
I think one of the residents you asked how would they broach a subject, and he said wording like, “Unfortunately, he still needs a ventilator.” ” You talk about this too, even in your own training, where even around CPR, the training is like he might need a ventilator if he couldn’t protect his airway.
I think one of the challenges, especially about liver, is it doesn’t have a dialysis, it doesn’t have an ecMo, it doesn’t have a ventilator. And the flip side, you have someone who’s relatively stable, who doesn’t make through the night because of a catastrophic bleed.
And yet, when the reality of breathing difficulties, BIPAP, the talks of tracheostomy and ventilators set in, what had seemed so clear on that piece of paper, no longer seemed so clear. And I share how years before this patient and their family had prepared advanced directives.
So whether or not somebody wants to be on CPR or ventilator, that sort of thing. The post Black/African American Caregivers of Older Adults Living with Dementia: Fayron Epps and Karen Moss appeared first on A Geriatrics and Palliative Care Podcast for Every Healthcare Professional.
I developed bilateral pneumonia and was hospitalized but thankfully not put on a ventilator. Poison center nurses usually have at least two years of experience working in an ICU or an Emergency Department, but nurses in other specialties such as pediatric, geriatric, or transplant nursing can successfully make the transition into toxicology.
Alex 00:54 And Jasmine Santoyo-Olsson, who’s a social behavioral scientist and a fellow in the T32 Research Fellowship at the UCSF Division of Geriatrics. Eric 19:31 So it was interventions like feeding tubes, mechanical ventilation, dialysis at the very end of life. Danny 00:52 Thank you very much. Excited to be here.
So legally dead in California, family moved to New Jersey, where she was kind of alive despite having a death certificate for another four years, and then died four years later after being actually home on a ventilator for a while, too, we talked more about that with the Bob Truog podcast. They don’t need a heart. Winston 14:17 Right.
Not one elderly person died on a ventilator. Jim Wright & Darrell Owens appeared first on A Geriatrics and Palliative Care Podcast for Every Healthcare Professional. Pretty tough. Pretty … Just all things, right? Just really powerful. I think during that time period, we had a significant number of deaths.
We did the Geriatric 5M approach to telemedicine with Lauren Mo. We sometimes take care of patients who are on home ventilators, so coming in for an office visit is not practically feasible. Brooke: I feel like you’re getting better year after year, so good. Alex: Hope so. So that song was already taken so we can’t do it.
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