In anticipation of episode number 34 on geriatric emergency medicine, we have with us Dr. Don Malady,

who's going to tell us about his best case ever when it comes to the care of the older person in the emergency department.

Don, let it rip.

Last case on an evening shift in the ambulatory area, 74-year-old man who's had a minor fall and has

a sore wrist, sounds pretty easy. By the time I saw him, the x-ray had already been done,

which was normal. He tells me that he's fallen many times over the last few months and that his wrist has started

hurting just over the last week, very, very severe, just like the neck pain I had when I went

to that other emergency department a month ago. Between him, his daughter, and his wife, I couldn't really get much more helpful information,

and he had a pretty normal physical exam with normal vital signs that are normal looking risk that did seem to be pretty painful.

A review of his medications didn't turn up anything either, and his active medical problems were just all of the usual things that you'd expect in a 74-year-old,

hypertension, hypercholestrelemia.

That was it.

I didn't start making any progress until I dug back in the old record.

And curiously, there was a prescription for Florenef and Prednisone, which he'd been on four months ago.

When I asked him about that, he said, oh yeah, that's the stuff that I was on before they

went, did that operation in through my nose into my brain.

This was a fact that he hadn't actually told anybody about either me, the triage nurse,

or on any of his previous three emergency visits at another

hospital. And it turned out that he'd had a pituitary microadnomah removed four months ago,

had had his prednisone and Fluorinef decreased appropriately, but as it turns out, a little bit too fast,

and had started having episodes of hypotension, presumably because of the loss of the

fluorinef and the prednisone, and around the same time, had started developing neck pain.

...