You pick up the chart of this 79 year old woman in the Fast Track area. It reads “UTI”; normal Vital signs on Nurse’s Notes; Bloodwork done on arrival is normal and the urine is positive for WBCs and bacteria.
- Watch the video below, and be prepared to comment on the interaction.
- What do think is missing from this assessment? What would you do differently?
This patient was found wondering on the road near the hospital. She was taken to a different hospital where some effort was put in to finding her family members. Her daughter identified that this was not much different from her usual condition and that sometimes she just wandered off from home. They submit a letter of complaint to the first hospital.
- What would happen if you took 30 seconds longer with this same patient?
- What do you see the doctor doing well here?
This patient’s daughter was contacted by ED staff. She came and said that there wasn’t much different from usual with her mother and took her home. She expressed gratitude for looking after her mother so well.
- Dementia is frequently overlooked in the Emergency Department because we have such a short exposure to the patient: being attentive to subtle signs (“vague” responses, historical elements that don’t fit together, unkempt appearance) may prompt you to screen for some sort of cognitive impairment
- Dementia is common (1 in 4 over the age of 80) and frequently not diagnosed in the community
- Dementia has a significant impact in the assessment and management of the patient in the ED – from how you acquire the history to how you ensure the patient participates in discharge planning