The American Geriatrics Association has finally published its guidelines on gomeritis, a complex entity caused by the progressive deterioration of a gomerular brain. A brief summary follows:
Gomeritis is a complex clinical entity and should be suspected when a patient:
- Is on Namenda, Aricept, Excellon, Seroquel and Ativan
- Has pulled out his PEG more than three times in the past three weeks
- Is sent in from the nursing home with a PMHx that contains more than 40 conditions or is longer than 3 pages typed
- Has a prior history of gomeritis flares
- Is on more than 28 medications
- Is found curled into a tighter ball than usual
- Swinging and cursing at staff more than usual
AGA experts warned physicians not to confuse gomeritis with dwindles, which, while frequently precedes gomeritis is still a distinct entity, has more treatment options, and carries a slightly better prognosis.
It is important for practitioners to understand that gomeritis is a progressive and incurable condition. Optimal strategies for managing gomeritis flares are not agreed upon. Various experts recommend broad-spectrum antibiotics, broad-spectrum antipsychotics, broad-spectrum laxatives, trials of hydration, trials of diuresis, and broad-spectrum consults.
A recent multi-center single arm trial of Turfing Admitted Patient with GOMERitis (TAP GOMER) concluded that, “The only feasible service where a gomeritis patient can be turfed is psychiatry and only if they have too many open beds.” Authors further concluded that the benefit of a successful turf were outweighed by the costs of having to read lengthy psychiatry consults with NNT (number needed to turf) of 48.
At present an approach of, “Lets just watch them for a while and send them back” is being evaluated across several centers against a control of high doses of intravenous Haldol.
Lmao!!
Put the bed at neurosurgical height! Sorted!
Buddy Gager James Elmer Davis Dawn Hartman Heather Hillman Overvold Tracy Byrd Kari Adcock Kelly Rogers Moree Susan Saucier Howard Wayne Martin …”not to be confused with the Dwindles!!!” Lol!!!
OMG, that could be me.
OMG, that could be me.
Heather Olson Bohannon
Fall risk >100
Interventions:
Bubble wrap floor
Velcro vest to velcro chair
Constant Bed and chair alarm
Side rails up X2 with freq Q 1 checks
Cyborg sitter at bedside ( resistance is futile! )
Gimme a ” G “!
Turf to psych….ROFL!
How about a lab which always posts “normal” results for any and all tests. That way, when a patient gets tired of searching for a physician who will accept his government sponsored health insurance, he can go back and admire his excellent blood tests.
How about a lab which always posts “normal” results for any and all tests. That way, when a patient gets tired of searching for a physician who will accept his government sponsored health insurance, he can go back and admire his excellent blood tests.
Gomers never die
Apply sterile pillow to face
CT, no acute changes.
Then sleep all day only to rewind at around 1600 hour.
And keeping everyone awake all night.
Spend the whole weekend keeping them from falling out of bed!
Follow best practices for fall risk.
They are never “medically stable”.
They usually end up in MedSurg since Psych can’t handle saline locks . They “must be medically stable.” They also make the best weekend admits! There goes the census!
The “normally sharp as a tack” is my second favorite thing to hear only to “she was driving just last week”.
Omfg
The worst part is that broad spectrum consults usually involves me… then at some point we are forced to cut on these poor folks…
Rule of thumb….Gomers go to ground!
Oh no, they turf them to Inpt Rehab too, right, Megan Hammersmith Waldren?
OMG, this is brilliant. As a geriatric neurologist, I need to disseminate this clinically relevant diagnostic entity broadly among my peers, and advocate for early diagnosis in order to minimize the use of “broad spectrum consults.” Better yet, the judicious use of DNR/DNI orders in the NH chart, to avoid hospitalization to begin with …
Is there a way that EMS can get this started like we do with a Code STEMI or Code Neuro? We frequently get called to a local SNF where staff, if they can be found, report that the patient was fine when last seen but now is altered. Or, “I’m new here and I don’t know this patient.” Or, reports that the patient’s family or PCP wants him transported for evaluation.
Code GOMER? Can we make guidelines to add to our protocols?
This sadly reminds me of a presentation with furious cdiff rage that was so uncontrollable it was literally streaming off the sides of the bed. Any thought of a flexiseal were scoffed off by total lack of tone. Oh, and the “output” smelled of fish oil caps, thousands and thousands of them though. Of, course this all stopped prior to moving them to the ICU, which was of course the turf place of choice. Gomeritis has made me die inside more than once.
Gomeritis Exposé reveals various health systems secretly vying for most dollars spent in last 2 weeks of life using ICU as turf place of choice.
I shouldn’t have been laughing as hard as I was
Oh no Gail Plavney Pestich!!!!!
Gomers go to ground!
Baaaaaahahahhahahahahhahahahhahaahahahahhahahahahahahhahahahahah! Snort ! Lmaooooo! That is so funny!
I LOVE “broad spectrum consults”
That’s why turkey sandwiches are needed in all the crash carts
@annien146 gomeritis. Ha!
Sandy, Gabrielle, Cindy: so sad it’s funny.
Sandy, Gabrielle, Cindy: so sad it’s funny.
They forgot the broad spectrum turkey sandwich…
They forgot the broad spectrum turkey sandwich…
Lol @ “broad spectrum consults”
Lol @ “broad spectrum consults”