icu pumps

American Geriatrics Association Publishes Guidelines on Gomeritis

  • 654
    Shares

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

icu pumpsAdditional clues to the diagnosis may be a family assurances that “Mom is normally sharp as a tack,” “altered mental status,” on the nursing home transfer sheet, and a sodium level above 180.

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.

image_pdfimage_print
  • Show Comments

  • Avatar
    Tracy Byrd

    Lmao!!

  • Avatar
    John Wood

    Put the bed at neurosurgical height! Sorted!

  • Avatar
    Susan Lang Greenough

    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!!!

  • Avatar
    Joanne Cameron

    OMG, that could be me.

  • Avatar
    Joanne Cameron

    OMG, that could be me.

  • Avatar
    Cecilia Pitts

    Heather Olson Bohannon

  • Avatar
    husaria

    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! )

  • Avatar
    husaria

    Gimme a ” G “!
    Turf to psych….ROFL!

  • Avatar
    John M. Pickett

    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.

  • Avatar
    John M. Pickett

    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.

  • Avatar
    Casca

    Gomers never die

  • Avatar
    Will Dunovant

    Apply sterile pillow to face

  • Avatar
    Angela Matisko

    CT, no acute changes.

  • Avatar
    Angela Matisko

    Then sleep all day only to rewind at around 1600 hour.

  • Avatar
    Angela Matisko

    And keeping everyone awake all night.

  • Avatar
    Angela Matisko

    Spend the whole weekend keeping them from falling out of bed!

  • Avatar
    Angela Matisko

    Follow best practices for fall risk.

  • Avatar
    Angela Matisko

    They are never “medically stable”.

  • Avatar
    Angela Matisko

    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!

  • Avatar
    Will Dunovant

    The “normally sharp as a tack” is my second favorite thing to hear only to “she was driving just last week”.
    Omfg

  • Avatar
    Christine Lovato

    The worst part is that broad spectrum consults usually involves me… then at some point we are forced to cut on these poor folks…

  • Avatar
    Gail Plavney Pestich

    Rule of thumb….Gomers go to ground!

  • Avatar
    Gail Plavney Pestich
  • Avatar
    Tammy Allen

    Oh no, they turf them to Inpt Rehab too, right, Megan Hammersmith Waldren?

  • Avatar
    Andrea Neurodoc

    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 …

  • Avatar
    Elliott says meow

    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?

  • Avatar
    George Murray

    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.

  • Avatar
    Rocco Arcieri

    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.

  • Avatar
    Stacie Rene Kurtz

    I shouldn’t have been laughing as hard as I was

  • Avatar
    Deb Plavney

    Oh no Gail Plavney Pestich!!!!!

  • Avatar
    Joanie Sapienza

    Gomers go to ground!

  • Avatar
    Joanie Sapienza

    Baaaaaahahahhahahahahhahahahhahaahahahahhahahahahahahhahahahahah! Snort ! Lmaooooo! That is so funny!

  • Avatar
    Sarah Johnstone Russell

    I LOVE “broad spectrum consults”

  • Avatar
    Sarah Johnstone Russell

    That’s why turkey sandwiches are needed in all the crash carts

  • Avatar
    Lee E. Rubin, M.D.

    @annien146 gomeritis. Ha!

  • Avatar
    Sarah Joy Hipple-Spence

    Sandy, Gabrielle, Cindy: so sad it’s funny.

  • Avatar
    Sarah Joy Hipple-Spence

    Sandy, Gabrielle, Cindy: so sad it’s funny.

  • Avatar
    Nancy Cox

    They forgot the broad spectrum turkey sandwich…

  • Avatar
    Nancy Cox

    They forgot the broad spectrum turkey sandwich…

  • Avatar
    Sarah Kohrmann

    Lol @ “broad spectrum consults”

  • Avatar
    Sarah Kohrmann

    Lol @ “broad spectrum consults”

Your email address will not be published. Required fields are marked *

comment *

  • name *

  • email *

  • website *

You May Also Like

10 Exciting Real Pages to Get, Especially at 2 AM

14.1KShares 1. Patient reporting 10/10 pain, wants stronger meds after his nap. 2. Patient’s ...

mri brain

MRI Brain Better Than Patient Examination for Neuroanatomical Localization

1.1KSharesROCHESTER, MN – Researchers at Mayo Clinic completed analysis of a 4-year prospective study comparing ...