About Christina Shenvi, MD, PhD, MBA

Professor of Emergency Medicine
Department of Emergency Medicine
University of North Carolina - Chapel Hill

Why the Holidays Can Be Deadly

The winter holiday season is a busy time in most EDs. Colder weather, respiratory infections, and many factors contribute to this. However Christmas Day and New Year’s Day in particular are two of the deadliest days of the year. Missed medications due to travel, delayed presentations because of a desire to stay home for family gatherings, increased stress, alcohol and substance abuse, travel, and drunk driving, are just a few of the things that can contribute to morbidity and mortality in patients of all ages, and particularly in older adults. If you are working this holiday season, here is a glimpse of what you can expect.

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By Christina Shenvi, MD, PhD, MBA|2018-01-30T02:31:20-08:00Dec 24, 2013|Cardiovascular, Geriatrics, Psychiatry, Tox & Medications|

Elder Abuse and Neglect: What to do in the Emergency Department

help concept, special toned photo f/x, focus point selective Have you ever identified elder abuse in a patient in your ED? The signs can often be subtle, can look like one of many other medical or traumatic problems, and can be mistaken for aging-related changes. This is an unpleasant topic, but rather than bury our heads in the sand and pretend it doesn’t happen, let’s face it and see what we can do to intervene and help. How can you miss it less often? And what are your legal obligations if you suspect elder abuse?

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By Christina Shenvi, MD, PhD, MBA|2016-11-27T12:38:12-08:00Dec 2, 2013|Geriatrics|

Putting an Older Patient Under: Tips for Geriatric Procedural Sedation

An 84-year old woman presents to your ED with a traumatic, left-sided posterior hip dislocation. You need to reduce the hip. But how should you sedate her? Procedural sedation is an important component of ED care. It allows us to more comfortably perform otherwise painful procedures such as fracture or dislocation reductions, endoscopies, large laceration repairs, and I&Ds. How safe is procedural sedation in older adults?

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By Christina Shenvi, MD, PhD, MBA|2017-03-05T14:18:37-08:00Oct 31, 2013|Expert Peer Reviewed (Clinical), Geriatrics, Tox & Medications|

10 Tips for Approaching Abdominal Pain in the Elderly

After seeing your fifth young patient of the day with chronic pelvic pain, constipation, and irritable bowel syndrome, it is easy to be lulled into the mindset that abdominal pain is nothing to worry about. Not so with the elderly. These 10 tips will help focus your approach to atraumatic abdominal pain in older adults and explain why presentations are frequently subtle and diagnoses challenging.

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By Christina Shenvi, MD, PhD, MBA|2021-03-07T22:03:56-08:00Oct 1, 2013|Expert Peer Reviewed (Clinical), Geriatrics|

Alcohol Problems Among Older Adults in the ED

The complications of alcohol use can be subtle in older adults, and the effects of alcohol are often incorrectly attributed to aging. Because of its under-recognition, the barriers to screening, and the many subtle ways in which it can present, some have suggested that alcohol misuse has replaced syphilis as the “great masquerader”. If you don’t think alcohol misuse is a problem among older adults in your ED, it may be because it has been hidden in plain sight.

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By Christina Shenvi, MD, PhD, MBA|2018-10-28T21:20:58-07:00Sep 2, 2013|Geriatrics, Tox & Medications|

A time-based approach to elderly patients with altered mental status

It’s 7 am on a Monday. Your first patient is an 82 year-old woman who was brought in by EMS from an assisted living facility. All EMS can tell you is that she was not acting herself. You enter her room and introduce yourself. “Hello Mrs. Jones. How are you today?” The woman startles, “Well, you see, I went to put my dog out, and then I was just walking, and couldn’t remember. So it’s all coming full circle, and then I ate a sandwich.” Just then EMS rolls in with another patient, a 75 year-old male coming from home, who was found by his wife in his recliner minimally responsive, with a GCS of 6. He is followed by a 76 year-old female who had a fall from standing three days ago, and has been increasingly confused today, and is currently oriented only to person.

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By Christina Shenvi, MD, PhD, MBA|2018-10-28T21:20:45-07:00Aug 1, 2013|Expert Peer Reviewed (Clinical), Geriatrics, Neurology|

Geriatric Blunt Trauma – Respect the Lactate

Which is a better prognostic tool in geriatric trauma, traditional vital signs or lactate level?

Meet Norma Nuance (NN), a 70-year-old woman with CAD, HTN, HLD, DM, and mild dementia. She was involved in an MVC as the restrained driver with questionable LOC. She arrives in your ED and appears confused, but has a history of dementia. There are no family members to tell you her baseline. Her BP is 120/80, and her HR is 90. She is not calling out in pain, but does mumble about her left arm when you ask if she is hurting. You think she may have sprained her wrist.

Now meet Frankie Obvious (FO), a 22-year-old male, who was the helmeted driver of a motorcycle that hit a car. He was thrown from the motorcycle, and arrives combative and yelling with a HR of 130 and a BP of 100/70.

Based on their vital signs, which patient is going to receive more immediate attention? Your lactate level is pending… (more…)

By Christina Shenvi, MD, PhD, MBA|2017-03-05T14:18:36-08:00Jul 1, 2013|Geriatrics, Trauma|

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