Download 1 Geriatric Emergency Medicine Initiative Resident Training Lecture

Geriatric Emergency Medicine Initiative
Resident Training Lecture Objectives
Trauma in the Aging Patient
Presenter: Dr. Anthony DiPasquale
Length: 1 hour
Target Audience:
Emergency Medicine Residents (Primary)
Internal Medicine Residents
Emergency Medicine Faculty
Presentation Overview:
Geriatric trauma results from a variety of causes prominent among them are an increased
incidence of motor vehicle accidents and falls with advancing age; seven percent of
Emergency Department admissions in patients over the age of 75 are due to falls.
Complications following falls represent a major cause of morbidity in the elderly
resulting in a third of all admissions to nursing homes. In this session, the emergency
medicine resident will learn how to evaluate, diagnose, and stabilize the elderly trauma
patient. In addition, the resident will also learn to identify common risk factors for falls.
Learning objectives:
At the end of this presentation, residents will be able to:
1. Evaluate elderly patients with traumatic injury due to falls including identifying
precipitating causes, such as medications, alcohol use/abuse, gait or balance
instability, medical illness, and/or deconditioning.
2. Institute appropriate early monitoring and testing of elders at risk for occult shock.
3. Advocate for appropriate interventions in the older patient with life-threatening
traumatic conditions without discrimination based solely on age.
4. Identify the most appropriate trauma imaging modality, based on the diagnosis and
weighing the potential risks to the older trauma patient.
5. Prescribe and appropriately dose with consideration for current medications, comorbidities, and age-related pathophysiologic changes.
6. Identify currently taken medications such as beta blockers, anticoagulants, antiplatelet agents, and psychotropic agents that might mask shock and life-threatening
hemorrhage in the older trauma patient.
7. Evaluate and manage pain and non-pain symptoms in the geriatric trauma victim.
Instructional Methods:
Didactic presentation with PowerPoint slides
Case-based discussion
Audience response questions
Evaluation Methods:
Pre-Test Items
Post-Test Items
1
Reaction survey
Resource(s):
YouTube Lecture Presentation: http://www.youtube.com/watch?v=Ij3uWs4SCs&feature=plcp
References:
1. Aschkenasy M, Rothenhaus TC. Trauma and falls in the elderly. Emerg Med Clin N
Am 2006;24(2):413-432.
2. Bub LD, Blackmore CC, Mann FA, Lomoschitz FM. Cervical fractures in patients
65 years and older: A clinical prediction rule for blunt trauma. Radiology
2005;234(1):143-149.
3. Callaway DW, Wolfe R. Geriatric trauma. Emerg Med Clin N Am 2007;25(3):837860.
4. Cassel C, Cohen H, Larson E, Meier D, Resnick N, Rubenstein L, Sorensen L.
Geriatric Medicine: An Evidence-Based Approach. 4th Ed. New York: SpringerVerlag, Inc, 2003.
5. Center for Disease Control and Prevention. Field Triage Decision Scheme: The
National Trauma Triage Protocol.
http://www.cdc.gov/fieldtriage/pdf/triage%20scheme-a.pdf (Accessed 19 July 2012).
6. Haentjens P, Magaziner J, Colon-Emeric C, et al. Meta-analysis: Excess mortality
after hip fracture among older women and men. Ann Int Med 2010;152(6):380-390.
7. Koval KJ, Aharonoff GB, Schwartz MC, et al. Pubic rami fracture: A benign pelvic
injury? J Orthop Trauma 1997;11(1):7-9.
8. Meldon SW, Ma OJ, Woolard R. Geriatric Emergency Medicine. New York, NY:
McGraw-Hill Professional, 2004.
9. Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: What
does the evidence show? Med Clin N Am 2006;90(5):807-824.
10. Touger M, Gennis P, Nathanson N, et al. Validity of a decision rule to reduce
cervical spine radiography in elderly patients with blunt trauma. Ann Emerg Med
2002;40(3):287-293.
11. Victorino GP, Chong TJ, Pal JD. Trauma in the elderly patient. Arch Surg
2003;138(10):1093-1098.
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