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Chapter XVIII TRAUMA IN THE ELDERLY trauma in the elderly 18-1 Overview Pathophysiology of aging Assessment of the elderly patient Management of the elderly patient trauma in the elderly 18-2 Geriatric Population 20% of U.S. population is >65. 1/3 of ambulance transports are of patients >65. Geriatric patients: » » » Respond less favorably to trauma. More likely to have a fatal outcome. Being older than 55 is more consistently associated with bad outcome than any mechanism of injury in MVC. trauma in the elderly 18-3 Pathophysiology of Aging Decreased sight and hearing » Problems communicating with the patient Decreased Mobility » Mobility aids: Walkers, canes, wheelchairs Tooth and gum disease common » » Bridges and dentures may cause airway obstruction. Diseased teeth may be easily knocked loose during intubation. trauma in the elderly 18-4 Pathophysiology of Aging Respiratory Decreased vital capacity » COPD more common » Hypoxia more likely after chest injury » trauma in the elderly 18-5 Pathophysiology of Aging Cardiovascular Decreased circulation to vital organs » Decreased cardiac output Poor reserve » Poor tolerance of Hypovolemia Hypoxia » Underlying cardiovascular disease » trauma in the elderly 18-6 Pathophysiology of Aging Renal Often have decreased renal function » Kidneys may not tolerate hypoxia » May not be able to excrete a fluid overload Increased risk of CHF » trauma in the elderly 18-7 Pathophysiology of Aging Neurological Atrophy of brain increases chance of subdural hematoma after trauma. » Decreased cerebral circulation. » Poor cerebral tolerance to hypoxia, hypotension, or shock. » Poor balance and coordination increase risk of injury. » trauma in the elderly 18-8 Pathophysiology of Aging Musculoskeletal » Osteoporosis Increased risk of fracture with minimal trauma (hip, wrist, compression fractures of spine ) » Kyphosis of spine Difficulty packaging on backboard Difficulty intubating trauma in the elderly 18-9 Pathophysiology of Aging Thermoregulation More susceptible to: Hypothermia Heat illness » When possible, document patient temperature. » trauma in the elderly 18-10 Pathophysiology of Aging General Medications often interfere with compensation for injury. » Elderly more prone to accidents due to decreased sight, hearing, balance, and coordination. » Elderly may have an acute medical problem (MI or CVA) that causes accident or fall. » trauma in the elderly 18-11 Assessment of the Elderly Scene Size-up Does the patient live alone? » Does the patient appear to be able to care for himself? » What medications does the patient take? Bring them with the patient! » Signs of abuse or neglect? Know your local EMS requirements for reporting abuse. » trauma in the elderly 18-12 BTLS Primary Survey Initial Assessment Rapid Trauma Survey or Focused Exam Check for dentures or bridges. » Be alert for signs of COPD. » Observe for hypoxia and hypoventilation. » Record accurate initial LOC. Check blood glucose if altered LOC. » Remember to check for Medical Alert tags. » Transport decision » Be very suspicious of occult injuries. trauma in the elderly 18-13 Critical Interventions Elderly patients have poor compensatory mechanisms. » » » » » Treat hypoxia and shock early. Be prepared to intubate. Dental disease and dentures can make intubation difficult. Be careful with IV fluid challenge. Can precipitate pulmonary edema. Keep the patient warm. When spinal motion restriction is indicated, pad where possible (vacuum backboard best). trauma in the elderly 18-14 Detailed Exam History is extremely important. S - Elderly may not be aware of pain. A - Allergies. M - Bring medications if available. P - Past medical history very important. L - When was last meal? E - Events prior to the injury. » Chest pain or syncope prior to an accident? » Be alert to medical problems. trauma in the elderly 18-15 Patients with Altered Mental Status Ask about patient’s usual LOC. Is this a change from usual LOC? Check blood glucose if altered LOC. Look for underlying causes of altered LOC. » Could patient have overdosed on his medications? trauma in the elderly 18-16 Summary Elderly patients have: Different response to trauma » High risk of underlying disease » Decreased compensatory mechanisms » Get a good history. Anticipate potential problems. trauma in the elderly 18-17 Questions? trauma in the elderly 18-18