Trauma in the elderly 18-1ChapterXVIII TRAUMA IN THE ELDERLY.

trauma in the elderly 18-1

ChapterChapter

XVIIIXVIIITRAUMA IN TRAUMA IN

THE THE ELDERLYELDERLY


OverviewOverviewOverviewOverview

Pathophysiology of aging Assessment of the elderly patient Management of the elderly patient


Geriatric PopulationGeriatric PopulationGeriatric PopulationGeriatric 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.


PathophysiologyPathophysiologyof Agingof AgingPathophysiologyPathophysiologyof Agingof 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.


Pathophysiology Pathophysiology of Agingof AgingPathophysiology Pathophysiology of Agingof Aging

Respiratory» Decreased vital capacity» COPD more common» Hypoxia more likely after chest

injury


Pathophysiology of Pathophysiology of AgingAgingPathophysiology of Pathophysiology of AgingAging

Cardiovascular» Decreased circulation to vital organs» Decreased cardiac output

Poor reserve» Poor tolerance of

Hypovolemia Hypoxia

» Underlying cardiovascular disease



Renal» Often have decreased renal function» Kidneys may not tolerate hypoxia» May not be able to excrete a fluid

overload Increased risk of CHF



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.



Musculoskeletal» Osteoporosis

Increased risk of fracture with minimal trauma (hip, wrist, compression fractures of spine )

» Kyphosis of spine Difficulty packaging

on backboard Difficulty intubating



Thermoregulation» More susceptible to:

Hypothermia Heat illness

» When possible, document patient temperature.



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.


Assessment of the Assessment of the ElderlyElderlyAssessment of the Assessment of the ElderlyElderly

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.


BTLS Primary SurveyBTLS Primary SurveyBTLS Primary SurveyBTLS 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.


Critical InterventionsCritical InterventionsCritical InterventionsCritical 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).


Detailed ExamDetailed ExamDetailed ExamDetailed ExamHistory 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.


Patients with Altered Patients with Altered Mental StatusMental StatusPatients with Altered Patients with Altered Mental StatusMental 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?


SummarySummarySummarySummary Elderly patients have:

» Different response to trauma» High risk of underlying disease» Decreased compensatory

mechanisms

Get a good history. Anticipate potential problems.


Questions?Questions?Questions?Questions?

Trauma in the elderly 18-1ChapterXVIII TRAUMA IN THE ELDERLY.

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