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trauma in the elderly 18-1

Chapter
XVIII
TRAUMA IN
THE
ELDERLY
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Overview
Pathophysiology of aging
Assessment of the elderly patient
Management of the elderly patient
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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.
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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.
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Pathophysiology
of Aging
Respiratory
Decreased vital capacity
COPD more common
Hypoxia more likely after chest
injury
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Pathophysiology of
Aging
Cardiovascular
Decreased circulation to vital organs
Decreased cardiac output
Poor reserve
Poor tolerance of
Hypovolemia
Hypoxia
Underlying cardiovascular disease
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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
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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.
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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
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Pathophysiology of
Aging
Thermoregulation
More susceptible to:
Hypothermia
Heat illness
When possible, document patient
temperature.
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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.
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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.
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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.
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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).
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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.

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Patients with Altered
Mental Status
Ask about patients 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?

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Summary
Elderly patients have:
Different response to trauma
High risk of underlying disease
Decreased compensatory
mechanisms
Get a good history.
Anticipate potential problems.
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