Trauma in the Elderly

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Chapter 18 Trauma in the Elderly
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Trauma in the Elderly
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Overview

• Changes that occur with aging
• How changes affect assessment of geriatric trauma
  
• Assessment of geriatric trauma
• Management of geriatric trauma

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Trauma in the Elderly

• Fatal outcomes more likely,even if injury
  isrelatively low in severity.

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Trauma in Elderly

• Age impairs bodys response.
• Trauma is major cause of death.
• Falls
• Fractures of hip, femur, wrist, and head injuries
• Motor-vehicle collisions
• Higher incidence of collision
• Thermal injury
• Inhalation, scalding, flame burns, electrical
  injury

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Trauma in Elderly

• Higher risk of injury
• Reflex response time increased
• Eyesight and peripheral vision decreased
• Hearing decreased
• Postural instability
• Arthritis
• Fragile skin and blood vessels
• Fragile bones

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The Aging Body

• Airway

• Respiratory system

• Potential obstruction

• Decreased
• Pulmonary circulation 30
• Alveolar exchange
• Capacity and work rate
• Chest wall movement
• Inhalation time
• Vital capacity due to increased residual volume

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The Aging Body
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The Aging Body

• Cardiovascular system
• Congestive heart failure and pulmonary edema
• Circulation decreased
• Cardiac output and stroke volume decreased
• Conduction system degenerates
• Heart valve efficiency decreased
• Arteriosclerosis
• Peripheral vascular resistance increased
• Systolic hypertension

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The Aging Body

• Neurological and sensory function
• Subdural hematoma
• Brain shrinks, dura mater adherent to skull
• Brain arteries harden, narrow, lose elasticity
• Unrecognized injury
• Blood flow to brain decreased
• Sensory responses decreased
• Pain tolerance increased
• Altered mental status
• Blood flow to brain decreased

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The Aging Body

• Thermoregulation
• Hypothermia
• Temperature control mechanism deteriorates
• Subcutaneous tissue decreased
• Afebrile with infection
• Temperature control mechanism deteriorates

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The Aging Body

• Renal system

• Immune system

• Drug toxicity
• Nephron function decreased
• Blood filtration decreased

• Infection
• Malnutrition
• Sepsis
• Immune response decreased

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The Aging Body

• Musculoskeletal system
• Postural changes
• Kyphotic deformity of spine
• Slight flexion of knees and hips
• Muscle strength decreased
• Fractures
• Advanced osteoporosis
• Bone density decreased
• Subcutaneous tissue decreased

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The Aging Body

• Gastrointestinal system
• Malnutrition
• Decreased ability to metabolize medications
• Overall system changes
• Prolonged illness and recovery time
• Decreased total body water leads to dehydration

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Medications

• Drug interaction problems
• Anticoagulants increase bleeding time
• Antihypertensives and peripheral vasodilators
  limit constriction response
• Beta-blockers limit tachycardia response

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Important Points

• General organ systems less effective.
• Especially cardiovascular, pulmonary, renal
• Chronic illness complicates trauma care.
• Difficult to distinguish
• Bones fracture more easily.
• Major bone fractures can be life-threatening

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Assessment

• Do not underestimate severity.
• Die from less-severe injuries
• May not report important symptoms
• Pain response, hypoxia, hypovolemia varies
• Multiple illnesses
• Communications

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ITLS Patient Assessment

• ITLS Primary and Secondary Surveys
• Anticipate complicating factors
• Peripheral pulses difficult to evaluate
• Many layers of clothing
• Chronic disease vs. acute problem
• Nonpathologic rales
• Loss of skin elasticity and mouth breathing
• Dependent edema
• Variation in normal vital signs

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Scene Size-up

• Verify history with reliable bystander.
• Observe surrounding area.
• Indications that unable to provide own care
• Alcohol or medication abuse
• Signs of violence, abuse, neglect
• Notify proper authorities
• Gather medications and take to hospital.

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Initial Assessment

• Initial level of consciousness
• Clarify normal level before trauma
• Preexisting condition or trauma
• Check blood glucose
• Chest injuries
• More likely serious
• Spinal precautions
• Arthritis and kyphosis

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Critical Transport Decision

• Low threshold for early transport

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Ongoing Exam

• Monitor IV fluid administration response.
• May precipitate congestive heart failure
• Frequently assess pulmonary status.
• Lung sounds
• Cardiac monitoring
• Pulse oximetry
• Capnography
• Do not withhold fluid if needed.

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Summary

• Increasing number of elderly patients
• Evaluation and treatment more difficult
• Physiologic processes of aging
• Frequent concurrent illnesses
• Medication effects
• Limited compensation mechanisms
• Respiratory and circulatory support essential

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Discussion