TRAUMA IN THE ELDERLY

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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 gt65.
• 1/3 of ambulance transports are of patients gt65.
• 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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Pathophysiologyof 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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Questions?