Transcript No Slide Title

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:
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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
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Problems communicating with the patient
 Decreased Mobility
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Mobility aids: Walkers, canes, wheelchairs
 Tooth and gum disease common
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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
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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
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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
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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.
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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.
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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.
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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.
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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.
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 Transport decision
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Be very suspicious of occult injuries.
trauma in the elderly 18-13
Critical Interventions
 Elderly patients have poor
compensatory mechanisms.
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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
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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.
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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
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 Get a good history.
 Anticipate potential problems.
trauma in the elderly 18-17
Questions?
trauma in the elderly 18-18