1 Geriatric Trauma Gram McGregor, 1Lt, WA ANG Critical Care Air Transport Nurse

2 Geriatric Defined  Older then 65 years  Decline starts in late 20’s  Leading causes of death: – Heart disease – Cancer – Stroke – Diabetes – Trauma

3 Trauma  Mechanisms of injury* – Falls – Motor vehicle trauma – Assault and Domestic abuse – Pedestrian accidents – Burns *In order by frequency

4 Trauma  Geriatric trauma patients die for the same reason as trauma patients of any age.  Often, because of preexisting physical conditions, the geriatric patient can often die from less severe injuries and sooner than younger patients.

5 Head Injury  Caused by brain tissue shrinking with age  More prone, even from minor trauma  Increased ICP signs develop slowly  Patient may have forgotten injury

6 Cervical Injury  Osteoporosis – Increased injury risk with trivial accidents – Shrinkage of disk spaces  Arthritic changes – Narrow spinal canal – Increased injury risk – Sudden movement may cause cord injury without fracture

7 Acute Abdomen  Abdominal Aortic Aneurysm-one of most rapidly fatal conditions – Most common with hypertension and atherosclerosis – Possible finding of decreased pulses in extremities  GI Bleed – Coffee-ground emesis – Black, Tarry or frankly bloody stools

8 Respiratory System  Larger less elastic lung functionally decreasing respiratory reserve  Decreased cilia in airways increases potential for respiratory infections  Stiffening of chest cage and airway cartilage.  Impaired cough and gag reflexes.

9 Cardiovascular System  Decreased ability to increase heart rate or vasoconstrict vessels  Increased chance of atherosclerosis leading to heart attack or stroke  Cardiac output decreases by 50% from 20 to 80 years of age  Increased chance of arteriosclerosis: – Stroke -Hypertension – Heart disease -Bowel Infarction

10 Renal System  30-40% Decrease in kidney function  Electrolyte disturbances more likely – Often manifests as apparent confusion, weakness

11 Nervous system  Number of brain cells may decrease by as much as 45%  Short-term memory impairment  Slower reflex times  Collaboratively make assessment more difficult and trauma more likely

12 Gastrointestinal System  Decreased saliva  Decreased gastric juices  Slowing of GI Tract – Potential constipation and impactions  Decreased liver function – Decreased ability to filter/detoxify the blood – Increased potential for toxic medication levels

13 Musculoskeletal System  Decreased bone density  Posture changes and vertebral discs dehydrate causing shortening of up to 5cm.  Decrease in muscle mass up to 30% between 30 and 70 years of age.  Increased propensity for falls and both traumatic and nontraumatic fractures

14 Altered mental status  Essential to compare to baseline!!  Delirium – Rapid onset, usually curable – inability to focus, think logically and maintain a train of thought.  Dementia – Slow onset, permanent – Progressive disorientation, shortened attention span and loss of cognitive function

15 Environmental Emergencies  Tolerate temperature extremes poorly  Develop hypo/hyperthermia rapidly  Decreased ability to respond to changes, decreased heat production and decreased ability to rid the body of excess heat.

16 Blast injuries  Higher associated risk of life-threatening injuries due to: – Less flexible tissues – Decreased cardiovascular reserve – Decreased respiratory reserve

17 Management  Airway  Breathing-possibility of Chronic Lung Disease  Circulation-may have different normal blood pressure  Protect the cervical spine  Control their temperature  Determine baseline/chronic medical conditions

18 Questions?

19 References  Browner, B.D. (2002) Emergency care and treatment of the sick and injured.  McSwain, N.E., Frame, S. (2003) Basic and advanced prehospital life support.