1. trauma in the elderly 18-1ChapterXVIII TRAUMA IN THE ELDERLY

2. trauma in the elderly 18-2 Overview  Pathophysiology of aging  Assessment of the elderly patient  Management of the elderly patient

3. trauma in the elderly 18-3 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.

4. trauma in the elderly 18-4 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.

5. trauma in the elderly 18-5 Pathophysiology of Aging  Respiratory » Decreased vital capacity » COPD more common » Hypoxia more likely after chest injury

6. trauma in the elderly 18-6 Pathophysiology of Aging  Cardiovascular » Decreased circulation to vital organs » Decreased cardiac output  Poor reserve » Poor tolerance of  Hypovolemia  Hypoxia » Underlying cardiovascular disease

7. trauma in the elderly 18-7 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

8. trauma in the elderly 18-8 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.

9. trauma in the elderly 18-9 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

10. trauma in the elderly 18-10 Pathophysiology of Aging  Thermoregulation » More susceptible to:  Hypothermia  Heat illness » When possible, document patient temperature.

11. trauma in the elderly 18-11 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.

12. trauma in the elderly 18-12 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.

13. trauma in the elderly 18-13 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.

14. trauma in the elderly 18-14 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).

15. trauma in the elderly 18-15 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.

16. trauma in the elderly 18-16 Patients with Altered Mental Status  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. » Could patient have overdosed on his medications?

17. trauma in the elderly 18-17 Summary  Elderly patients have: » Different response to trauma » High risk of underlying disease » Decreased compensatory mechanisms  Get a good history.  Anticipate potential problems.

18. trauma in the elderly 18-18 Questions?