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Atls Chapter 11 Geriatric Trauma: Florence A M

Elderly trauma patients have unique characteristics that require special consideration in their care. Falls are the most common cause of injury, and elderly patients have less physiologic reserve and increased risks of bleeding due to medications. Their airways require careful securement, breathing and ventilation close monitoring due to reduced lung function, and circulation evaluation is critical as blood pressure may not indicate volume status. Brain and spine injuries also require attention due to anatomical changes. Elder abuse is also more common and must be identified and addressed. End of life planning should reflect patient wishes whenever possible.

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535 views15 pages

Atls Chapter 11 Geriatric Trauma: Florence A M

Elderly trauma patients have unique characteristics that require special consideration in their care. Falls are the most common cause of injury, and elderly patients have less physiologic reserve and increased risks of bleeding due to medications. Their airways require careful securement, breathing and ventilation close monitoring due to reduced lung function, and circulation evaluation is critical as blood pressure may not indicate volume status. Brain and spine injuries also require attention due to anatomical changes. Elder abuse is also more common and must be identified and addressed. End of life planning should reflect patient wishes whenever possible.

Uploaded by

Akmalia Hardini
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ATLS CHAPTER 11

GERIATRIC
TRAUMA
FLORENCE A M
OBJECTIVES

• Identify the unique characteristic of elderly trauma


• Describe the patientsrimary management of critical
injuries in geriatric patients
• Identify common causes and signs of elder
maltreatment & a strategy for managing situations
TYPES AND PATTERNS OF INJURY

• Older patients are more likely to have a fatal outcome from their
injuries
• Falls are the most common mechanism of injury among the
elderly
• Medications : Anticoagulants  increased risk of bleeding
• Changes in the central nervus & musculoskeletal system less
flexible & less coordinated
(A) AIRWAY
• Provide adequate oxygenation is the first objective
• Supplemental O2 should be administered as soon as
possible (even in the presence of chronic pulmonary)
• Endotracheal intubation  preferred method for
definitive airway control
• If acute airway obstruction exists or the vocal cords
cannot be visualized  cricothyroidotomy as an option
(B) BREATHING AND VENTILATION

• The loss of respiratory reserve due to the effect of aging &


chronic disease  careful monitoring respiratory system
• Respiratory failure  intubation & mechanical ventilation
• Chest wall injuries  rib fractures or pilmonary contusio
• Pneumothorax & hemothorax  ICU observation
(C) CIRCULATION

• Changes with ages


With aging, total blood volume decreases & circulation time increases
• Evaluation and management:
1. Mistaken impression that “normal” blood pressure and heart rate
indicate normovolemia
2. Avoid blood transfusion
3. A rapid & complete assessment for all sources of blood loss  FAST
(D) BRAIN & SPINAL CORD INJURY
• Changes with ages
1. Brain mass decreases  replaced by cerebrospinal fluid
2. Loss of brain vol brain movement
3. Significant amount of blood can collect aron the brain (subdural
space) before symptoms become apparent
4. Spine : changes occur in the intervertebral disks loss water &
protein affect shape & compressibility of the disks 
degeneration of facet joint & spinal stenosis
•EVALUATION & MANAGEMENT

 Higher incidence of subdural and intraparenchymal hematomas


 Rapid screeening for anticoagulant use and subsequent correction
 Cervical spine more common in elderly patients
 Magnetic resonance imaging (MRI) is particularly used for diagnosing
ligamentous injuries
(E) EXPOSURE AND ENVIRONMENT

• Skin changes  loss of thermal regulatory ability,


decreased barrier function against bacterial invasion 
significant impairment of wound healing
• Injured elderly patients must be protected from
hypothermia
• Hypotermia not attributable to shock, should alert the
physician to the possibility of occult disease ( sepsis,
endocrin disease or pharmacologic causes
UNIQUE CHARACTER IN GERIATRIC

•Aging results in stiffening of ligaments, cartolage, invertebral disks & joint capsules  increased risk of injury, rupture & decreased joint
stability
Musculoskeletal •Reduction in the size & total number of muscle cells - decrease of muscle strength
sustem

•Poor nutritional status contributes to increased complication rate

Nutrition and •Early & adequate nutritional support is a cornerstone of succesful trauma care
metabolism

•Elderly patients have an impaired ability to respon to bacteria & viruses, a reduced ability to respond to vaccination & a lack of reliable
response to skin antigen testing
Immune system
and infection •Elderly indivdsuals are less able to tolerate infection & more prone to multiple organ system failure

•Often taking several pharmacologic agents even before an injury occurs

Medication •Drug interactions are frequently encountered & side effects are much more common because of the narrow therapeutic range
ELDER MALTREATMENT
• Maltreatment is defined as any willful infliction of injury, unreasonable
confinement, intimidation or cruel punishment that results in physical harm, pain,
mental anguis
• Classified into six categories :
1. Physical maltreatment
2. Sexual maltreatment
3. Neglect
4. Psycological maltreatment
5. Financial & material exploitation
6. Violation of right
END OF LIFE DECISIONS

• Age significantly increases mortality from injury, but more


aggressive care especially early in the evaluation &
resuscitationn of elderly trauma patients,has been shown to
improve survival
• Trauma team should try to determine the patient’s wishes as
evidenced by living will, advanced directive, or similar
document
THANKS

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