Initial Assessment and Management

Committee on Trauma Presents

Geriatric
Trauma
Case Scenario
A 79-year-old male is brought to the ED
after he was found at the base of the
stairs by his wife.
Initial vital signs: RR 32; Pulse 64; BP
110/60; GCS score 12
What issues should you consider in
managing this patient?
Objectives
Describe characteristics of the elderly
patient that affect trauma management.
Discuss the relevance of comorbidity
and medication.
Explore the potential for elder abuse.
Special Considerations
Age-related changes in anatomy and
physiology
Preexisting diseases and comorbidities
Medications
Possibility of elder abuse

What are the special issues to consider in
treating elderly trauma patients?
The Problem of Elder Trauma
Increase in proportion of world population
by 2050 will be 20% or 2.5 billion
Increased mortality and morbidity

Majority can return to preinjury status
with appropriate management
Decline in Function with Age
Brain mass
Eye disease
Depth of perception
Discrimination of colors
Pupillary response
Respiratory vital capacity
Renal function
2- to 3-inch loss in height
Impaired blood flow to lower leg(s)
Degeneration of the joints
Total body water
Nerve damage (peripheral
neuropathy
Stroke
Diminished hearing
Sense of smell and taste
Saliva production
Esophageal activity
Cardiac stroke volume and rate
Heart disease and high blood
pressure
Kidney disease
Gastric secretions
Number of body cells
Elasticity of skin, thinning of
epidermis
15%30% body fat
Unique Characteristics
What are the unique characteristics of
elderly trauma?
Fall
Burn
Alcohol
Pedestrian vs. vehicle
Motor vehicle crash
Leading
Causes
of
Injury
Unique Airway Problems
ABCDE
Priorities are the same
Decreased reserve requires early
intubation
Factors affecting airway management
Dentition (dentures)
Nasopharyngeal mucosal fragility
Cervical arthritis
Unique Breathing Problems
Diminished respiratory reserve
Use of supplemental oxygen
COPD
Hypoxemic respiratory drive
Chest injuries poorly tolerated
Minor chest injuries with major effects
Unique Circulatory Problems
Decreased cardiovascular function and
reserve
Cautious fluid administration
Increased BP, decreased HR, and loss of
renal function with age
Anticoagulants and other medications
Pharmacologic effects
Catecholamine effects and dysrhythmias
Drugs That Affect Resuscitation
Beta blockers
Antihypertensives
NSAIDS
Anticoagulants
Corticosteroids
Diuretics
Hypoglycemics
Psychotropics
Unique Neurologic Problems
Acute and chronic subdural hematomas
Altered sensorium secondary to
cerebral atrophy, hypoperfusion, and
medications
Spinal osteoarthritis, leading to frequent
spinal column and cord injuries
Cervical Spine MRI
Unique Exposure Problems
Abnormal thermoregulatory mechanism
Increased sensitivity to hypothermia
Increased risk of infection
Tetanus immunization status

Unique Musculoskeletal Problems
Most frequent cause of morbidity
Susceptible to certain fractures
Osteoporosis
Preexisting deformities complicate
evaluation
Immobility can lead to complications

Recognizing Elder Abuse
High index of suspicion
Patterns of injury
Multiple types
Physical
Emotional
Confinement
Intimidation
Poor hygiene
Strategy for Elder Abuse
Dont query in presence of possible abuser.
If abuse is suspected, remove patient from
abusive environment.

Failure to recognize and report
Pitfalls
End-of-Life Decisions
When is enough, enough?
Advance directives?
Right to self-determination paramount
Treatment only in patients best interest
Benefits of treatment outweigh adverse
consequences
Summary
Trauma in the elderly is increasing globally.
Treatment priorities are the same.
Evaluation and management affected by:
Anatomic and physiologic changes
Comorbid conditions and medications
Consider elder abuse