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International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in the Elderly 18.

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Presentation on theme: "International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in the Elderly 18."— Presentation transcript:

1 International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in the Elderly 18

2 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in the Elderly © Pearson

3 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Changes that occur with aging –How changes affect assessment of geriatric trauma Assessment of geriatric trauma Management of geriatric trauma

4 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in the Elderly Fatal outcomes more likely, even if injury is relatively low in severity.

5 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in Elderly Age impairs body's response Trauma is major cause of death –Falls  Fractures of hip, femur, humeral/wrist, head injuries –Motor-vehicle collisions  Higher incidence of collision –Thermal injury  Inhalation, scalding, flame burns, electrical injury

6 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in Elderly Higher risk of injury –Reflex response time increased –Eyesight and peripheral vision decreased –Hearing decreased –Postural instability –Arthritis –Fragile skin and blood vessels –Fragile bones

7 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians The Aging Body Airway –Potential obstruction Respiratory system –Decreased  Pulmonary circulation 30%  Alveolar exchange  Capacity and work rate  Chest wall movement  Inhalation time  Vital capacity due to increased residual volume

8 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians The Aging Body

9 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians The Aging Body Cardiovascular system –Congestive heart failure and pulmonary edema  Circulation decreased  Cardiac output and stroke volume decreased  Conduction system degenerates  Heart valve efficiency decreased –Arteriosclerosis  Peripheral vascular resistance increased  Systolic hypertension

10 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians The Aging Body Neurological and sensory function –Subdural hematoma  Brain shrinks, dura mater adherent to skull  Brain arteries harden, narrow, lose elasticity –Unrecognized injury  Blood flow to brain decreased  Sensory responses decreased  Pain tolerance increased –Altered mental status  Blood flow to brain decreased

11 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians The Aging Body Thermoregulation –Hypothermia  Temperature control mechanism deteriorates  Subcutaneous tissue decreased –Afebrile with infection  Temperature control mechanism deteriorates

12 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians The Aging Body Renal system –Drug toxicity  Nephron function decreased  Blood filtration decreased Immune system –Infection  Malnutrition –Sepsis  Immune response decreased

13 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians The Aging Body Musculoskeletal system –Postural changes  Kyphotic deformity of spine  Slight flexion of knees and hips  Muscle strength decreased –Fractures  Advanced osteoporosis  Bone density decreased  Subcutaneous tissue decreased © Pearson

14 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians The Aging Body Gastrointestinal system –Malnutrition –Decreased ability to metabolize medications Overall system changes –Prolonged illness and recovery time –Decreased total body water leads to dehydration

15 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Medications Drug interaction problems –Anticoagulants increase bleeding time  Increased risk of intracranial and other bleeds –Antihypertensives and peripheral vasodilators limit constriction response  Increased risk of shock –Beta-blockers limit tachycardia response  Missing red flag signs of hypovolemia –Anti hyperglicemic agents  Increased risk of hypoglicemia

16 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Important Points General organ systems less effective –Especially cardiovascular, pulmonary, renal Chronic illness complicates trauma care –Difficult to distinguish Bones fracture more easily –Major bone fractures can be life-threatening

17 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Assessment Do not underestimate severity –Die from less-severe injuries –May not report important symptoms –Pain response, hypoxia, hypovolemia vary –Multiple illnesses –Communications © Pearson

18 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians ITLS Patient Assessment ITLS Primary and Secondary Surveys Anticipate complicating factors –Peripheral pulses difficult to evaluate –Many layers of clothing –Chronic disease vs. acute problem  Nonpathologic rales  Loss of skin elasticity and mouth breathing  Dependent edema  Variation in normal vital signs

19 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Scene Size-up Verify history with reliable bystander Observe surrounding area –Indications that unable to provide own care –Alcohol or medication abuse –Signs of violence, abuse, neglect  Notify proper authorities Gather medications and take to hospital

20 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Initial Assessment Initial level of consciousness –Clarify baseline mental level before trauma (get collateral information from family) –Preexisting condition or trauma –Check blood glucose Chest injuries –More likely serious Spinal precautions –Arthritis and kyphosis © Pearson

21 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Critical Transport Decision Low threshold for early transport

22 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Ongoing Exam Monitor IV fluid administration response –May precipitate congestive heart failure Frequently assess pulmonary status –Lung sounds –Cardiac monitoring –Pulse oximetry –Capnography Do not withhold fluid if needed

23 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Summary Increasing number of elderly patients Evaluation and treatment more difficult –Physiologic processes of aging –Frequent concurrent illnesses –Medication effects Limited compensation mechanisms –Respiratory and circulatory support essential


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