TRANSITION SERIES Topics for the Advanced EMT CHAPTER Trauma in Special Populations: Geriatrics 42

Objectives Discuss statistical rates pertinent to the aging population. Identify pathophysiologic changes that accompany injuries in geriatrics. Differentiate early from late assessment findings. Review current treatment strategies for the geriatric patient suffering from trauma.

Introduction In geriatric trauma, one of the most important questions is “How old is the patient?” Elderly patients do not survive trauma as well, and concurrent chronic diseases make survival even more unlikely.

Introduction (cont’d) The Advanced EMT may need to reconsider the assessment approach and care techniques.

Epidemiology Over 40 million geriatric people in the U.S. Geriatric patients use a disproportionate amount of EMS and health care services. Geriatric patients account for 75% of fall-related deaths. The elderly drive fewer miles, but have a three times higher death rate in MVCs.

Pathophysiology Head and Brain Trauma –Brain atrophy increases injury. –Higher risks of blood occupying lesions.  Findings may be delayed. –Patient or family may not remember injury.

Pathophysiology (cont’d) Neck Trauma –Perception of pain is diminished. –C1 and C2 fractures common with minimal traumatic mechanisms. –Immobilization concerns

Neck injuries are common in patients with a history of either head or chest wall trauma.

Pathophysiology (cont’d) Spinal Trauma –Degenerative bone disorders are more common. –Presence of kyphosis or scoliosis increases injury risks. –Anterior cord syndrome is almost exclusively a geriatric emergency.

Pathophysiology (cont’d) Thoracic Trauma –Ribs become brittle. –Disease states of lung tissue decrease function. –Compensatory mechanisms are unable to recover when a thoracic injury occurs.

Pathophysiology (cont’d) Abdominal Trauma –Liver and spleen are more exposed to injury. –Internal bleeding can be masked by what is thought to be a “normal” systolic pressure.

Motor vehicle collisions are the second-leading cause of accidental death, after falls, in the geriatric population. (© Mark C. Ide)

Pathophysiology (cont’d) Burn Trauma –4 th leading cause of death in geriatrics. –Changes in the skin make burns more severe. –Burn shock occurs more readily as does airway occlusion due to burns. –Linear increase in mortality of a burn injury based on age alone.

Common Manifestations of Trauma in Geriatric Patients

Emergency Medical Care Spinal immobilization considerations –Allow for cervical/spinal curvature. Assess and maintain the airway. Determine breathing adequacy. –High-flow via NRB with adequate breathing. –High-flow via 10-12/min if inadequate.

Emergency Medical Care (cont’d) Assess circulatory components. –Check pulse, skin characteristics. –Control major bleeds Provide full immobilization. Initiate transport to an appropriate trauma facility. Consider establishing IV access to keep SBP >90 mmHg.

Emergency Medical Care (cont’d) Consider calling for a Paramedic for rendezvous on scene or intercept en route to ED. Treat any minor injuries, time allowing. Frequently reassess for rapid deterioration.

Summary Although they are adults, approaching a geriatric patient should be given the same consideration as approaching the pediatric patient. Many times the Advanced EMT will need to anticipate deterioration, modify treatment to fit the patient, and not expect all care to have the same effect as on a younger patient.