Elderly Flashcards
Why is the heart rate is an unpredictable gauge of hypovolemia in the elderly?
Decreased response to catecholamines, and collagen replacement of cardiac myocytes
If an elderly person falls and is unable to get up for a significant periods of time, what comorbid diagnosis should be entertained?
Rhabdomyolysis
What are five major causes of syncope/LOC in the elderly that can lead to falls?
- Dysrhythmias
- Seizures
- ACS
- Hypoglycemia
- PE
What is the formula for the Baux score, and what is its significance?
Age + Surface area burned
Predicts mortality
How reliably can vital signs be used to assess stability of an elderly patient?
Not very
In blunt trauma patients ≥65 years old, there is an association between hypotension and mortality starting with systolic blood pressures below (__) mm Hg and heart rates above (__) beats/min
n blunt trauma patients ≥65 years old, there is an association between hypotension and mortality starting with systolic blood pressures below 110 mm Hg and heart rates above 90 beats/min
A decrease in blood pressure of (__) mm Hg below a known baseline or a falling trend is also a marker of instability.
A decrease in blood pressure of 30 mm Hg below a known baseline or a falling trend is also a marker of instability.
Why are the elderly less prone to developing epidural hematomas than younger patients?
Denser fibrous bond between the dura mater and the inner table of the skull
Why is there an increased incidence of subdural and intraparenchymal hemorrhage in the elderly as compared to the young?
Decreasing brain mass and greater tension on bridging veins
True or false: the INR of a patient taking warfarin correlates with the risk of adverse outcomes in an elderly patient with head trauma
true
True or false: there is no increased risk of intracrainial hemorrhage with clopidogrel use
False (maybe)–some studies have shown an increased risk
What is central cord syndrome?
Hyperextension of the neck causes trauma to the spinal cord, leading to motor deficits, more so in the upper than lower extremities
What is the role of the canadian cervical spine rules and NEXUS criteria in patients over 65 years old?
Patients over 65 are excluded–image them
If a fracture is found on imaging of part of the spine in an elderly patient, what else should be done?
Look for other fractures in the spine (entire spine)
Chest trauma/rib fractures in the elderly is highly associated with what infectious condition?
Pneumonia
What must always be suspected in cases of lower ribcage or pelvic fractures?
Intraabdominal injuries
What can reduce the risk of contrast induced nephropathy?
Isotonic crystalloids
How sensitive are plain films for evaluating pelvic fractures?
Not very–always follow continued pain with CT
Where should you check for axillary nerve function following humeral trauma?
Deltoid muscle sensation and motor function
What two labs are useful indicators of shock?
Lactate levels and base deficit
What are the trauma labs? (8)
- CBC
- CMP
- Coags
- d-dimer
- Lactate
- Trop
- EtOH
- CK
True or false: you should reverse all anticoagulation in a patient presents with intracranial bleeding
True
How long can intracranial hemorrhages present after the fall? What is the significance of this?
up to 24 hours later
Need to assess need for observation
When is it appropriate to discharge elderly patients with rib fractures?
Until good pain control and pulmonary toilet are assured
