Elderly Trauma

Question 1

What is the guidelines definition for an elderly trauma patient?

Answer 1

Someone over the age of 70

Question 2

What is important to consider for elderly trauma patients?

Answer 2

• that ageing, co-morbidities. Medications and frailty may have an unexpected effect on the physiological condition of the patients
• the patients may not present with an obviously significant mechanism
• consider anticoagulant reversal
• get collateral history and medication history
• cognitive and communication impairments

Question 3

What type of rib fractures in elderly patients have greater physiological significance?

Answer 3

Vertebrosternal ribs (rib 1-7)

Question 4

What is an important consideration for rib fractures in elderly patients?

Answer 4

The type and number of rib fractures

Question 5

What are the key objectives in elderly chest trauma?

Answer 5

• early recognition of rib injury
• appropriate assessment and management of pain
• reduced duration of supportive ventilation
• long term stabilisation
• return to functional baseline

Question 6

How should the key objectives in elderly chest trauma be achieved?

Answer 6

• appropriate analgesia sufficient to allow normal respiration and coughing
• protection of the underlying lung
• adequate ventilation and oxygenation
• infection prevention
• ventilator support and suction to remove secretions and prevent atelectasis
• surgical fixation within 48 hours

Question 7

What are the low threshold criteria for initiating and trauma call and obtaining a CT head in elderly patients?

Answer 7

• known or suspected head injury
• low level fall
• patient on anticoagulants
• unclear cause of a fall or the presentation to ED is unclear

Question 8

What should be taken into consideration when doing a repeat head CT on a elderly patient if their first one was normal but they are on anti coagulation?

Answer 8

Mechanism of injury
Frailty
Degree of anticoagulation

Question 9

What should patients in warfarin with an intracranial bleed receive?

Answer 9

Prothrombin complex concentrate (PCC) and bit K

Question 10

What should be carried out if an elderly patient/any patient has a confirmed bleed and is on anticoagulation?

Answer 10

INR point of care testing and if required anticoagulant reversal should occur within 1 hour of decision to reverse

Question 11

What can worsen neurological injuries to the spine?

Answer 11

Poorly fitted collars or hyperextended positions

Question 12

With elderly patients what can put them at risk of trying to safety spinal immobilise them?

Answer 12

Severe spinal degenerative disease
Dementia
Delirium
Coexistent TBIs

Question 13

What management techniques can be used to help a patient better tolerate spinal immobilisation?

Answer 13

Optimise comfort - correctly fitted collar
Delirium reduction strategies
Balance risk/benefit of immobilisation - consider mechanism of injury, co-morbidities and clinical assessment
Risk/benefit of sedation if in the patients best interest

Question 14

As per the nice guidelines, what criteria mean a patient should have a whole body CT?

Answer 14

All adult patients presenting following blunt trauma and suspected multiple injuries

Question 15

Why is hypovalaemic shock difficult to detect in an elderly patient?

Answer 15

They have poor resilience to haemodynamic instability following haemorrhage due to pre-existing hypertension, altered cardiovascular reserve or beta blocker therapy