EM Trauma 17: Elderly Flashcards
Define frailty
The state of decreased physiologic reserve and resistance to stressors.
Most common cause of fatal and nonfatal injury in people ≥65 years of age
Falls
Most common fracture in elders hospitalized for injury
Hip fractures
but the overal incidence of nonhip, nonspine fractures in women >55 y/o is 5x greater than hip fractures
Leading cause of mortality in elderly
Motor vehicle crashes
with a case fatality rate twice that of those under 65 ya4rs
Remarks on BP cutoffs in the elderly trauma
- In blunt trauma patients ≥65 y/o, there is an association between hypotension and mortality starting with SBP <110 mm Hg and HR >90 bpm
- A decrease in BP of 30 mm Hg below a known baseline or a falling trend is also a maker of instability
TBI in the elderly
- Elders are less prone to develop epidural hematomas than the general population because of the denser fibrous bond between the dura mater and the inner table of the skull.
- There is, however, a higher incidence of subdural and intraparenchymal hematomas in the elderly
- Immediate non-contrast head CT is recommended for patients who take warfarin or clopidogrel and have a minor head injury mechanism, even if asymptomatic
Remarks on cervical spine injuries
- Odontoid fractures are particularly common in geriatric patients.
- The CCS rule, but not the NEXUS criteria, excludes patients age ≥65 from being considered low-risk for cervical spine injury
- Thus, liberal imaging of the cervical spine in geriatric pateints is warranted.
- Many fractures in one section of the spine are accompanied by fractures in another secdtion, so identification of one fracture should prompt imaging of the entire spinal column
These account for almost half of all osteoporotic fractures
Thoracic and lumbar spine fractures.
- most common at the thoracolumbar junction (T12-L1) and midthoracic areas (T7-T8)
Most common pelvic bone fracture
Pubic ramus
Most common pelvic fracture mechanism
lateral compression
single most common injury diagnosis that leads to hospitalization in the elderly
Hip fractures
- significant cause of mortality, with about 25% of elderly patients dying within a year of injury
- Femoral neck (intracapsular) and intertrochanteric fractures are about equally common, with subtrochanteric fractures comprising the remaining 5% to 10%
Most common fractures in women up to age 75
Distal radius fractures (Colles’ fractures)
with a lifetime risk of about 15%
Remarks on shoulder injuries
Note that the initial 18 degrees of shoulder abduction are generated by the supraspinatus muscle, so movement in this range may still be possible with an axillary nerve injury.
Useful initial indicators of shock in the elderly
Base deficit and lactate levels
BASE DEFICIT
-3 to -5 - mild
-6 to -9 - moderate
≤10 - severe
*vital signs are an unreliable marker of shock in the elderly
Most important determinants of morbidity and mortality in head injury
The volume of intracranial blood and hematoma expansion