Geriatric Trauma Flashcards
Discuss limitation in data surrounding geriatric trauma
- Older adults are frequently excluded from clinical trials,
- There is a limitation in considering high risk interventions such as surgery or invasive HD monitoring
Discuss geriatric trauma patterns
Increased morbidity and mortality for similar mechanisms compared to younger popualtion.
Elder abuse is common
Elderly patients are more likley to have significant underlying medical conditions that limit their physiologic response to injury and increase the risk of death after trauma.
Discuss age as a trauma triage criterion
Age should be considered in determining criteria for transfer to a trauma centre and for activation of a trauma team.
Fewer older patients are transferred to trauma centres despite meeting trauma entre criteria.
Discuss mechanisms of injury in the elderly
Falls are the leading mechanisms of injury and leading cause of injury related death in patients older than 65 years of age.
Risk factors for falling include
- weakness
- balance or gait deficit
- VA deficit
- mobility limitation
- cognitive iompairment
- impaired functional status
- postural hypotension
Thermal injuries, self injury and elder abuse are less common but important injury patterns in older adults.
Discuss anatomical and physiological difference in the elderly
Airway -should suspect difficult airway in all methods
- Limited cervical mobility
- reduced mobility at the TMJ
- Cricothyrotomy is more likley to be complex in older adults due to increase risk of sacrring from surgyer, radiation or neck tumors (distort anatomy for all airway)
- -Require tailoring of RSI drugs
Breathing
- Decreased functional reserve
- Tire faster and deteriorate rapidly
- More likely to have significant pulmonary co-morbidities
Circulation
- Blunted response to stress -
- Limited physiological reserve and increased risk of organ dysfunction
- May not mount tachycardia due to reduced reserve or drugs
- Vitals signs are less easy to interpret as systolic hypertension is common among elderly so normotension can indicate significant hypovolaemia
- gentler approach to fluid and blood resus as more likley to be pushed into overload
- warm products
- anticoagulation may need to be reversed
Disability
- Complicated mental status assessment due to pre-exisiting pathology such as strokes or dementia.
- Higher risk of vertebral fractures and cervical fractures in particular - osteoporosis
- intracranial physiological changes such as brain atrophy increase risk of intra-cranial pathology from minimal mechanism
Exposure
- More likely to develop hypothermia due to physiological changes and mechanisms of injury.
- Skin thins with aging and muscle and fat decrease thermo-regulation mechanisms are no longer intact
- Prolonged exposure in the setting of falls and not being able to mobilise
List commonenst fractures sustained in the elderly
1) distal radius fracture (colles)
2) Proximal humerus fracture
3) elbow fractures
Lower
- Ankle
- Hip
- Pelvis
- tib platuea
Discuss Ageing change on pharmacokinetics
- Increased total body fat and a decrease in relative skeletal muscle mass in older adults compared to young adults. -lipophlic medications have a greater VD
- Hepatic blood flow and mass decrease by 40% reducing delivery of drug to the liver and their subsequent metabolism. This decrease in first pass increases drugs bioavailability
- Renal blood flow, mass and number of nephrons decreases with age leading to decrease in renal function.
Define elder abuse
Physical, sexual or psychological abuse as well as neglect, abandonment and financial exploitation of an older person by another person or entity that occurs in any setting either in a relationship where there is an expectation of trust and/or when an older person is targeted based on age or disability.
Can include self neglect if patient does not have capacity
Describe the Eder abuse suspicion index (EASI)
A response of yes on one or more of question 2-6 should raise concern for abuse
1) have you relied on people for any of the following
- bathing
- dressing
- shopping
- banking
- meals
2) has anyone prevented you from getting food clothes, medications glasses, hearing aids or medical care or from being with people you wanted to be with
3) Have you been upset becuase someone talked to you in a way that made you feel shamed or threatened
4) Has anyone made you afraide touched you in ways that you did not want or hurt you physcially
5) has anyone tried to force you to sign papers or to use money against your will
6) Doctor: elder abuse may be associated with finding such as
- poor eye contact
- withdrawn nature
- malnourishment
- hygiene issues
- cuts
- bruises
- inappropriate clothing
- medication non compliance
Discuss physical signs suspicious for protentional elder abuse or neglect
Physical
1) bruising in atypical locations
- not over bony prominences
- lateral arms
- back, face, ears or neck
2) Patterned injury
- bite maeks
- belt buckle
- finger tip
3) Wrist or ankles lesions suggesitve of inappropriate restraint
4) burns - particularly stocking and glove pattern
5) Multiple fracture or bruises of different ages
6) Traumatic alopecia or scalp haemoatoma\
7) subconjunctival veitrous or retinal opthalmic haemorrahge
Sexual
- genital rectal or oral trauma
- evidence of STI
Neglet
- cachexia/malnutrition
- Dehydration
- Pressure sores/decutbius ulcer
- poor body hygiene, unchanged diaper
- dirty severely worn clothing
- elongated toenails
- poor oral hygiene
Discuss management of Elder abuse
Treat acute medical and psychological issues
Ensure patient safety
- can include finding alternative living arrangement
- having perpetrator removed from the ED
- If patient refuses intervention need to ascertain capacity to make that decision
ADMIN
1) Proper reporting
- Mandated to file a report if they know or reasonably suspect that elder abuse has occured
2) Accurate and thorough documentation of history and physical exam finding
- document in patient own words
- pertinent social history should be included
- Injury of any type should be described including there number size location and stage of healing.
