Geriatric trauma

Question 1

Airway considerations in the elderly

Answer 1

loss of protective airway reflexes
dentures
lack of teeth
arthritic changes
reduced dosages for RSI

Question 2

breathing considerations

Answer 2

Decreased FRC, gas exchange, cough reflex, mucociliary clearance, reserve
Increaased kyphoscoliosis

Question 3

cardiac considerations

Answer 3

preexisting cardiac disease
lack of respones to hypovolemia
increased afterload
fixed cardiac output and heart rate

Question 4

how to prevent failure to recognise shock in the elderly

Answer 4

Do not equate BP with shock
Monitor GCS and u/o
Use lactate and base deficit for evidence of shock
Use ECHO to assess global function and volume status

Recognise increase risk of blood loss from soft tissue injury and long bone #

Early reversal of antiplatelet and anticoagulation

Awareness that cardiac drugs blunt the response to shock, early treatment and scanning

Question 5

Elderly patient developing delirium after long-acting opioid - alternative

Answer 5

Short-acting
Transdermal local anaesthetic
Nerve block
Epidural

Question 6

Potential cause of mental status decline in elderly

Answer 6

Delirium
Dementia
Pain meds
Sedative
Increased ICP
Decreased CPP