Silver Trauma Flashcards
What is the criteria for a silver trauma?
All patients over the age of 70 who has an obvious injury including falling from standing
What are the different presentations that apply for a silver trauma?
Injury to 2 or more body regions or suspected injury to pelvis, head, spine, chest
On anticoagulation medication or has a bleeding disorder
Sever pain
Acutely short of breath
Uncontrollable major haemorrhage
What are the physiological criteria for a silver trauma?
Systolic BP under 110 mmHg
Heart rate over 90 bpm
GCS under 15 (even if baseline)
Lactate over 2 or BE under -2
Why is hypovalaemic shock difficulty to detect in an elderly patient?
They have poor resilience to haemodynamic instability following haemorrhage due to preexisting hypertension, altered cardiovascular reserve or beta blocker therapy
As per the nice guidelines, what criteria mean a patient should have a whole body CT?
All adult patients presenting following blunt trauma and suspected multiple injuries
What management techniques can be used to help a patient better tolerate spinal immobilisation?
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
With elderly patients what can put them at risk of trying to safety spinal immobilise them?
Severe spinal degenerative disease
Dementia
Delirium
Coexistent TBIS
What can worsen neurological injuries to the spine?
Poorly fitted collars or hyperextended positions
What should be carried out if an elderly patient/any patient has a confirmed bleed and is on anticoagulation?
INR point of care testing and if required anticoagulant reversal should occur within 1 hour of decision to reverse
What should patients on warfarin with an intracranial bleed receive?
Octaplex and Vit K
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?
Mechanism of injury
Frailty
Degree of anticoagulation
What are the low threshold criteria for initiating and trauma call and obtaining a CT head in elderly patients?
Known or suspected head injury
Low level fall
Patient on anticoagulants
Unclear cause of a fall or the presentation to ED is unclear
How should the key objectives in elderly chest trauma be achieved?
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
What are the key objectives in elderly chest trauma?
Early recognition of rib injury
Appropriate assessment and management of pain
Reduced duration of supportive ventilation
Long term stabilisation
Return to functional baseline
What is an important consideration for rib fractures in elderly patients?
The type and number of rib fractures
