Trauma in Special Populations Flashcards
1
Q
Classifications of Ages (Middle, Late, Older)
A
Middle Age - 50-64
Late Age - 65-79
Older Age - 80+
2
Q
General Differences Between Older People
A
- Decrease in bone density
- Decrease in muscle tone
- Decrease in skin elasticity
- Decrease in brain mass (can bleed into brain more before showing increase in ICP
- Respiratory capacity is decreased
- Decrease in renal function
- Decrease in body fat percentage
- Decrease in stroke volume/cardiac output
- Decrease in gastric secretions
- Decrease in saliva production
- Thinning in skin
- Decrease in oesophageal activity
- Decrease in ability to maintain homeostasis
- Due to pre-existing physical conditions, elderly die from less sever injuries than a younger pt would
3
Q
MSK Differences to Older People
A
- Height loss due to dehydration of vertebral discs
- Kyphosis
- Bones more porous, fragile, brittle - increases fracture risk
- Changes in vertebral column result in decreased range of motion, narrowing canal and increased chance of cord compression
- Weakening muscles fatigue more easily
4
Q
Breathing Differences in Older People
A
- Increased stiffness in chest wall
- Alveolar surface decreases
- Body loses ability to saturate haemoglobin with oxygen
- Decreasein respiratory capacity
5
Q
Cardiovascular Differences in Older People
A
- Pre-existing cardiovascular problems contributes to cellular hypoxia
- Fluid resuscitation should be carefully monitored to prevent volume overload
- Think about their normal systolic - 110 might be massively hypotensive if 180 is normal
- They might be on blood thinners/anti-coagulants
- If on Beta-blockers (that lower HR) it will be more difficult for them to compensate and increase HR
- Older pts will struggle to maintain or increase cardiac output
6
Q
Nervous System Differences
A
- Cerebral atrophy
- Increased cerebrospinal fluid
- Nerve impulse conduction slowed
- Mental and psychomotor activity declines
7
Q
NS; Sensory Changes Between Older People
A
- 28% have a hearing impairment
- 13% have a visual impairment
- Temperature regulation and pain perception are altered
8
Q
(Older) Considerations of Mananagement: Airway and Breathing
A
- Differences in facial structure eg loss of teeth will mean harder to get a seal
- Impaired cough/gag reflexes and diminished oesophageal sphincter tone
- Co-morbidities can mean reduced surface area for gas exchange
- There is an increased sensitivity on the diaphragm meaning there’s increased sensitivity to intra-abdominal pressure changes and difficulty lying flat
9
Q
(Older) Considerations in Management: Circulation
A
- Delayed CRT is a poor indicator of perfusion status
- Many elderly patients have pre-existing conditions or medications to consider
- Some medications may directly affect clotting ability and observation readingseg HR
- Blood pressure may be an unreliable findings if AF, normally hypertensive and may have had an inital drop that’s gone unnoticed
10
Q
General Mangagement of Older Persons
A
- Wide differences in mentation, memory and orientation exist in the elderly
- Decrease in pain/temperature sensation may result in poor awareness of environment or injury
- Many elderly patients are malnourished which can effect response to treatment
- Changes in body structure requires modifications in packaging and immobilisation
11
Q
General Differences in Paeds
A
- Less body fat and increased elasticity of connected tissue
- Closer proximity of organs meaning forces are not dissipated as well, decreasing ability of absorbtion
- Skeletal system not fully calcified and has more active growth centres eg will mean greenstick fracture
- Children compensate very well and will fall off a cliff when unable to compensate anymore; laboured breathing to tachypnoea, exhaustion then apnoea
- Hypoventilation and hypoxia are more common than hypovolaemia and hypotension
- They also have a high body SA:Vol resulting in heat loss
12
Q
Circulation Differences in Paeds
A
- The likelihood of immediate exsanguination is low
- Blood pressure alone is a poor indicator of peripheral perfusion - use colour, temperature, CRT
- Children’s compensate for haemorrhage by increasing systemic vascular resistance at the expense of peripheral perfusion - therefore pay attention to peripheral perfusion
13
Q
Assessing End Organ Perfusion in Paeds
A
Brain; confusion in child
Cardiovascular; slow CRT, colour, temp
Kidney; low urine output (oliguria)
14
Q
(Paed) Differences in Airway
A
- Larger head - means trachea alignment is curved when doing head tilt chin lift so should roll up bit of blanket and put behind shoulders to lift the body into a more neutral alignment
- Larger tongue - will make bagging more difficult
- No teeth - less structure to face so harder to get seal on the BVM
- Epiglottis is larger and floppier - harder to manipulate in laryngoscopy
- Airway is more funnel shaped increasing their choking risk
- Smaller airway diameter - greater risk of obstruction, swelling causing issues
- Loose deciduous teeth - easier to injure during airway manoeuvres, may dislodge into airway
- ET difficulties - epiglottis is shaped like a horseshoe so view is different, larynx and cricothyroid obstructs view and trachea is shorter meaning right bronchi intubation more likely
- Up to 1yr - use a straight blade and for over 1yr a curved scope (Macintosh)
15
Q
(Paeds) Considerations in Management: Ciruclation
A
- Evaluate colour, temperature and peripheral perfusion
- Children compensate so well; they wont show signs of hypotension until they have lost 30% of their volume, then will decompensate quickly
- Limit attempts at IV to 2 then IO should be considered
- Fluid replacement
- Child requiring more than one bolus may be deteriorating (done by age)
16
Q
(Paeds) Considerations in Management: Disability
A
- A child can be deeply obtunded but have excellent recovery if cerebral hypoxia is avoided
- Baseline neurological evaluation includes; GCS and pupils as well as response to sensory stimulation and motor function
- LOC is an important factor in initial assessment of CNS
17
Q
General Considerations in Paeds
A
- Use appropriately sized equipment
- Preserve body heat - as increased SA
- Use modified GCS for children under 4
- Regardless of size, a BP of less than 50 is bad
- Modify immobilisation to ensure proper alignment of the entire spine and limit lateral movement of body
- Transport to paeds facility if possible
18
Q
Child GCS Changes
A
- Eyes - as normal
- Motor - as normal
Verbal:
5 - appropriate words or social smiles, fixes on and folows objects
4 - cries but is consolable
3 - persistently irritable
2 - restless, agitated
1 - silent
19
Q
General Differences in Pregnant People
A
- Heart rate increases 15-20 beats by the 3rd trimester
- BP pressure drop s slightly in 2nd trimester but is normal at term
- Cardiac output increases; blood volume increases as much as 48%
- Gastric emptying slows - higher risk of aspiration
- Physiological anaemia and iron deficiency is common
20
Q
(Paed) Differences in Breathing
A
- Babies will nasal breath and use diaphragmatic breathing in the early months - if baby is very snotty, could occlude airway, important to decompress the stomach to avoid its splinting
- Ribs are more horizontal and flexible - serious pathology can occur without fracture and limits tidal volume
- Greater chest wall compliance - less protection/more potential for visceral injury with minimal external signs
- Less muscle - tire quicker
- Heart rate - infants become bradycardic when hypoxic
21
Q
(Paed) Considerations in Managment: Airway and Breathing
A
- Always prioritise oxygen therapy to be 95%+
- Management with BVM may be adequate, reserve intubation for when BVM is inneffective. Consider choking
- Tachypnoea and signs of increased effort may be the first signs of respiratory distress or shock
- Watch for signs of increasing respiratory fatigue
- Consider neutral alignment when bagging
22
Q
Differences in Airway and Breathing Managment (Pregnancy)
A
- Intubation is more indicated in pregnant people as they have an increased risk of aspiration and regurgitation because of delayed gastric emptying and increased reflux
- Add cricoid pressure when tubing and ventilating to reduce the risk of regurgitation
23
Q
Considerations Of Managment: Ciruculation (Pregnancy)
A
- The foetus is an end organ therefore foetal distress can mean maternal hypovolaemia
- This is because the mother will decrease blood flow to the baby to compensate
- A pregnant person can lose 35% of their blood volume before signs of hypovolaemia can show
- BP is characteristically unreliable
- In heavily pregnant people, if supine can cause compression tot he aorta and vena cava reducing CO so should be managed on a tilt to their left hand side
24
Q
History/Assessment of Pregnancy in Trauma
A
- Has the baby been kicking/moving?
- Any abnormal PV bleeding?
- Have you had any pregnancy complications? (meconium, pre-eclampsia, diabetes)
25
Q
Blunt Trauma in Pregnancy (Causes, effects, seatbelt practice)
A
- Blunt trauma includes; RTCs, assault (domestic abuse) and falls
- Commonly causes placental abruption - partial separation of the placenta from the uterus causing blood to haemorrhage into the amniotic sac - this can cause significant blood loss
- Uterine rupture is rare (layers of the uterus tear open into the abdominal cavity) - this will most likely kill the foetus
- Any blunt trauma there is a large increase of risk of post partum haemorrhage (PPH)
- Encourage good seatbelt practice - do not put seatbelts over the bump only above and below
26
Q
Penetrating Trauma in Pregnancy
A
- Uterus is vulnerable so foetal survival is poor
- Maternal survival is better as uterus provides protection to the other organs
