Trauma In The Elderly

Question 1

Differentiate chronologic age from physiologic age

Answer 1

Chronologic age is the actual number of years the individual has lived, whereas physiologic age describes the functional capacity of the patient’s organ systems.

Question 2

With age, myocytes are lost and replaced by collagen. Contractility and compliance decrease for any given preload.5 An 80-year-old person will have approximately _________% of the cardiac output of a 20-year-old, even without significant coronary artery disease.

Answer 2

50%

Question 3

The response to hypoxia may decline by __% and that to hypercarbia by __%

Answer 3

The response to hypoxia may decline by 50% and that to hypercarbia by 40%

Question 4

This state of decreased physiologic reserve and resistance to stressors, now formally referred to as ______

Answer 4

Frailty

Question 5

These are the most common cause of fatal and nonfatal injury in people ≥65 years of age.

Answer 5

Falls

Question 6

These are the most common fracture in elders hospitalized for injury,

Answer 6

Hip fractures

Question 7

Falls in which an individual is unable to get help for a prolonged period should prompt investigation for___________ and dehydration with a check of the creatine kinase and electrolytes.

Answer 7

Rhabdomyolysis

Question 8

These are the second most common cause of injury in the elderly and are the leading cause of death

Answer 8

Motor vehicle crashes

Question 9

These are the second leading cause of traumatic death in the home in older adults.

Answer 9

Burns

Question 10

In blunt trauma patients ≥65 years old, there is an association between hypotension and mortality starting with systolic blood pressures________ and heart rates_____ beats/min.

Answer 10

In blunt trauma patients ≥65 years old, there is an association between hypotension and mortality starting with systolic blood pressures <110 mm Hg and heart rates >90 beats/min.

Question 11

A decrease in blood pressure of____ mm Hg below a known baseline or a falling trend is also a marker of instability.

Answer 11

A decrease in blood pressure of 30 mm Hg below a known baseline or a falling trend is also a marker of instability.

Question 12

One study found that patients with a respiratory rate____ breaths/ min had 100% mortality.

Likewise, a systolic blood pressure___ mm Hg in the blunt trauma patient has been associated with a mortality between 82% and 100%.

Answer 12

One study found that patients with a respiratory rate <10 breaths/ min had 100% mortality.

Likewise, a systolic blood pressure <90 mm Hg in the blunt trauma patient has been associated with a mortality between 82% and 100%.

Question 13

Elders are less prone to develop epidural hematomas than the general because _____________________.

Answer 13

of the denser fibrous bond between the dura mater and the inner table of the skull.

Question 14

There is, however, a higher incidence of__________________ and _________________ hematomas in the elderly than in younger patients.

Answer 14

subdural and intraparenchymal hematomas

Question 15

Diagnosis of intracranial bleeding may be delayed because____________________________________.

Answer 15

brain atrophy increases intracranial free space, allowing blood to accumulate without initial signs or symptoms.

Question 16

True or false

As the brain mass decreases with age, there is greater stretching and tension of the bridging veins that pass from the brain to the dural sinuses. Bridging veins are more susceptible to traumatic tears.

Answer 16

True

Question 17

One study of blunt head trauma patients taking warfarin who were experiencing no or minimal symptoms found a rate of injury on head CT that changed disposition in ____%

Answer 17

7%

Question 18

True or false

Immediate non- contrast head CT is recommended for patients who take warfarin or clopidogrel and have a minor head injury mechanism, even if asymptomatic.

Answer 18

True

Question 19

— fractures are particularly common in geriatric patients, accounting for 20% of geriatric cervical spine fractures, as compared with 5% of nongeriatric fractures.

Answer 19

Odontoid

Question 20

— is the preferred initial modality for assessing the geriatric cervical spine because of the higher pretest probability of injury and the difficulties in inter- preting plain radiographs in a patient with age-related degeneration.

Answer 20

Ct scan

Question 21

True or False

identification of one fracture should prompt imaging of the entire spinal column.

Answer 21

True

Many fractures in one section of the spine are accompanied by fractures in another section, so identification of one fracture should prompt imaging of the entire spinal column.

Question 22

Thoracic and lumbar spine fractures account for almost half of all osteoporotic fractures.

They are most common at the thoracolumbar junction (_______) and midthoracic areas (_____).

_________________fractures are the most common.

Answer 22

(T12-L1) (T7-T8)

Anterior wedge compression fractures

Question 23

While pelvic fractures in the young are generally caused by high-energy mechanism s, the elderly, especially women, frequently suffer pelvic fractures from low-energy falls to the ground from a standing or seated position.

_________ fractures are the most common injuries, and______________ compression is the most common mechanism.

Answer 23

Pubic ramus fractures are the most common injuries, and lateral compression is the most common mechanism.

Question 24

_________ is the single most common injury diagnosis that leads to hospitalization in the elderly.

Answer 24

Hip fracture

Question 25

________________ are the most common fractures in women up to age 75, with a lifetime risk of about 15%

Answer 25

Distal radius fractures (Colles’ fractures)

Question 26

Fractures of the proximal humerus and humeral shaft are also common after falls from standing.

Carefully assess for__________ nerve injury by checking sensation at the area of deltoid muscle insertion and deltoid muscle engagement with shoulder abduction.

Note that the initial 18 degrees of shoulder abduction are generated by the_____________ muscle, so movement in this range may still be possible with an axillary nerve injury

Answer 26

axillary nerve

Supraspinatus

Question 27

___________ and__________ levels are useful initial indicators of shock, and serial measurements can guide resuscitation progress.

Answer 27

Base deficit and lactate levels are useful initial indicators of shock, and serial measurements can guide resuscitation progress.

Elevated lactate levels correlate with systemic hypoperfusion, intensive care unit and hospital length of stay, and mortality.

A “normal” or mild base deficit of –3 to –5 correlates with 24% mortality, a moderate base deficit of –6 to –9 correlates with 60% mortality, and a severe base deficit of ≤–10 correlates with 80% mortality.

Question 28

2011 U.S. Centers for Disease Control and Prevention National Expert Panel on Field Triage recommended a lower threshold for triage of injured elderly patients, giving three key recommendations:

Answer 28

“Risk of injury/death increases after age 55 years.

Systolic blood pressure < 110 mm Hg might represent shock after age 65 years.

Low impact mechanisms (e.g. ground level falls) might result in severe injury.”

Question 29

The___________ and__________ are the most important determinants of morbidity and mortality in head injury

Answer 29

volume of intracranial blood and hematoma expansion