Week 11

Question 1

what happens to body systems with age?

Answer 1

decreased ability to maintain homeostasis
decreased ability to regulate blood volume
Changes in body composition

Question 2

What are some changes in body tissue experienced by the elderly?

Answer 2

decreased lean body mass
increased fat tissue
decreased total body water

Question 3

what happens in the resp system when you get old af

Answer 3

decreased cough and gag reflexes leading to impairment of defence against inhaled bacteria

loss of cilia in airways

decrease in pulmonary defense leads to increased infections

increased chest wall stiffening and decreased compliance

joints are stiffer

decreased elastic fibres - loss of elastic recoil

increased weakening of resp muscles

decreased surface area for gas diffusion at alveolar level due to decrease in alveolar wall tissue and capillaries
-> leads to decrease in o2 uptake

decreased resp reserve

Question 4

what are some resp trauma considerations with elderly?

Answer 4

• thoacic trama to chest is potentially lethal
• less elastic thorax has an increased susceptibility to injury
• diseased lungs are less elastic and more susceptible to pneumothorax
• pulmonary system has marginal reserve
• decreased VC & PaO2
• organs have less tolerance to hypoxia
• ability to compensate during shock is impaired (resp rate may not be able to increase to compensate)

Question 5

what are the changes in the cardiovascular system for elderly?

Answer 5

• coronary atherosclerosis
• arterial stiffening occurs leading to increase in systolic BP
• internal thickening of arteries leading to risk of AMI & CVA and arrythmias
• increased cholesterol leading to CAD and PVD
• decrease in resting CO by 30% from ages 30 - 80

Question 6

What are the myocardial changes in elderly?

Answer 6

• hypertrophy
• decreased compliance of ventricle
• increased duration of contraction
• anastomoses
• decreased responsiveness to catecholamine
• > leads to decreased CO due to decreased HR, decreased exercise tolderance, increased workload

Question 7

What are the cardiac conduction changes in elderly?

Answer 7

• decreased # of pacemaker cells

- arrythmias

Question 8

what are the cardiac trauma considerations with elderly?

Answer 8

• chest injuries increase risk of heart/aorta/major vessels
• > calcified aortic arch, less flexible.
• consider disecting aortic aneurism
• impaired coronary response to o2 demands - decreased response to hypovolaemia
• may require increased arterial pressure to perfuse organs
• hypovolaemia and hypotension are poorly tolerated

Question 9

What are the renal considerations for the elderly?

Answer 9

• decrease renal flow by 50% between 30 - 80
• proportional decrease in glomerular filtration by 8ml/min/decade
• 30 - 50% decrease in nephrons by age 75
• decreased ability to excrete concentrated urine

Question 10

what are the renal trauma considerations with the elderly?

Answer 10

• decreased kidney function makes pt at greater risk of renal failure and renal hypoperfusion
• decreased ability to compensate for fluid changes
• metabolising medication

Question 11

what are the nervous system changes in elderly?

Answer 11

• decreased # of neurons
• decrease brain size and weight
• increased sub arachnoid space
• increased adherence of dura mater to skull
• fibrosis and thickening of meninges
• decreased cerebral blood flow
• decreased reaction time & motor responses
• increased pain threshold
• decreased thermoregulatory mechanisms

Question 12

what are the nervous system trauma considerations with the elderly?

Answer 12

shrinking brain sign - easier to tear and make sub dural bleeding

Question 13

what immune system changes are seen in elderly?

Answer 13

decreased t cell response

decreased immune response

Question 14

what happens in the joints with elderly?

Answer 14

• cartilage rigidity and fragility increased

- decreased range of movement

Question 15

what is sarcopenia?

Answer 15

age related loss of skeletal muscle

Question 16

what happens to the liver in elderly?

Answer 16

decreases in size and weight

- decreased blood flow to liver means potential increase in medication toxicity

Question 17

what are some physiologic considerations for paediatric patients?

Answer 17

• more susceptible to multiple injuries and more severe given the same force
• force more widely distributed
• proportionally larger surface area
• capacity to maintain normal BP despite blood loss of up to 24 -30%
• changes in HR, RR and peripheral perfusion can indicate immediate cardiopulmonary collapse
• have significantly higher energy requirement when injured (o2/glucose use)

Question 18

what is the age cut off for the royal children’s hospital

Answer 18

15 - if never been before

18 - if they have a history at the hospital

Question 19

what are the 3 steps in the paediatric assessment triangle?

Answer 19

Appearance
Work of breathing
Circulation to the skin

Question 20

what falls under appearance in the paediatric assessment triangle?

Answer 20

tone
interactiveness
consolability
look/gaze
speech cry

Question 21

what falls under work of breathing in the paediatric assessment triangle?

Answer 21

abnormal breathing
abnormal positioning
retractions
nasal flaring

Question 22

what falls under circulation to skin in the paediatric assessment triangle?

Answer 22

pallor
mottling
cyanosis

Question 23

why do you put a towel under the shoulders of an infant?

Answer 23

more prominent occipult

Question 24

why do we ventilate paeds to rise and fall of chest?

Answer 24

• avoid barotrauma

- stop inflation of stomach (causes pressure against diaphragm making ventilating hard)

Question 25

what are the s&s of shock in paeds

Answer 25

• cool and pale extremeties
• weak peripheral pulses
• mottled/cyanotic skin
• altered mental status
• delayed cap refil

Question 26

what are the causes of shock in paeds?

Answer 26

external/internal blood loss
cardiac related (contusion/rupture)
decreased return / Systemic Vascular R (spinal cord injury)

Question 27

what should you consider in a head to toe on a paed?

Answer 27

<2 years - sutures not completely fused

- skill more pliable

Question 28

what should you consider when looking at c spine injuries in paeds?

Answer 28

children under 8 are more succeptible to injures of upper c spine due to anatomical differences:

• larger head size and weight
• weaker c spoine musculature
• increased laxity of spinal ligiaments
• immature vertebal joints & ossification centres
• increased elasticity of the spinal column

Question 29

what hsould you consider with paeds and chest injuries?

Answer 29

less rib fractures due to more compliant chest wall,

but

can mask serious underlying injuries due to lack of external signs

• Mediastinum is more freely mobile

Question 30

what hsould you consider with paeds and abdo injuries?

Answer 30

kids have:

• larger solid organs
• less protective subcutaneous fat and abdo muscles
• more flexible rib cage
• smaller torso
• allowing for wide spread of force