Advanced Trauma Life Support ATLS Student Course Manual 2018
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Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 11 Outline Objectives iNtroduction Effects of Aging and Impact of Preexisting Conditions MechANism of Injury • Falls • Motor Vehicle Crashes • Burns • Penetrating Injuries PrimARy Survey with Resuscitation • Airway • Breathing • Circulation • Disability • Exposure and Environment Types of Injury • Rib Fractures • Traumatic Brain Injury • Pelvic Fractures Special CircumstANces • Medications • Elder Maltreatment • Establishing Goals of Care Teamwork Chapter Summary BibliogRAphy OBJECTIVES After reading this chapter and comprehending the knowledge components of the ATLS provider course, you will be able to: 1. Explain the physiological changes that occur with aging and how they affect geriatric injury and the patient’s response to trauma. 2. Identify mechanisms of injury commonly encountered in older adult patients. 4. Discuss the unique features of specific types of injury seen in the elderly, such as rib fractures, traumatic brain injury, and pelvic fractures. 5. Identify common causes and signs of elder maltreatment, and formulate a strategy for managing situations of elder maltreatment. 3. Describe the primary survey with resuscitation and management of critical injuries in geriatric patients by using the ABCDE principles of ATLS. n BACK TO TABLE OF CONTENTS 215

216 CHAPTER 11 n Geriatric Trauma Nearly every country in the world is experiencing a growth in the proportion of older people in their population. Older adults comprise the fastest-growing segment of the United States’ population. In fact, by 2050 almost one-half of the world’s population will live in a country where at least 20% of the population is older than 60 years, and one-fourth will live in a country where older people comprise more than 30% of the population. Aging of the population is expected to be one of the most significant social transformations of the 21st century. This generation will live longer than the preceding one and will have access to high-quality health care. In addition, the ever-increasing mobility and active lifestyles of today’s elderly individuals places them at increased risk for serious injury. Injury is now the fifth leading cause of death in the elderly population. Geriatric trauma patients pose a unique challenge to trauma teams. Although the mechanisms of injury may be similar to those for the younger population, well-established data demonstrates increased mortality with similar severity of injury in older adults. Failure to properly triage elderly trauma patients, even those with critical injuries, may be responsible in part for the attributable mortality. Of course, failure to triage is just one factor that impacts mortality from geriatric trauma. Senescence of organ systems, both anatomically and physiologically, preexisting disease states, and frailty all play a part in placing older adults at higher risk from trauma. Depression, substance abuse, and maltreatment are additional factors to consider, and screening can be accomplished through several different tools. Acceptable outcomes Men depend upon proper identification of the elderly patient at risk for death and a well-coordinated, frequently multidisciplinary, aggressive therapeutic approach. For these reasons, thorough evaluation of geriatric patients at a trauma center improves their outcomes. Effects of Aging and Impact of Preexisting Conditions Declining cellular function, eventually leading to organ failure, is part of the aging process. Therefore, aging is characterized by impaired adaptive and homeostatic mechanisms that cause an increased susceptibility to the stress of injury. This condition is commonly described as decreased physiologic reserve. Insults commonly tolerated by younger patients can lead to devastating results in elderly patients. There is a large body of evidence documenting that preexisting conditions (PECs) impact morbidity and mortality. In a recent study, investigators identified five PECs that appeared to influence outcomes in trauma patients: cirrhosis, coagulopathy, chronic obstructive pulmonary disease (COPD), ischemic heart disease, and diabetes mellitus. In the study of more than 3,000 patients, one-fourth of individuals over the age of 65 years had one of these five PECs. Patients with one or more of these conditions were nearly two times more likely to die than those without PECs. The same researchers reported on the interaction between injury and host factors, which included age, gender, and PECs (n FIGURE 11-1). Although injury severity was the primary Women Predicted increased mortality A 0.5 3+ conditions 1-2 conitions 0 conditions 0.4 0.3 0.2 30% risk 0.1 20 30 40 50 60 70 80 90 Age (by decade) Predicted increased mortality B 0.5 3+ conditions 1-2 conitions 0 conditions 0.4 0.3 0.2 30% risk 0.1 20 30 40 50 60 70 80 90 Age (by decade) n FIGURE 11-1 Risk of mortality-associated geriatric complications or death, by age and number of preexisting conditions for A. Males, and B. Females. Note the risk of death increases with an increasing number of preexisting conditions and age. Source: Adapted with permission from Min L, Burruss, S, Morley E, et al. A simple clinical risk nomogram to predict mortality-associated geriatric complications in severely injured geriatric patients. J Trauma Acute Care Surg 2013;74(4):1125–1132. Copyright © 2013 Lippincott Williams & Wilkins. n BACK TO TABLE OF CONTENTS

CHAPTER 11 Outline<br />

Objectives<br />

iNtroduction<br />

Effects of Aging and Impact of Preexisting<br />

Conditions<br />

MechANism of Injury<br />

• Falls<br />

• Motor Vehicle Crashes<br />

• Burns<br />

• Penetrating Injuries<br />

PrimARy Survey with Resuscitation<br />

• Airway<br />

• Breathing<br />

• Circulation<br />

• Disability<br />

• Exposure and Environment<br />

Types of Injury<br />

• Rib Fractures<br />

• <strong>Trauma</strong>tic Brain Injury<br />

• Pelvic Fractures<br />

Special CircumstANces<br />

• Medications<br />

• Elder Maltreatment<br />

• Establishing Goals of Care<br />

Teamwork<br />

Chapter Summary<br />

BibliogRAphy<br />

OBJECTIVES<br />

After reading this chapter and comprehending the knowledge<br />

components of the <strong>ATLS</strong> provider course, you will be able to:<br />

1. Explain the physiological changes that occur with aging<br />

and how they affect geriatric injury and the patient’s<br />

response to trauma.<br />

2. Identify mechanisms of injury commonly encountered<br />

in older adult patients.<br />

4. Discuss the unique features of specific types of injury<br />

seen in the elderly, such as rib fractures, traumatic brain<br />

injury, and pelvic fractures.<br />

5. Identify common causes and signs of elder<br />

maltreatment, and formulate a strategy for managing<br />

situations of elder maltreatment.<br />

3. Describe the primary survey with resuscitation and<br />

management of critical injuries in geriatric patients by<br />

using the ABCDE principles of <strong>ATLS</strong>.<br />

n BACK TO TABLE OF CONTENTS<br />

215

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