Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 11 n Geriatric Trauma
table 11-4 physiological changes and management considerations: circulation
PHYSIOLOGICAL CHANGES WITH AGING
MANAGEMENT CONSIDERATIONS
• Preexisting cardiac disease or hypertension
• Lack of a “classic response” to hypovolemia
• Likelihood of cardiac medications
• Look for evidence of tissue hypoperfusion.
• Administer balanced resuscitation and blood transfusion early for
obvious shock.
• Use advanced monitoring as necessary and on a timely basis.
Pitfall
Failure to
recognize
shock
Disability
prevention
• Do not equate blood pressure with
shock.
• Recognize the likelihood of
preexisting hypertension and, when
possible, obtain medical history.
• Use serum markers such as lactate
and base deficit to evaluate for
evidence of shock.
• Use noninvasive studies such as
echocardiography to assess global
function and volume status.
• Recognize the potential for increased
blood loss from soft-tissue injuries
and pelvic and long-bone fractures.
Traumatic brain injury (TBI) is a problem of epidemic
proportion in the elderly population. Aging causes the
dura to become more adherent to the skull, thereby
increasing the risk of epidural hematoma with injury.
Additionally, older patients are more commonly
prescribed anticoagulant and antiplatelet medications
for preexisting medical conditions. These two factors
place the elderly individual at high risk for intracranial
hemorrhage. Atherosclerotic disease is common with
aging and may contribute to primary or secondary
brain injury. Moderate cerebral atrophy may permit
intracranial pathology to initially present with a normal
neurological examination. Degenerative disease of the
spine places elderly patients at risk for fractures and
spinal cord injury with low kinetic ground-level falls. The
early identification and timely, appropriate support—
including correction of therapeutic anticoagulation—
can improve outcomes in elderly patients.
Key physiological changes and management considerations
of concern to assessment and management
of disability are listed in n TABLE 11-5.
Exposure and Environment
Musculoskeletal changes associated with the aging
process present unique concerns during this aspect
of the initial assessment of the elderly trauma patient.
Loss of subcutaneous fat, nutritional deficiencies,
chronic medical conditions, and preexisting medical
therapies place elderly patients at risk for hypothermia
and the complications of immobility (pressure injuries
and delirium). Rapid evaluation and, when possible,
early liberation from spine boards and cervical collars
will minimize the complications.
Key physiological changes and management considerations
concerning exposure and environment are
listed in n TABLE 11-6.
Specific Injuries
Specific injuries common in the elderly population
include rib fractures, traumatic brain injury, and
pelvic fractures.
table 11-5 physiological changes and management considerations: disability
PHYSIOLOGICAL CHANGES WITH AGING
MANAGEMENT CONSIDERATIONS
• Cerebral atrophy
• Degenerative spine disease
• Presence of preexisting neurological or psychiatric disease
• Liberally use CT imaging to identify brain and spine injuries.
• Ensure early reversal of anticoagulant and/or antiplatelet
therapy.
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