Advanced Trauma Life Support ATLS Student Course Manual 2018

BIBLIOGRAPHY 223
comprise only 12% of the overall population; but
strikingly, they account for nearly 30% of deaths due
to trauma. Without question, advancing age contributes
to increased morbidity and mortality. Preexisting
medical diseases may accompany the aging physiology.
A patient-centered approach to care should include
early discussion with the patient and family regarding
goals of care and treatment decisions. In the trauma
setting, it is important to have early and open dialogue
to encourage communication. Many patients have
already discussed their wishes regarding life-sustaining
therapies before the acute event occurs. Early consultation
with palliative care services may be helpful
in determining limitations in care, as well as effective
palliative approaches to ease the patient’s symptoms.
TeamWORK
••
Trauma teams are increasingly managing
trauma in the elderly population.
••
Because of preexisting medical conditions and
the potential complications of anticoagulant
and antiplatelet drug therapy, successful
management of geriatric trauma remains
challenging. A trauma team with an
understanding of the unique anatomical and
physiological changes related to aging can have
a positive impact on patient outcome.
••
Early activation of the trauma team may
be required for elderly patients who do not
meet traditional criteria for activation. A
simple injury, such as an open tibia fracture,
in a frail elderly person may quickly become
life-threatening.
••
The effect of cardiac drugs, such as beta
blockers, may blunt the typical physiological
response to hemorrhage, making interpretation
of traditional vital signs difficult. The team
member responsible for managing circulation
must ensure that the team leader is made
aware of even minor changes in physiological
parameters, and he or she should assess for
perfusion status to promptly identify and
manage catastrophic hemorrhage.
••
The outcomes for elderly trauma patients
are often poor. The team leader must
consider patients’ advanced directives and
recognize the patient's goals of care. Often,
members of the team provide opinions or
suggestions that may be helpful in caring for
patients in these difficult situations.
Chapter Summary
1. Older adults are the fastest growing segment of
the population. Trauma providers will see an
increasing number of elderly injured.
2. The elderly patient presents unique challenges
for the trauma team. The influence of changes
in anatomy and physiology, as well as the impact
of pre-existing medical conditions, will influence
outcomes.
3. Common mechanisms of injury include falls, motor
vehicle crashes, burns, and penetrating injuries.
4. The primary survey sequence and resuscitation
are the same as for younger adults; however, the
unique anatomy and physiology of older patients
will influence timing, magnitude, and end-points.
5. Common injuries in the elderly include rib
fractures, traumatic brain injury, and pelvic
fractures. Understanding the impact of aging and
the influences on pitfalls seen with these injuries
will result in better outcomes.
6. The impact of medications, elderly maltreatment,
and understanding the goals of care are
unique features of trauma care of the elderly
patient. Early identification will influence care
and outcomes.
Bibliography
1. American College of Surgeons, Committee on
Trauma, National Trauma Data Bank (NTDB).
http://www.facs.org/trauma/ntdb. Accessed
May 12, 2016.
2. Braver ER, Trempel RE. Are older drivers actually
at higher risk of involvement in collisions
resulting in deaths or nonfatal injuries among
their passengers and other road users? Inj Prev
2004;10:27–29.
3. Bulger EM, Arenson MA, Mock CN, et al. Rib
fractures in the elderly. J Trauma 2000;48:
1040–1046.
4. Li C, Friedman B, Conwell Y, et al. Validity of
the Patient Health Questionnaire-2 (PHQ-2) in
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