GERIATRIC TRAUMA Trauma in Elderly Referred Book: tintinalli emergency medicine

1. Trauma in the Elderly
(Geriatric Trauma)
Alpesh Jadhav
B.Sc. (Hons) Sports &
Exercise Sciences

2. GERIATRIC POPULATION
• Nearly 104 million elderly persons
(aged 60 years or above) in India; 53
million females and 51 million males.
• The Number of Elderly Persons is
Expected to Grow to 173 million by
2026

3. GERIATRIC POPULATION
• The Rapid Growth of the Senior population has had a
significant Economic Impact
• Because of their Unique Medical Requirements
• Geriatric Population Consume more than One Third of the
country’s health care resources.

4. Why to Give Special Attention ?

7. CLINICAL FEATURES
• Falls: Most Common Cause of Injury in Patients Over 65 Years of Age.
• Syncope: Temporary Loss of Consciousness caused by a Fall in Blood Pressure
• Which May be Secondary to Dysrhythmias, Venous Pooling, Autonomic
Derangement, Hypoxia, Anemia, or Hypoglycemia.
• Motor Vehicle Crashes: Most Common Mechanism for Fatal Incidents in
Elderly Persons through 80 years of Age.

8. CLINICAL FEATURES
• The Geriatric Trauma Patient should be Viewed as Both:
A Medical Patient, &
A Trauma Patient
• A Precise History is Vital.
• Because Elderly Patients may have a Significant Past Medical History that
Impacts their Trauma Care.

9. • Often, the Time Frame for obtaining Information about the Traumatic Event,
Past Medical History, Medications, and Allergies is Quite Short.
• Family members, Medical records, and the Patient’s Primary Physician may be
helpful in Gathering Information regarding the Traumatic Event and the
Patient’s Previous Level of Function.
• Medications, such as Cardiac Agents, Diuretics, Psychotropic Agents, and
Anticoagulants, must be carefully listed.

10. • On Physical Examination, Frequent Monitoring of Vital Signs is Essential.
• Emergency Physicians should be Cautious of a “Normal” Heart Rate in the
Geriatric Trauma Victim.
• A Normal Tachycardic Response to Pain, Hypovolemia, or Anxiety may be
Absent or Blunted in the Elderly Trauma Patient.
• Medications such as β-blockers may mask Tachycardia and Delay appropriate
Resuscitation.

11. CLINICAL FEATURES
•Special attention should be paid to
Anatomical Variation that may make Airway
Management more difficult.
•These include the Presence of Dentures,
Cervical Arthritis, or TemporoMandibular
Joint Arthritis.

12. CLINICAL FEATURES
• A Thorough Secondary Survey is Essential to Uncover Less Serious
Injuries.
• These “Minor” Injuries may not be severe enough to cause
problems during the Initial Resuscitation, but cumulatively may
cause significant Morbidity and Mortality.
• Seemingly Stable Geriatric Trauma Patients can deteriorate Rapidly
and without warning.

13. DIAGNOSIS AND DIFFERENTIAL

14. Head Injury
• Higher incidence of Subdural
Hematomas.
• The rate of Intracranial
Haemorrhage approaches 7% to
14% in Anticoagulated Patients with
Blunt Head Injury who are
experiencing “No” or “Minimal”
symptoms.
• Recommended Radiography:
Computed Tomography (CT)

15. Cervical Spine Injuries
• An increased Incidence of C1 and C2 Fractures.
• Special Emphasis on Maintaining Cervical Immobilization until the
Cervical Spine is Properly Assessed.
• Because Underlying Cervical Arthritis may hide Fracture Lines, in the
elderly patient with Persistent Neck Pain.
• Negative Plain Radiographs should undergo CT of the Neck.

16. Chest Trauma
•In Blunt Trauma, an Increased
Incidence of “Rib Fractures” due
to Osteoporotic Changes.
•The Pain associated with Rib
Fractures, along with any
decreased Physiologic Reserve,
may predispose patients to
“Respiratory Complications”.

17. Chest Trauma
•More Severe Thoracic Injuries, such as
HemoPneumothorax, Pulmonary Contusion, Flail Chest, and
Cardiac Contusion, can quickly lead to Decompensation in
elderly individuals whose Baseline Oxygenation Status may
already be Diminished.
•Arterial Blood Gas Analysis may provide Early Insight into
Elderly Patients’ Respiratory Function and Reserve.

18. Abdominal Trauma
• The Abdominal Examination in elderly patients is “Unreliable”.
• The Adhesions associated with Previous Abdominal Surgical
Procedures may increase the risk of performing “Diagnostic
Peritoneal Lavage”.
• The Focused Assessment with Sonography for Trauma (FAST)
examination may assist in evaluating for Hemoperitoneum and the
need for Exploratory Laparotomy in Hemodynamically Unstable
Patients.

19. Abdominal Trauma
•CT with Contrast is a “Valuable Diagnostic Test” for
patients who are Stable.
•Important to ensure Adequate Hydration and
Baseline Assessment of Renal Function prior to the
Contrast Load for the CT Scan.

20. Abdominal Trauma
•Some Patients may be Volume Depleted due to
Medications, such as Diuretics.
•This Hypovolemia coupled with Contrast
Administration may exacerbate any Underlying
Renal Pathology.

21. BIBLIOGRAPHY

22. THANKS