ATLS CHAPTER 11

GERIATRIC
TRAUMA
FLORENCE A M
 OBJECTIVES

• Identify the unique characteristic of elderly trauma

• Describe the patientsrimary management of critical
injuries in geriatric patients
• Identify common causes and signs of elder
maltreatment & a strategy for managing situations
 TYPES AND PATTERNS OF INJURY

• Older patients are more likely to have a fatal outcome from their
injuries
• Falls are the most common mechanism of injury among the
elderly
• Medications : Anticoagulants  increased risk of bleeding
• Changes in the central nervus & musculoskeletal system less
flexible & less coordinated
 (A) AIRWAY
• Provide adequate oxygenation is the first objective
• Supplemental O2 should be administered as soon as
possible (even in the presence of chronic pulmonary)
• Endotracheal intubation  preferred method for
definitive airway control
• If acute airway obstruction exists or the vocal cords
cannot be visualized  cricothyroidotomy as an option
 (B) BREATHING AND VENTILATION

• The loss of respiratory reserve due to the effect of aging &

chronic disease  careful monitoring respiratory system
• Respiratory failure  intubation & mechanical ventilation
• Chest wall injuries  rib fractures or pilmonary contusio
• Pneumothorax & hemothorax  ICU observation
 (C) CIRCULATION

• Changes with ages

With aging, total blood volume decreases & circulation time increases
• Evaluation and management:
1. Mistaken impression that “normal” blood pressure and heart rate
indicate normovolemia
2. Avoid blood transfusion
3. A rapid & complete assessment for all sources of blood loss  FAST
 (D) BRAIN & SPINAL CORD INJURY
• Changes with ages
1. Brain mass decreases  replaced by cerebrospinal fluid
2. Loss of brain vol brain movement
3. Significant amount of blood can collect aron the brain (subdural
space) before symptoms become apparent
4. Spine : changes occur in the intervertebral disks loss water &
protein affect shape & compressibility of the disks 
degeneration of facet joint & spinal stenosis
 •EVALUATION & MANAGEMENT

 Higher incidence of subdural and intraparenchymal hematomas

 Rapid screeening for anticoagulant use and subsequent correction
 Cervical spine more common in elderly patients
 Magnetic resonance imaging (MRI) is particularly used for diagnosing
ligamentous injuries
 (E) EXPOSURE AND ENVIRONMENT

• Skin changes  loss of thermal regulatory ability,

decreased barrier function against bacterial invasion 
significant impairment of wound healing
• Injured elderly patients must be protected from
hypothermia
• Hypotermia not attributable to shock, should alert the
physician to the possibility of occult disease ( sepsis,
endocrin disease or pharmacologic causes
 UNIQUE CHARACTER IN GERIATRIC

•Aging results in stiffening of ligaments, cartolage, invertebral disks & joint capsules  increased risk of injury, rupture & decreased joint
stability
Musculoskeletal •Reduction in the size & total number of muscle cells - decrease of muscle strength
sustem

•Poor nutritional status contributes to increased complication rate

Nutrition and •Early & adequate nutritional support is a cornerstone of succesful trauma care
metabolism

•Elderly patients have an impaired ability to respon to bacteria & viruses, a reduced ability to respond to vaccination & a lack of reliable
response to skin antigen testing
Immune system
and infection •Elderly indivdsuals are less able to tolerate infection & more prone to multiple organ system failure

•Often taking several pharmacologic agents even before an injury occurs

Medication •Drug interactions are frequently encountered & side effects are much more common because of the narrow therapeutic range
 ELDER MALTREATMENT
• Maltreatment is defined as any willful infliction of injury, unreasonable
confinement, intimidation or cruel punishment that results in physical harm, pain,
mental anguis
• Classified into six categories :
1. Physical maltreatment
2. Sexual maltreatment
3. Neglect
4. Psycological maltreatment
5. Financial & material exploitation
6. Violation of right
 END OF LIFE DECISIONS

• Age significantly increases mortality from injury, but more

aggressive care especially early in the evaluation &
resuscitationn of elderly trauma patients,has been shown to
improve survival
• Trauma team should try to determine the patient’s wishes as
evidenced by living will, advanced directive, or similar
document
THANKS