Initial management of geriatric trauma

This post is a must read if you are en emergency physician.

The geriatric population is the only age group who had an increased proportion in trauma. They have a higher mortality rate but also complications.

Here is a summary of the basic tips to remember when your in coming trauma activation is 80 years old. It is a brief review of the recommendations of the American College of Surgeons. My top ten tips includes:

  1. Lower threshold for a trauma activation
    • A trivial mechanism can lead to significant injury and the evaluation of the vitals signs can be altered by medications and normal physiologic changes with age.
  2. Rapid evaluation of these medications that can impair the management: warfarin, clopidogrel, aspirin, beta-blocker, ACE, not so new anticoagulants.
  3. Consider a possible cause to this trauma. For example, pneumonia, ACS, CHF, stroke, syncope, etc.
  4. Get them off the back board as soon as possible. High risk of decubitus ulcer.
  5. Liberal use of CT-Scan. No worries for radiation consequences at this age.
  6. Use the same principle for volume resuscitation with this addition: CLOSE MONITORING and adjustment depending on your findings.
  7. Adequate pain control. They are less likely to scream or complain of pain. But it is IMPOSSIBLE that a hip fracture does not hurt!
  8. Caution with temperature control, they are at high risk of hypothermia because of the physiologic changes of aging (alteration of central thermoregulation and skin atrophy)
  9. Goals of care discussion is a must when the injuries are life-threatening.
  10. Implementation of geriatric inpatient consultation protocol (We talked about this!)

 

A final tip would be if you see an older adults with a fall, treat him like it was a high velocity MVC. It will change your perspective and your management as well. It is not just a fall!!

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