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Geriatric Trauma Gram McGregor, 1Lt, WA ANG Critical Care Air Transport Nurse
Geriatric Defined <ul><li>Older then 65 years </li></ul><ul><li>Decline starts in late 20’s </li></ul><ul><li>Leading caus...
Trauma <ul><li>Mechanisms of injury* </li></ul><ul><ul><li>Falls </li></ul></ul><ul><ul><li>Motor vehicle trauma </li></ul...
Trauma <ul><li>Geriatric trauma patients die for the same reason as trauma patients of any age. </li></ul><ul><li>Often, b...
Head Injury <ul><li>Caused by brain tissue shrinking with age </li></ul><ul><li>More prone, even from minor trauma </li></...
Cervical Injury <ul><li>Osteoporosis </li></ul><ul><ul><li>Increased injury risk with trivial accidents </li></ul></ul><ul...
Acute Abdomen <ul><li>Abdominal Aortic Aneurysm-one of most rapidly fatal conditions </li></ul><ul><ul><li>Most common wit...
Respiratory System <ul><li>Larger less elastic lung functionally decreasing respiratory reserve </li></ul><ul><li>Decrease...
Cardiovascular System <ul><li>Decreased ability to increase heart rate or vasoconstrict vessels </li></ul><ul><li>Increase...
Renal System <ul><li>30-40% Decrease in kidney function </li></ul><ul><li>Electrolyte disturbances more likely </li></ul><...
Nervous system <ul><li>Number of brain cells may decrease by as much as 45% </li></ul><ul><li>Short-term memory impairment...
Gastrointestinal System <ul><li>Decreased saliva  </li></ul><ul><li>Decreased gastric juices </li></ul><ul><li>Slowing of ...
Musculoskeletal System <ul><li>Decreased bone density </li></ul><ul><li>Posture changes and vertebral discs dehydrate caus...
Altered mental status <ul><li>Essential to compare to baseline!! </li></ul><ul><li>Delirium </li></ul><ul><ul><li>Rapid on...
Environmental Emergencies <ul><li>Tolerate temperature extremes poorly </li></ul><ul><li>Develop hypo/hyperthermia rapidly...
Blast injuries <ul><li>Higher associated risk of life-threatening injuries due to: </li></ul><ul><ul><li>Less flexible tis...
Management <ul><li>Airway  </li></ul><ul><li>Breathing-possibility of Chronic Lung Disease </li></ul><ul><li>Circulation-m...
Questions?
References <ul><li>Browner, B.D. (2002)  Emergency care and treatment of the sick and injured. </li></ul><ul><li>McSwain, ...
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Geriatric Trauma

Gram McGregor, 1Lt, WA ANG
Critical Care Air Transport Nurse

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Geriatric Trauma

  1. 1. Geriatric Trauma Gram McGregor, 1Lt, WA ANG Critical Care Air Transport Nurse
  2. 2. Geriatric Defined <ul><li>Older then 65 years </li></ul><ul><li>Decline starts in late 20’s </li></ul><ul><li>Leading causes of death: </li></ul><ul><ul><li>Heart disease </li></ul></ul><ul><ul><li>Cancer </li></ul></ul><ul><ul><li>Stroke </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Trauma </li></ul></ul>
  3. 3. Trauma <ul><li>Mechanisms of injury* </li></ul><ul><ul><li>Falls </li></ul></ul><ul><ul><li>Motor vehicle trauma </li></ul></ul><ul><ul><li>Assault and Domestic abuse </li></ul></ul><ul><ul><li>Pedestrian accidents </li></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><li>*In order by frequency </li></ul></ul>
  4. 4. Trauma <ul><li>Geriatric trauma patients die for the same reason as trauma patients of any age. </li></ul><ul><li>Often, because of preexisting physical conditions, the geriatric patient can often die from less severe injuries and sooner than younger patients. </li></ul>
  5. 5. Head Injury <ul><li>Caused by brain tissue shrinking with age </li></ul><ul><li>More prone, even from minor trauma </li></ul><ul><li>Increased ICP signs develop slowly </li></ul><ul><li>Patient may have forgotten injury </li></ul>
  6. 6. Cervical Injury <ul><li>Osteoporosis </li></ul><ul><ul><li>Increased injury risk with trivial accidents </li></ul></ul><ul><ul><li>Shrinkage of disk spaces </li></ul></ul><ul><li>Arthritic changes </li></ul><ul><ul><li>Narrow spinal canal </li></ul></ul><ul><ul><li>Increased injury risk </li></ul></ul><ul><ul><li>Sudden movement may cause cord injury without fracture </li></ul></ul>
  7. 7. Acute Abdomen <ul><li>Abdominal Aortic Aneurysm-one of most rapidly fatal conditions </li></ul><ul><ul><li>Most common with hypertension and atherosclerosis </li></ul></ul><ul><ul><li>Possible finding of decreased pulses in extremities </li></ul></ul><ul><li>GI Bleed </li></ul><ul><ul><li>Coffee-ground emesis </li></ul></ul><ul><ul><li>Black, Tarry or frankly bloody stools </li></ul></ul>
  8. 8. Respiratory System <ul><li>Larger less elastic lung functionally decreasing respiratory reserve </li></ul><ul><li>Decreased cilia in airways increases potential for respiratory infections </li></ul><ul><li>Stiffening of chest cage and airway cartilage. </li></ul><ul><li>Impaired cough and gag reflexes. </li></ul>
  9. 9. Cardiovascular System <ul><li>Decreased ability to increase heart rate or vasoconstrict vessels </li></ul><ul><li>Increased chance of atherosclerosis leading to heart attack or stroke </li></ul><ul><li>Cardiac output decreases by 50% from 20 to 80 years of age </li></ul><ul><li>Increased chance of arteriosclerosis: </li></ul><ul><ul><li>Stroke -Hypertension </li></ul></ul><ul><ul><li>Heart disease -Bowel Infarction </li></ul></ul>
  10. 10. Renal System <ul><li>30-40% Decrease in kidney function </li></ul><ul><li>Electrolyte disturbances more likely </li></ul><ul><ul><li>Often manifests as apparent confusion, weakness </li></ul></ul>
  11. 11. Nervous system <ul><li>Number of brain cells may decrease by as much as 45% </li></ul><ul><li>Short-term memory impairment </li></ul><ul><li>Slower reflex times </li></ul><ul><li>Collaboratively make assessment more difficult and trauma more likely </li></ul>
  12. 12. Gastrointestinal System <ul><li>Decreased saliva </li></ul><ul><li>Decreased gastric juices </li></ul><ul><li>Slowing of GI Tract </li></ul><ul><ul><li>Potential constipation and impactions </li></ul></ul><ul><li>Decreased liver function </li></ul><ul><ul><li>Decreased ability to filter/detoxify the blood </li></ul></ul><ul><ul><li>Increased potential for toxic medication levels </li></ul></ul>
  13. 13. Musculoskeletal System <ul><li>Decreased bone density </li></ul><ul><li>Posture changes and vertebral discs dehydrate causing shortening of up to 5cm. </li></ul><ul><li>Decrease in muscle mass up to 30% between 30 and 70 years of age. </li></ul><ul><li>Increased propensity for falls and both traumatic and nontraumatic fractures </li></ul>
  14. 14. Altered mental status <ul><li>Essential to compare to baseline!! </li></ul><ul><li>Delirium </li></ul><ul><ul><li>Rapid onset, usually curable </li></ul></ul><ul><ul><li>inability to focus, think logically and maintain a train of thought. </li></ul></ul><ul><li>Dementia </li></ul><ul><ul><li>Slow onset, permanent </li></ul></ul><ul><ul><li>Progressive disorientation, shortened attention span and loss of cognitive function </li></ul></ul>
  15. 15. Environmental Emergencies <ul><li>Tolerate temperature extremes poorly </li></ul><ul><li>Develop hypo/hyperthermia rapidly </li></ul><ul><li>Decreased ability to respond to changes, decreased heat production and decreased ability to rid the body of excess heat. </li></ul>
  16. 16. Blast injuries <ul><li>Higher associated risk of life-threatening injuries due to: </li></ul><ul><ul><li>Less flexible tissues </li></ul></ul><ul><ul><li>Decreased cardiovascular reserve </li></ul></ul><ul><ul><li>Decreased respiratory reserve </li></ul></ul>
  17. 17. Management <ul><li>Airway </li></ul><ul><li>Breathing-possibility of Chronic Lung Disease </li></ul><ul><li>Circulation-may have different normal blood pressure </li></ul><ul><li>Protect the cervical spine </li></ul><ul><li>Control their temperature </li></ul><ul><li>Determine baseline/chronic medical conditions </li></ul>
  18. 18. Questions?
  19. 19. References <ul><li>Browner, B.D. (2002) Emergency care and treatment of the sick and injured. </li></ul><ul><li>McSwain, N.E., Frame, S. (2003) Basic and advanced prehospital life support. </li></ul>

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