GERIATRIC TRAUMAGERIATRIC TRAUMA

Dr.RIDHA JAWAD AL-BASRIDr.RIDHA JAWAD AL-BASRIAL-KINDI TEACHING HOSP.AL-KINDI TEACHING HOSP.

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OBJECTIVESOBJECTIVES Identify the unique characteristics of geriatric trauma & Identify the unique characteristics of geriatric trauma &

common types & patterns of inj. With anatomic & common types & patterns of inj. With anatomic & physiologic differences.physiologic differences.

Describe the prim. Mx of geriatric trauma & differences Describe the prim. Mx of geriatric trauma & differences from younger and their impact on resuscitation. from younger and their impact on resuscitation. 1- AIRWAY Mx 2- BREATHING & 1- AIRWAY Mx 2- BREATHING & VENT.VENT.

3- SHOCK , FLUID & ELECTROLYTE Mx.3- SHOCK , FLUID & ELECTROLYTE Mx. 4- CNS & CERVICAL SPINE INJ.4- CNS & CERVICAL SPINE INJ. Identify & Mx elder abuse.Identify & Mx elder abuse.Causes of Death inCauses of Death in ElderlyElderly 1- Head inj. 2- - Cancer 3-COPD 4- Stroke 5- DM 6- Pneumonia 7-Trauma

Types & patterns of inj.1- >65 yare less likely to be injured than young but they 1- >65 yare less likely to be injured than young but they

have more fatal outcome.have more fatal outcome.2- >80% of the injured return to independent life.2- >80% of the injured return to independent life.3- physiologic reserve ----- Aging3- physiologic reserve ----- Aging ----- comorbidity----- comorbidity ------ lack of understanding of their ------ lack of understanding of their

needs needs 4- Death in patients with comorbidity 3 times > others4- Death in patients with comorbidity 3 times > othersCauses of death due to inj. Falls 40% Motor Vehicle Crashes Thermal Inj. Mx “ ABCDEs”

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AIRWAY problems ---- Dentationproblems ---- Dentation ----- Nasopharyngeal fragility ----- Nasopharyngeal fragility ----- Macroglossia & microstomia----- Macroglossia & microstomia ----- Cervical arthritis & TMJ ----- Cervical arthritis & TMJ

arthritisarthritis ET intubation is the preferred way of ET intubation is the preferred way of

definitive airway control.definitive airway control. Difficult intubation or obstructed airway Difficult intubation or obstructed airway

-- surgical cricothyriodotomy-- surgical cricothyriodotomy

Breathing & Ventilation

Admission even in Admission even in minor trauma( resp. minor trauma( resp. reserve & incidence reserve & incidence of complications)of complications)

CIRCULATION 1- CHANGES WITH AGING --- cardiac1- CHANGES WITH AGING --- cardiac functionfunction -- 50% have-- 50% have CAD by age of 65yCAD by age of 65y 2- circulation time2- circulation time 3- kidney loses mass rapidly after 3- kidney loses mass rapidly after

age of 50 y renal perfusion age of 50 y renal perfusion GFR GFR

Disability : Disability : Brain & Spinal CordBrain & Spinal Cord Changes with AgingChanges with Aging :1- Cerebral Atrophy 2- cerebral blood flow by 20%

at 70 y.3-Demylinization peripheral conduction

velocity.4- reaction time visual & auditory acuity with

impaired vibratory & position sense.5- ? Confusion Drugs , Alcohol , pre-existing Dis.6- intervert. Disk changes Facet joint degen.

Spinal Stenosis7-osteoporosis #8- OA changes spinal stenosis kyphosis

SPECIAL CIRCUMSTANCESSPECIAL CIRCUMSTANCES MEDICATIONS ELDER ABUSE Medications : Drug interactions Drug Adverse Effects B-blockers –limit

chronotropic activity Ca channel blockers

prevent periph VC hypothermia NSAI blood loss Steroids inflam. & immune response Pain control in elderly is important.

ELDER ABUSEELDER ABUSE1-Physiologic abuse ---- 14% 1-Physiologic abuse ---- 14% in elder trauma.in elder trauma.

2-Neglect.2-Neglect.3- psychological abuse.3- psychological abuse.4- Financial & material 4- Financial & material abuse.abuse.

5- Violation of rights.5- Violation of rights.

SUMMARYSUMMARY1.1. No. of elderly .No. of elderly .2.2. Elderly less than young to be injured.Elderly less than young to be injured.3.3. Mortality rate is high.Mortality rate is high.4.4. Many injured can return to independent life.Many injured can return to independent life.5.5. Awareness of physiologic changes of aging.Awareness of physiologic changes of aging.6.6. = = possibility of abuse.= = possibility of abuse.7.7. Presence of comorbidity.Presence of comorbidity.8.8. use of medications.use of medications.9.9. Rx options same as in young.Rx options same as in young.10.10. Resuscitation with monitoring.Resuscitation with monitoring.

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