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:
- 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.
- Rapid evaluation of these medications that can impair the management: warfarin, clopidogrel, aspirin, beta-blocker, ACE, not so new anticoagulants.
- Consider a possible cause to this trauma. For example, pneumonia, ACS, CHF, stroke, syncope, etc.
- Get them off the back board as soon as possible. High risk of decubitus ulcer.
- Liberal use of CT-Scan. No worries for radiation consequences at this age.
- Use the same principle for volume resuscitation with this addition: CLOSE MONITORING and adjustment depending on your findings.
- Adequate pain control. They are less likely to scream or complain of pain. But it is IMPOSSIBLE that a hip fracture does not hurt!
- 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)
- Goals of care discussion is a must when the injuries are life-threatening.
- 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!!