Thursday, June 11, 2009

Trauma in the elderly

Went to a lecture today at one of the major hospitals in town about "Trauma in the elderly".
Turns out that calling people elderly is now deemed ageist, go figure. Certainly not going to stop me, personally I think this whole politically correct movement has gone way too far for far too long.

Anyway, here are a few key points I picked up:

- Physiological Changes in the Elderly include
  • Cardiac
  • Pulmonary (decreased mucociliary clearance)
  • Neurological (the brain shrinks with age)
  • Renal (less nephrons available)
  • GI tract
  • Immune systems
  • Musculoskeletal

- Meds: May mask problems (more on that later)
The elderly often take
  • Antihypertensive drugs
  • Antiplatelet/Anticoagulants
  • Antideressant and other related psychiatric drugs

- Beware of Co-morbidities in the elderly

- Most common site of injury for elderly patients:
  • Head
  • Pelvis
  • Lower limbs
  • Wrist

Older patients have 2x the risk of sustaining c-spine injuries

- each rib fracture increases mortality around 19%

- Patients with >2 rib fractures should be admitted to hospital

- ABCs
  • Reduced Airway Reflexes
  • Difficult Airway
  • Less sedative doses
  • Higher vent rates
  • Diagnosis of shock difficult (antihypertensives, Beta Blockers...)

- Many elderly patients have a Vitamin D deficiency. Vit D plays an important role in bone strength, and can be obtained from sunlight exposure.

- Adapted for us ambulance staff: If a patient has had a fall, or is likely to have a fall (regardless if they refuse transport to hospital), get a Falls Risk Assessment done. This may vary wherever you are, but it's usually linked to social/community/other government service.

- Another prehospital tip: document on your case sheet how the patient lives: 'independent', 'independent with support' etc. Important for the hospital and further treatment, if any intervention is needed (stairlift, rails, ramps etc).

- Some definitions:
  • older: >65 yrs
  • oldest: >85yrs
In Australia, an indigenous (aboriginal) person is classed as 'older' above the age of 65. This is due to their shorter average life span (~19yrs les than the typical white population).


All in all a great seminar, with a few good hints and background information that I picked up. I'll keep those in mind the next time I have an ELDERLY (sorry, couldn't resist) patient. Which will be soon, as they always seem to have a tumble here and an ache there.
I don't mind, hey, I signed up for this job well knowing what it's all about!