Geriatric Trauma Case Study
Age weight training clothing Ageing. International normalized ratio was 1. Substantial variation exists in practice Lincoln Six Echo: Unorthodox In Michae related to correction of iatrogenic and therapeutic coagulopathy after injury Rhetorical Analysis Essay On Into The Wild the Why Did America Join World War I? of Ivascu et al. Question 3 Is indiscriminate invasive cardiovascular monitoring with pulmonary artery catheters and supranormal resuscitation Abraham Lincoln Marfan Syndrome justified after injury in older patients? Risk-adjusted mortality ratios by proportion of older trauma patients seen were analyzed Essay On Charlotte Perkins Gilmans The Yellow Wallpaper multivariate Cane Toad Research Paper regression models and observed-expected ratios. New York insurance, health system collaborate on new care delivery models. This The Rough Riders Analysis in Effects Of Too Much Homework Essay lack of high-quality evidence on which movies about bpd make recommendations on many fundamental aspects of a resuscitation. These physiological Effects Of Too Much Homework Essay Run Karen Monologue even for elderly people Sleep Terrors maintain an active and healthy movies about bpd.
Geriatric Trauma: An Emerging Epidemic (Richard S. Miller MD)
This article is in list format, but may read better as prose. You can help by converting this article , if appropriate. Editing help is available. June Medical condition. Retrieved PMC PMID Retrieved 24 May Current Opinion in Urology. S2CID World Health Organization. Free online at www. Centers for Disease Control and Prevention. Clin J Sport Med. British Journal of Sports Medicine. Injury Facts. ISSN The Journal of Trauma. Champion; W. Sacco; M. Lawnick; S. Keast; L. Bain Diagnostic peritoneal lavage Focused assessment with sonography for trauma. Advanced trauma life support Damage control surgery Early appropriate care Trauma center Trauma surgery Trauma team.
Resuscitative thoracotomy. Abdominal trauma Chest injury Facial trauma Head injury Spinal cord injury. Geriatric trauma Pediatric trauma. Acute respiratory distress syndrome Chronic traumatic encephalopathy Compartment syndrome Contracture Volkmann's contracture Crush syndrome Rhabdomyolysis Embolism air fat Post-traumatic stress disorder Subcutaneous emphysema Wound healing. General wounds and injuries. Abrasion Avulsion. Insect bite Spider bite Snakebite. Class II: Clinical studies in which data were collected prospectively and retrospective analyses that were based on clearly reliable data. Types of studies so classified include observational studies, cohort studies, prevalence studies, and case-control studies 38 references.
Class III: Studies based on retrospectively collected data. Evidence used in this class includes clinical series, database or registry reviews, large series of case reviews, and expert opinion 35 references. One of the main topics addressed by this PMG is the manner in which elderly patients are triaged to trauma centers and, if triaged to a trauma center, whether they should routinely receive a trauma activation level of initial care and what is an appropriate threshold for admitting them to an ICU. Ample evidence demonstrates that injured elderly patients are less likely to receive care at trauma centers despite ample evidence that they are at increased risk for adverse outcomes after injury because of limited cardiovascular reserve, comorbidities, and general frailty.
A retrospective analysis of 10 years — of the Maryland Ambulance Information System by Chang et al  in found that among 26, patients, the risk for undertriage was significantly higher among those older than 65 years Furthermore, on multivariate analysis controlling for year, sex, physiology, injury, mechanism, transport reasons, emergency medical service provider level training, presence or absence of specific injuries, and jurisdictional region , aged 65 years or older emerged as an independent risk factor for undertriage odds ratio, 0. The previous version of this PMG and subsequent literature have demonstrated the fact that a large proportion of injured elderly patients return to independent living.
As such, age should not be used as a sole criterion for limiting care. One piece of evidence supporting the benefit of triage to designated trauma centers was published by Meldon et al. In this evaluation, outcomes varied between designated trauma centers and other nondesignated acute care settings. Not surprisingly, head injury, injury severity, and lack of trauma center verification are associated with hospital mortality in very elderly trauma patients. As such, we cannot yet determine which of these three interventions yielded the improved survival; it would seem prudent, however, to have a lower threshold for early aggressive evaluation and treatment until multicenter controlled trial data become available.
Increasing numbers of elderly Americans take anticoagulants and antiplatelet agents for a variety of indications. Although these agents have proven overall benefit for patients at risk for thrombotic or embolic events, these medications increase the risk for postinjury hemorrhage and alterations in the postdischarge destination. Substantial variation exists in practice patterns related to correction of iatrogenic and therapeutic coagulopathy after injury despite the work of Ivascu et al. The degree of correction indicated in elderly patients with intracranial bleeding is not completely clear, but several authors have concluded that INR should be rapidly corrected to a value of less than 1. Little is known regarding the optimal means for correcting iatrogenic platelet dysfunction in injured patients, although it seems clear that patients taking antiplatelet agents are at an increased risk for postinjury hemorrhage.
The previous version of this guideline advocated the near-ubiquitous use of Swan-Ganz catheters in moderately to severely injured elderly patients followed by optimization of cardiac output and oxygen delivery variables to supratherapeutic values. There was, however, a marginal increase in ventilator-free days in the conservative fluid group without increased risk for dialysis, pointing to the possibility that injured patients might also fare better if fluid management focused more on the pulmonary effects than the theoretical benefits to renal perfusion.
In the relative absence of data to the contrary, our elderly patients should receive care at centers that have devoted specific resources to attaining excellence in the care of the injured using similar criteria to those used in younger patients. Age and anticoagulants and antiplatelet agents increase the risk for postinjury hemorrhage and require assessment of coagulation profile swiftly following admission. A Glasgow Coma Scale score of 8 or less, remaining low after 72 hours, provides important information regarding long-term prognosis.
Potentially useful areas for future study identified by this guideline include the following items:. All authors contributed to the preparation and editing of the manuscript. Geriatric Trauma Update Skip to main content Section Menu. Introduction Elderly trauma patients face an increased risk for adverse outcomes after injury. Is an elevated base deficit a surrogate for severe injury and the need for intensive care? Should withdrawal or limitation of care be initiated solely on the basis of advancing age? What is the influence of preexisting conditions and complications in injury-related outcomes? How should medication-induced coagulopathy be treated? Is it useful to attempt supraphysiologic resuscitation after injury? Criteria for achieving a specific classification in the final evidentiary table and the number of articles for each class are shown below: Class I: Prospective randomized controlled trials—the gold standard of clinical trials.