TY  - CHAP
M1  - Book, Section
TI  - Geriatric Trauma
A1  - Stein, Deborah M.
A1  - Crawford, Angela M.
A1  - Yelon, Jay A.
A2  - Feliciano, David V.
A2  - Mattox, Kenneth L.
A2  - Moore, Ernest E.
Y1  - 2020
N1  - 
T2  - Trauma, 9e
AB  - KEY  POINTSFor  the  year  2016,  the  National  Trauma  Data  Bank  noted  that  43%  of  all  patients  in  the  registry  were  55  years  or  older  and  the  mortality  for  this  group  was  58%  of  all  deaths  reported.There  is  evidence  that  immune  function  is  significantly  attenuated  during  the  aging  process  and  that  cytokine  response  is  impaired  as  well.In  the  event  of  hypovolemia  secondary  to  trauma,  the  “stiffer”  heart  with  atherosclerotic  changes  in  elderly  patients  may  be  unable  to  compensate  with  tachycardia  and  an  increase  in  cardiac  output.The  Trauma-Specific  Frailty  Index  includes  reviews  of  comorbidities,  daily  activities,  health  attitude,  sexual  function,  and  albumin  level.In  the  National  Trauma  Triage  Protocol,  a  systolic  blood  pressure  of  110  mm  Hg  in  an  injured  patient  65  years  of  age  or  older  is  a  criterion  for  transport  to  a  trauma  center.When  performing  rapid  sequence  intubation  in  an  elderly  patient,  the  doses  of  induction  agents  may  need  to  be  reduced  between  20%  and  40%  to  minimize  the  risk  of  cardiovascular  depression.Elderly  patients  on  anticoagulants  who  have  had  a  negative  computed  tomography  (CT)  scan  of  the  brain  after  injury  should  have  a  follow-up  CT  of  the  brain  before  discharge  from  the  emergency  department,  although  the  time  frame  for  observation  is  controversial.Many  of  the  falls  in  older  trauma  patients  are  from  a  standing  height  but  still  lead  to  significant  injuries  requiring  hospitalization.Preexisting  conditions  such  as  cirrhosis,  congenital  coagulopathy,  chronic  obstructive  pulmonary  disease,  ischemic  heart  disease,  and  diabetes  mellitus  have  a  significant  negative  impact  on  mortality  in  older  trauma  patients.Mortality  in  elderly  trauma  patients  is  significantly  reduced  in  an  intensivist-model  intensive  care  unit  (ICU)  as  compared  to  an  open-model  ICU.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1175135301
ER  -