Makindo Medical Notes.com

Related Subjects: |Initial Trauma Assessment and Management |Thoracic Trauma Assessment and Management |Flail Chest Rib fractures |Resuscitative Thoracotomy |Haemorrhage control |Traumatic Head/Brain Injury |Traumatic Cardiac Arrest |Abdominal trauma |Tranexamic Acid |Silver Trauma |Cauda Equina

Silver Trauma: Recognising Major Trauma in >65 matching this needs a full trauma assessment

Introduction

• Fall <2m is commonest mechanism of injury
• Issues are failure to identify as major trauma
• This leads to a denial of specialist care
• Higher mortality and morbidity than younger patients
• Often have more than one significant injury
• Traumatic brain and chest injuries commonest cause of death
• Systolic BP < 110mmHg same mortality as < 90mmHg in younger person

Mechanism of Injury

• Fall downstairs
• Fall from any height other than standing
• Pedestrian / Cyclist struck by vehicle
• Road Traffic Collision (except simple rear shunt or speed <30mph)
• Penetrating or crush injury to torso

Notable Physiology/Injuries

• Systolic BP <110mmHg
• HR >90bpm
• GCS <15
• 2 or More Body Regions (i.e. Chest and Pelvis)
• Suspected Head or Spinal Injuries
• More than = 3 rib fractures

Medication

• Anticoagulation/Coagulopathies

Clinical Warning

• Occult Shock - medication and pre-existing cardiovascular disease
• Spinal Injury - CT is recommended in this group & look for 2nd #
• Trauma Vs Collapse? - coexisting medical cause ? (i.e. MI > RTC)
• Secondary Survey - don't get distracted by first injury found
• Co-Morbidities - don't forget Parkinson's Medication

Specific Management

• Hydration, watch for delirium, analgesia using age appropriate doses
• Early trauma scanning
• Anticoagulation reversal if bleeding
• C-Spine: Usual Canadian C-spine rules don’t apply, and the imaging modality of choice is CT
• Have a low threshold for CT head as SDH is common
• Pain relief and hydration (helps prevent delirium)
• Know your local pathways for referral to specialist services
• Patient’s and relative’s wishes need to be considered
• If survival how to prevent further falls
• Ensure patients with PD get their medications at right time
• Discuss DNACPR and ceilings of care