Trauma in Elderly
- Everything in the body deteriorates
- Atrophy of the brain (extra risk of subdural bleed): There is more cerebrospinal fluid
surrounding the atrophied brain and that may indeed offer some protection, but at the same
time the anchor veins are stretched which makes them more vulnerable (possibly resulting
in subdural hematomas)
- Smaller vital capacity
- Limited capacity to react with tachycardia
- Less fat % thinner skin – less insulation
- Decreased kidney function
- Decreased body water and circulating volume
- Bad eyes
- Hearing loss
- Diminished equilibrium
- Osteoporosis
- Diminished immune response
People on diuretics may lose a lot of water (and potassium) over time, resulting even in a
circulating volume that is (much) smaller than normal. Remarkably, their vital signs may remain
"normal". As a consequence these people will go into shock after a smaller (traumatic or otherwise)
blood loss. Apart from that the hypokaliaemia will need to be corrected, in particular when
cristalloid solutions are infused.
Trauma in Pregnancy
- Pregnant trauma patients can very easily aspirate
- A ‘normal‘ PaCO2 is worrying because during pregnancy slight hyperventilation with
hypocapnia is the norm. normocapnia may point to impending respiratory insufficiency.
- All visibly pregnant trauma victims (i.e. from the 0th week on) have the same family name.
They are all colled: Mrs. TILT. The reason is that the growing uterus will compress the caval
vein in the supine position once the uterus reaches the level of umbilicus. Left lateral tilt of
appr. 20 degrees is to be provided, e.g. by a wedge under the right hip. This should be done
IMMEDIATELY and takes precedence over protecting the spine.
- In pregnancy the circulation blood volume is increased, with the same number RBC’s. This
leads to apparent ‘anemia’ and a larger volume of blood lost before circulatory parameters
change.
- Bloodloss in the mother leads to preferential decreases in the placental circulation. The
fetus already suffers before becoming bradycardic. the placental vasculature is very
sensitive to catecholamine stimulation. Acute hypovolemia of the mother leads to
catecholamine release, leads to vasoconstriction and an increase in vascular resistance (.i.e.
decreased flow) in the placenta.
- Iso-immunization is provided for ALL Rh-negative pregnant trauma victims UNLESS the
trauma involves the limbs ONLY.
- when the circulation of the mother is in jeopardy, placental circulation is decreased
preferentially at the detriment of the fetus. The mother's body (and survival) comes first
Ecclampsia may develop up to 6 weeks after childbirth. This has to be taken into account if
convulsions develop after head injury in a women who has given the birth recently.
- Everything in the body deteriorates
- Atrophy of the brain (extra risk of subdural bleed): There is more cerebrospinal fluid
surrounding the atrophied brain and that may indeed offer some protection, but at the same
time the anchor veins are stretched which makes them more vulnerable (possibly resulting
in subdural hematomas)
- Smaller vital capacity
- Limited capacity to react with tachycardia
- Less fat % thinner skin – less insulation
- Decreased kidney function
- Decreased body water and circulating volume
- Bad eyes
- Hearing loss
- Diminished equilibrium
- Osteoporosis
- Diminished immune response
People on diuretics may lose a lot of water (and potassium) over time, resulting even in a
circulating volume that is (much) smaller than normal. Remarkably, their vital signs may remain
"normal". As a consequence these people will go into shock after a smaller (traumatic or otherwise)
blood loss. Apart from that the hypokaliaemia will need to be corrected, in particular when
cristalloid solutions are infused.
Trauma in Pregnancy
- Pregnant trauma patients can very easily aspirate
- A ‘normal‘ PaCO2 is worrying because during pregnancy slight hyperventilation with
hypocapnia is the norm. normocapnia may point to impending respiratory insufficiency.
- All visibly pregnant trauma victims (i.e. from the 0th week on) have the same family name.
They are all colled: Mrs. TILT. The reason is that the growing uterus will compress the caval
vein in the supine position once the uterus reaches the level of umbilicus. Left lateral tilt of
appr. 20 degrees is to be provided, e.g. by a wedge under the right hip. This should be done
IMMEDIATELY and takes precedence over protecting the spine.
- In pregnancy the circulation blood volume is increased, with the same number RBC’s. This
leads to apparent ‘anemia’ and a larger volume of blood lost before circulatory parameters
change.
- Bloodloss in the mother leads to preferential decreases in the placental circulation. The
fetus already suffers before becoming bradycardic. the placental vasculature is very
sensitive to catecholamine stimulation. Acute hypovolemia of the mother leads to
catecholamine release, leads to vasoconstriction and an increase in vascular resistance (.i.e.
decreased flow) in the placenta.
- Iso-immunization is provided for ALL Rh-negative pregnant trauma victims UNLESS the
trauma involves the limbs ONLY.
- when the circulation of the mother is in jeopardy, placental circulation is decreased
preferentially at the detriment of the fetus. The mother's body (and survival) comes first
Ecclampsia may develop up to 6 weeks after childbirth. This has to be taken into account if
convulsions develop after head injury in a women who has given the birth recently.
