ITLS Geriatric Trauma Considerations 2

Question 1

An 82-year-old patient on warfarin falls from standing height and hits her head on a countertop.
She feels fine and has no external signs of injury.
Why should this patient still be transported to a trauma center?

Accepted Answer

Anticoagulant use dramatically increases intracranial hemorrhage risk, and symptoms may be delayed hours to days

Answer

All elderly patients must go to trauma centers regardless of injury

Answer

Standing-height falls never cause serious injury in adults

Answer

She needs her warfarin dose adjusted after the fall

Question 2

Why might an elderly trauma patient have a normal heart rate despite significant hemorrhage?

Accepted Answer

Beta-blocker and calcium channel blocker medications may blunt the tachycardic response to hypovolemia

Answer

Elderly patients have better blood volume reserves

Answer

Elderly patients don't develop tachycardia from any cause

Answer

Decreased pain sensation prevents the stress response

Question 3

What physiologic change in the elderly makes rib fractures more likely from minor trauma and more dangerous when they occur?

Accepted Answer

Decreased bone density (osteoporosis) and reduced chest wall compliance increase fracture risk, while decreased respiratory reserve makes complications more likely

Answer

Increased bone density makes ribs more brittle

Answer

Enlarged rib cage from emphysema provides less protection

Answer

Elderly ribs are flexible like children's ribs

Question 4

An elderly patient is found on the ground after a fall. She is alert but confused and cannot recall the events. What important consideration must ITLS providers evaluate beyond the injuries from the fall?

Accepted Answer

What caused the fall—was it a mechanical trip or did a medical event (syncope, stroke, cardiac dysrhythmia) cause the fall?

Answer

Whether the patient has health insurance

Answer

Whether the patient was exercising before the fall

Answer

If the patient's neighbors heard the fall

Question 5

How does the geriatric patient's reduced total body water affect their response to hemorrhage?

Accepted Answer

Less total body water means less blood volume, so smaller absolute blood losses cause proportionally greater hemodynamic compromise

Answer

Reduced body water has no effect on hemorrhage response

Answer

Reduced body water makes them more resistant to dehydration

Answer

It only affects their response to burns, not hemorrhage

Question 6

Why is the cervical spine of elderly patients more vulnerable to injury, even from low-energy mechanisms?

Accepted Answer

Degenerative changes (osteoarthritis, spinal stenosis, disc disease) create a rigid, brittle spine with a narrowed spinal canal

Answer

Elderly patients have larger, heavier heads

Answer

Cervical spine injuries only occur with high-energy mechanisms regardless of age

Answer

Elderly patients have more flexible cervical spines that are prone to hyperextension

An 82-year-old patient on warfarin falls from standing height and hits her head on a countertop.She feels fine and has no external signs of injury.Why should this patient still be transported to a trauma center?

An 82-year-old patient on warfarin falls from standing height and hits her head on a countertop.
She feels fine and has no external signs of injury.
Why should this patient still be transported to a trauma center?