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

Elderly patients on anticoagulants have a dramatically increased risk of intracranial hemorrhage from even minor head trauma, and clinical deterioration may be delayed due to brain atrophy allowing more blood accumulation before symptoms appear.

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

Many elderly patients take beta-blockers or calcium channel blockers that pharmacologically prevent the heart from mounting a compensatory tachycardic response to hemorrhage, masking a key sign of shock.

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

Osteoporosis weakens bones, and calcification of costal cartilage reduces chest wall flexibility, making rib fractures common from minor mechanisms. Reduced pulmonary reserve means rib fractures more often lead to pneumonia, respiratory failure, and death.

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

In elderly patients, falls are often symptoms of underlying medical events. ITLS providers must determine if a medical cause precipitated the fall, as this affects both immediate treatment and hospital evaluation.

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

Elderly patients have decreased total body water (from ~60% to ~50% of body weight), resulting in lower baseline blood volume. This means a smaller absolute blood loss represents a larger percentage of their volume, causing earlier hemodynamic deterioration.

ITLS - International Trauma Life Support Practice Test

ITLS - International Trauma Life Support Practice Test

ITLS Geriatric Trauma Considerations 2