PHTLS Geriatric Trauma

Question 1

Why is tachycardia an unreliable indicator of hemorrhagic shock in many elderly trauma patients?

Accepted Answer

Beta-blocker use and reduced chronotropic reserve blunt the heart rate response to hemorrhage

Answer

Elderly patients have a higher baseline heart rate that masks changes

Answer

Elderly patients compensate through increased stroke volume instead

Answer

Aging accelerates baroreceptor sensitivity, causing bradycardia instead

Question 2

An 80-year-old woman falls from standing height. Compared to a 30-year-old with the identical fall mechanism, why does PHTLS recommend a higher index of suspicion for serious injury?

Accepted Answer

Osteoporosis, anticoagulant use, and reduced physiologic reserve amplify injury severity from the same mechanism

Answer

Elderly patients have a lower center of gravity, creating more kinetic energy

Answer

Risk is identical because the mechanism and kinetic energy are the same

Answer

Elderly patients have thicker cortical bone that causes more energy transfer

Question 3

An elderly trauma patient has a blood pressure of 122/80 mmHg. Why might PHTLS consider this finding concerning even though it falls within a 'normal' range?

Accepted Answer

Many elderly patients have chronic hypertension, so 122/80 may represent relative hypotension from their normal baseline

Answer

Diastolic pressure above 80 is always abnormal in elderly patients

Answer

Elderly patients' systolic pressure should exceed 160, making 122 dangerously low

Answer

The pulse pressure is too narrow, indicating tamponade

Question 4

Which musculoskeletal injury is MOST commonly caused by ground-level falls in elderly patients due to osteoporotic changes?

Accepted Answer

Proximal femur (hip) fractures

Answer

Lumbar vertebral compression fractures

Answer

Distal radius (Colles') fractures

Answer

Calcaneal fractures

Question 5

When assessing a 78-year-old trauma patient who appears confused, what is the MOST important initial step before attributing the confusion to head injury?

Accepted Answer

Determine the patient's baseline mental status from available history or family

Answer

Assume intoxication and proceed to physical examination

Answer

Obtain a blood glucose immediately to rule out hypoglycemia before any other assessment

Answer

Age-related dementia makes further neurological assessment unreliable

Question 6

Which drug class is MOST critical to identify during medication history in a geriatric trauma patient because of its direct effect on hemorrhagic injury severity?

Accepted Answer

Anticoagulants and antiplatelet agents (e.g., warfarin, clopidogrel)

Answer

Statins (e.g., atorvastatin)

Answer

Proton pump inhibitors (e.g., omeprazole)

Answer

ACE inhibitors (e.g., lisinopril)