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

Many elderly patients take beta-blockers, which pharmacologically prevent the compensatory tachycardia expected with hemorrhagic shock. Additionally, the aging heart has reduced chronotropic reserve. A geriatric trauma patient in Class II or III shock may present with a 'normal' heart rate of 70–80 bpm, masking the severity of hemorrhage.

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

The same low-energy mechanism causes disproportionately severe injury in elderly patients due to osteoporosis (fractures from minimal force), anticoagulant use (catastrophic bleeding from minor head trauma), and reduced physiologic reserve (inability to compensate). Falls from standing height are a leading cause of fatal injury in patients over 75.

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

A geriatric patient with a chronic baseline of 170/90 mmHg who presents at 122/80 has experienced a nearly 50-point systolic drop — significant hemorrhagic compromise despite a 'normal-looking' reading. PHTLS emphasizes always determining the patient's baseline BP, ideally from the patient, family, or medical history.

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

Proximal femur (hip) fractures are the most common serious musculoskeletal injury from ground-level falls in elderly patients. Osteoporotic bone at the femoral neck fails under forces that would not fracture younger bone. Hip fractures in elderly patients carry a 1-year mortality of 20–30% and are a major cause of morbidity.

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

Altered mental status in an elderly trauma patient may reflect their baseline (pre-existing dementia) or a new change (TBI, hypoperfusion). PHTLS emphasizes establishing the baseline from family, caregivers, or medical records. A subtle decline from normal in a sharp elder may be more clinically significant than the same presentation in someone with baseline dementia.

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS - Prehospital Trauma Life Support Practice Test

PHTLS Geriatric Trauma