ATLS | Geri Trauma

Demographics and Physiology The global population is aging rapidly, with older adults comprising the fastest-growing segment in the United States. As mobility and active lifestyles increase among the elderly, injury has become the fifth leading cause of death in this demographic. Geriatric trauma presents unique challenges; data shows that older adults face higher mortality rates than younger patients with similar injury severity,. This vulnerability is largely due to "decreased physiologic reserve," characterized by declining cellular function and impaired homeostatic mechanisms that reduce the body's ability to tolerate the stress of injury,. Furthermore, preexisting conditions (PECs) such as cirrhosis, coagulopathy, COPD, ischemic heart disease, and diabetes significantly increase the likelihood of mortality.Mechanisms of Injury Falls are the most common cause of fatal injury and traumatic brain injury (TBI) in the elderly. Risk factors include physical impairments, medication use, dementia, and environmental hazards like loose rugs,. Motor vehicle crashes are another significant cause, often occurring during the day due to issues like slower reaction times, vision loss, and cognitive impairment,. Burns are particularly devastating in older adults; due to a paucity of hair follicles and aging organ systems, even small burns carry high mortality rates,. Penetrating injuries are less common but often fatal, with many gunshot wounds related to suicide.Clinical Assessment and Management Trauma care follows the standard ABCDE survey but requires age-specific modifications.• Airway: Management is complicated by loss of protective reflexes, dentures, and arthritic changes that make intubation difficult,. Drug dosages for rapid sequence intubation should be reduced to avoid cardiovascular depression.• Breathing: Aging lungs have decreased compliance and a suppressed heart rate response to hypoxia, making respiratory failure a high risk.• Circulation: Traditional vital signs can be misleading. Because older patients often have preexisting hypertension, a systolic blood pressure of 110 mm Hg should be utilized as the threshold for hypotension. Fixed heart rates or beta-blocker use can mask shock, necessitating the use of markers like lactate and base deficit to assess tissue hypoperfusion,.• Disability: Cerebral atrophy and the high prevalence of anticoagulant use place the elderly at high risk for intracranial hemorrhage, even with minor trauma.• Exposure: Older patients are highly susceptible to hypothermia and pressure injuries caused by immobilization on spine boards,.Specific Injuries Rib fractures carry a high risk of pneumonia (up to 30%), making pain control and pulmonary hygiene critical, though narcotics must be used with extreme caution to avoid delirium,. TBIs are associated with high mortality, often due to the patient's inability to recover, requiring aggressive reversal of anticoagulants,. Pelvic fractures, usually resulting from ground-level falls in osteoporotic patients, result in high transfusion needs and frequently lead to a permanent loss of independence,.Special Considerations Clinicians must be vigilant for elder maltreatment, including physical abuse and neglect, especially when physical findings conflict with the patient's history,. Given that trauma accounts for nearly 30% of deaths in patients over 65, establishing goals of care and consulting palliative services early is essential to patient-centered treatment