The management of trauma is one of the core competencies of the Emergency Physician. Trauma in the older patient has all of the complexity of trauma management in the younger patient – plus some extras! Penetrating trauma is rare in older patients. But blunt trauma is a major and frequent reason for older patients to present to the ED.
Older people who have fallen need evaluation in several modalities. A thorough ED assessment of a patient who has fallen – taking into account the changes of normal aging, medication, medical illness, as well as home environment — can have a profound effect on that person’s well-being and future function.
This module will explore the ways in which normal changes of aging affect standard trauma resuscitation, and make suggestions for the next time you have a “major trauma.” We will also explore an approach to management of the routine patient who has fallen, and what constitutes an adequate ED work-up of the first-time or frequent faller.
At the end of this module you should be able to:
- Define special trauma management issues in the older patient regarding patterns of injuries and assessment of shock – how ATLS may be different over 65;
- Describe an approach to a patient who has fallen, identifying potential causes of falls (identified by history, physical examination and functional assessment) as well as management of injuries, coordination of a discharge plan, and prevention of future falls.
- Understand the importance of an interdisciplinary team in assessing older patients with falls.
- Communicate the key components of a safe discharge plan for older patients who have fallen (e.g., accurate medication list, plan for follow-up), including considering the potential sites for discharge.