1. Which of the following statements are FALSE regarding the older persons airway in trauma?

• A) Generally decreased cervical spine mobility due to kyphosis, arthritis and other changes of aging make positioning for intubation difficult.
• B) Dentures should be removed for bag-valve mask ventilation and left in place for intubation.
• C) Friable mucous membranes can lead to hemorrhage during intubation or insertion of nasal trumpets, placing the airway at risk
• D) Temporomandibular joint arthritis may limit access to the oral cavity, prompting the use of a smaller layngoscopic blade for intubation.

2. A 78 year old male was brought into your department found down after an unwitnessed fall. He has a GCS of 5 (not opening his eyes, non-verbal, with decorticate posturing to pain). You decide to intubate him to protect his airway for transport to the CT scanner, and you decide that to provide your best first chance at successful intubation you will perform Rapid Sequence Intubation. How will you change your drugs/doses in this scenario? Select all that apply

• A) No change. RSI drugs and doses are the same in all adults
• B) No change for paralytics.
• C) No change for sedatives.
• D) Decreased dose for paralytics.
• E) Decreased dose for sedatives.
• F) Consider using Rocuronium instead of Succinylcholine due to concern over rhabdomyolysis and hyperkalemia in the older patient who was found down.

3. An 82 year old woman presents with shoulder pain after a fall in her home. It is her fifth fall this month. As well as assessment for injuries, what interventions are reasonable in the ED? Choose all that apply.

• A) Review of medications.
• B) Assessment of gait and balance and use of walking assists – cane, walker – to ensure safety for discharge.
• C) Referral to a Falls Clinic.
• D) Arranging for an in-home assessment by a community care provider (OT, PT, geriatric nurse).
• E) All of the above.

4. A 75 year old woman presents to the ED after a fall 30 minutes ago complaining of neck pain and bilateral upper extremity parasthesias. She slipped forward on a wet floor falling and striking her head on the ground. On physical examination, you note subjective parasthesias in both upper extremities but no motor deficit. Cervical spine radiographs and cervical spine CT are both unremarkable for evidence of acute injury. What is the next most appropriate step in the care of this patient?

• A) Discharge home with semi-rigid cervical collar (Philadelphia collar) and outpatient follow-up in spine surgery clinic.
• B) Maintain cervical spine precautions, consult spine surgery service, and obtain MRI of the cervical spine.
• C) Obtain head CT and if negative, discharge home with semi-rigid cervical collar, and outpatient follow-up in the spine surgery clinic.
• D) Obtain head CT and if negative, remove cervical collar, and discharge home with outpatient follow-up in neurology clinic

5. A 75-year-old man presents to the emergency department 2 hours after a fall on an icy sidewalk. He is complaining of left hip and left knee pain, and notes difficulty bearing weight since the injury. On physical examination, there is moderate tenderness to palpation over the left hip. You note no deformity and no neurovascular deficits. What is the next most appropriate course of action?

• A) Perform passive range of motion of the hip to further evaluate.
• B) Order x-rays of the hip and pelvis. If these are negative, discharge the patient with appropriate pain control and Orthopaedic follow-up.
• C) Order x-rays of the hip and pelvis. If these are negative, assess passive range of motion and weight-bearing status. If the patient has severe pain to passive range of motion testing, or is unable to bear weight, ordering advanced imaging is indicated (MRI or CT).