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Trauma in elderly, pediatric and women

Trauma in elderly, pediatric and women. Chapter 10 and 11. Objectives. Identify unique characteristics of the pediatric, elderly and female patient Identify unique injury patterns Discuss applications of ATLS management principles to the unique population. Pediatric population.

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Trauma in elderly, pediatric and women

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  1. Trauma in elderly, pediatric and women Chapter 10 and 11

  2. Objectives • Identify unique characteristics of the pediatric, elderly and female patient • Identify unique injury patterns • Discuss applications of ATLS management principles to the unique population

  3. Pediatric population • Anatomic considerations • Narrow upper airway • Anterior, funnel-shaped larynx • Short trachea • Pliable soft chest wall • Softer thinner-walled abdomen • Lower-riding liver • Flexible spine • Thin skin and high ratio BSA:body mass

  4. Management issues • Management priorities are still the same! • A - Size of uncuffed ET tube • B - Compliant ribs, chest tube size • C - Fluid challenge, use of blood • D - GCS score, pediatric verbal score • E - Prevent heat loss

  5. Elderly population • Physiologic changes • Pre-existing diseases • Medications • Increasing age and decreasing organ function

  6. Unique problems • Difficult intubation: cervical arthritis, mucosal fragility • Unique breathing problems: diminished reserve, COPD, chest injuries poorly tolerated • Unique circulatory problems: fixed HR, hypertension, limited reserve, renal function, medications • Unique neuro problems: subdural hematomas, altered sensorium, spinal osteoarthritis

  7. Unique problems • Exposure: increased sensitivity to hypothermia • MSK: most frequent cause of morbidity, osteoporosis, fractures, preexisting deformities, immobility may lead to complications

  8. Trauma in women • Is she pregnant? • Ask, uterine enlargement, pregnancy test • Pregnancy changes: • Uterus intrapelvic and thick-walled in 1st trimester • Uterus extrapelvic and large volume fluid in 2nd • Uterus thin-walled and displaced organs in 3rd • Pregnancy risks: • Pelvic fractures • Abruptio placenta • Amniotic fluid embolism

  9. How do changes affect assessment? • A – Aspiration risk • B – Hyperventilation • C – Hypervolemia with anemia • D - Eclampsia

  10. How do I manage the mother? • A – same as non-pregnant • B – Same as non-pregnant • C – displace uterus/volume infusion • D – Eclampsia vs brain injury • E – same as non-pregnant

  11. How do I manage the fetus? • Resuscitate the mother • Monitor fetal heart tones • Consider fetal injury with • Vaginal bleeding • Abruptio placenta • Uterine tenderness • Uterine rupture • labor

  12. Summary • Is she pregnant? • What are the changes? • How do these changes affect injury patterns? • How do you manage both patients?

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