Profound, life-threatening hypovolaemia may occur in the setting of normal blood pressure. Physiological reserve is minimal, and haemodynamic decompensation can occur quickly“I can go from normotensive to hypotensive in a heartbeat.”
The therapeutic window for cardiac preload is narrow, and inadequate preload monitoring may lead to errors in volume resuscitation“I respond poorly to too much or too little fluid.”
Cortical atrophy, common in the elderly, may act to delay the clinical manifestations of serious intracranial haemorrhage. This haemorrhage may be clinically occultMy subdural haematoma hasn’t expanded enough yet to really affect my level of consciousness.”
Stroke, myocardial infarction, and seizures may result from falls or motor vehicle crashes and delayed diagnosis of principle underlying problem“Trauma is not really my major problem.”
Ventilatory failure & respiratory arrest may occur suddenly in conjunction with chest or abdominal injuries despite a benign outward clinical appearance“I only look like I have adequate ventilatory reserve.”
Myocardial (demand) ischaemia may result from severe or prolonged pain or from transfusion threshold that have not been appropriately liberalized in the setting of coronary artery disease“I get demand ischaemia if I have too much pain or my haematocrit drops.”
Even minor perturbations in perfusion, oxygenation, or vasoconstriction may lead to major cardiac complications“I can’t stand even a little shock or hypoxia… and neither can my myocardium.”
Decrease in connective tissue integrity with less “tamponade effect” for haemorrhage into soft tissues. Blood loss into soft tissue spaces, including subcutaneous loss, may be excessive and is often overlooked“My connective tissue just ain’t what it used to be..”
Clinical manifestations of serious abdominal injury in elderly patients are often minimal. Reliance on the abdominal examination often leads to missed abdominal injuries“The sensitivity of my abdominal examination is better that flipping a coin… but not much.”
Blunt aortic injury may occur in the elderly in the absence of conventional signs or symptoms. A low threshold for CT imaging should exist“My bones are brittle…my hip bone, my shin bone, and my aortic bone!”
Failure to adjust medication dosage, particularly sedative-hypnotics and analgesics, may result in serious complications“A little medication goes a long way with me…”
Chronic malnutrition is common and often undiagnosed“I just haven't been eating so well lately”
Understanding and undermanaging comorbidities (eg, COPD, CAD, smoking, ETOH consumption) may result in preventable morbidity/mortality“Major trauma? Heck, I wouldn’t even tolerate a brisk haircut….”
Elder abuse is common and often unreported and undiagnosed“My injuries weren’t accidental.”
Reference
Mackersie, R. (2010). Pitfalls in the Evaluation and Resuscitation of the Trauma Patient. Emergency Medical Clinics North America, 28 1-27. PMID: 19945596
About Kane Guthrie
