Actual Questions and Answers

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• True or false? Although the mechanism of injury may be similar to those for the

younger population, data shows increased mortality with similar severity of injury in older adults.

Answer: True

• In the elderly population, what is decreased physiological reserve?

Answer: aging is characterized by impaired adaptive and homeostatic mechanisms

that caused an increased susceptibility to the stress of injury. Insults tolerated by the younger population can lead to devastating results in elderly patients.

3. Pre-existing conditions that affect morbidity and mortality include:

Answer: cirrhosis, coagulopathy, COPD, ischemic heart disease, DM

• What is the most common mechanism of injury in the elderly?

Answer: Fall. Nonfatal falls are common in women and fractures are common in

women who fall. Falls are the most common cause of TBI.

• In the elderly population, what are risk factors for falls?

Answer: advanced age, physical impairment, history of previous fall, medication

use, dementia, unsteady gait, and visual, cognitive impairment

• Most of elderly traffic fatalities occur in the daytime and on weekends and

typically involve other vehicles. Why?Answer: Older people drive on more familiar roads and at lower speeds and tend to drive during the day. Older people have slower reaction time, a larger blind spot, limited cervical mobility, decreased hearing, and cognitive impairment.

• True or False? Mortality associated with small to moderate sized burns in older

adults remains high

Answer: True

• Spilled hot liquids on the leg, which in younger patients may re-epithelialize due to

an adequate number of hair follicles, will result in a full thickness burn in older patients.

Answer: this is true

• Airway-patients may have dentures that may loosen or obstruct the airway. If

dentures are not obstructing the airway, leave them in place for what? 1 / 3

Answer: bag mask ventilation, as it improves mask fitting.

• When preforming rapid sequence intubation, the dose of benzos, barbiturates,

and other sedatives should be reduced to what percentage to minimize the risk of cardiovascular depression?

Answer: 20-40%

• Functional changes in cardiac system include declining function, de- creased

sensitivity to catecholamines, atherosclerosis of coronary vessels, increased afterload, fixed heart rate (beta blockers) Answer: this results in lack of classic response to hypovolemia, risk for cardiac ischemia, elevated BP at baseline, and increased risk of dysrythmias.

• Functional changes in pulmonary system include decreased elastic recoil,

reduced residual capacity, decreased gas exchange and decreased cough Reflex Answer: thus they are at increased risk for respiratory failure, increased risk for pneumonia, and poor tolerance to rib fractures

• Functional changes in renal system include loss of renal mass, decreased GFR,

and decreased sensitivity to ADH and aldosterone

Answer: resulting in drug dosing for renal insufficiency, decreased ability to

concentrate urine, increased risk for AKI and urine flow may be normal with hypovolemia

• Functional changes to MSK include loss of lean body mass, osteoporosis,

changes in joints and cartilage, c spine degenerative changes and loss of skin elastin and subcutaneous fat Answer: resulting in increased risk for fractures, decreased mobility, difficulty for oral intubation, risk of skin injury, increased risk for hypothermia, challenges in rehabilitation

• Functional changes in Endocrine system include decreased production and

response to thyroxin and decreased dehydroepiandrosterone (DHEA)

Answer: resulting in occult hypothyroidism, relative hypercortisone states and

increased risk of infection

• True or false: Arthritis can complicate the airway and cervical spine. Pa- tients

can have multilevel degenerative changes affecting disk spaces and posterior elements associated with severe central canal stenosis, cord com- pression, and myelomalacia

Answer: true 2 / 3

• In elderly population, due to their changes in pulmonary system, placing a gauze

between gums and cheek to achieve seal when using bag valve mask ventilation is okay. In addition, because aging causes a suppressed heart rate response to hypoxia respiratory failure may present insidiously in older adults.

• Age related changes in the cardiovascular system place the elderly trauma patient

at significant risk for being inaccurately categorized as hemodynamically stable.Answer: Elderly patients have a fixed heart rate and fixed cardiac output, thus, their response to hypovolemia will involve increasing their systemic vascular resistance.Furthermore, since older patients have HTN, an acceptable BP may truly reflect a hypotensive state. A systolic BP of 110 is to be utilized as the threshold for identifying hypotension in patients 65 and older.

• Do no equate blood pressure with shock in older patients

Answer: BP in older patients may look normal due to the medications they are on.Use lactate and base deficit to evaluate for evidence of shock

• what 2 factors place elderly patients at risk for intracranial hemorrhage?-

Answer: aging causes dura to become more adherent to the skull increasing risk of injury and older patients are on anticoagulant and antiplatelet medications.

• Loss of subcutaneous fat, nutritional deficiencies, chronic medical conditions

place elderly patients as risk for hypothermia and complications for immobility.Answer: Rapid evaluation and when possible early liberation from spine boards and cervical collars will minimize complications.

22. True or False: Fall prevention is the mainstay of reducing the mortality

associated with pelvic fractures.

Answer: true

• poor hygiene, dehydration, oral injury, contusions affecting the inner arms, inner

thighs, palms, soles, scalp, ear, nasal bridge and temple injury from being struck while wearing glasses, contact burns and scalds. These are all signs of.......?

Answer: Elder maltreatment. The presence of physical findings of maltreatment

should prompt a detailed history. if history conflicts with findings, immediately report findings to authorities.

• True of false: early activation of the trauma team may be required for elderly

patients who do not meet traditional criteria for activation Answer: True. A simple injury such as an open tibia fracture in a frail elderly patient may become life threatening.

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