ITLS - International Trauma Life Support Geriatric Trauma Considerations Questions and Answers 1 — Questions and Answers
Question 1: An 82-year-old female falls and complains of hip pain. Her vital signs are BP 110/70 mmHg, pulse 68/min, and respirations 20/min. Her skin is cool and pale. Her family states she takes metoprolol for hypertension. Which finding is most concerning given her medication history?
- The blood pressure of 110/70 mmHg
- The respiratory rate of 20/min
- The presence of hip pain
- The heart rate of 68/min (Correct answer)
Correct answer: The heart rate of 68/min
Beta-blockers, like metoprolol, blunt the body's normal tachycardic response to shock. In a geriatric patient with trauma and signs of shock (cool, pale skin), a 'normal' heart rate is an ominous sign and may mask significant internal hemorrhage.
Question 2: Which age-related physiological change is the primary reason that a seemingly minor head injury can cause a life-threatening subdural hematoma in a geriatric patient?
- Cerebral atrophy causing stretching of the bridging veins (Correct answer)
- Increased intracranial pressure due to decreased CSF absorption
- Thickening of the dura mater, making it less pliable
- Arteriosclerosis of the cerebral arteries, making them prone to rupture
Correct answer: Cerebral atrophy causing stretching of the bridging veins
As people age, their brain tissue atrophies (shrinks), which increases the space between the brain and the skull. This stretching places tension on the bridging veins that cross this space, making them highly susceptible to tearing from even minor acceleration-deceleration forces, leading to a subdural hematoma.
Question 3: You are treating an 80-year-old male who was a restrained driver in a low-speed, rear-end collision. He denies neck pain but complains of significant weakness and tingling in both of his hands, while his leg strength remains mostly intact. This pattern of neurologic deficit is most characteristic of which condition?
- Anterior Cord Syndrome
- Central Cord Syndrome (Correct answer)
- Brown-Séquard Syndrome
- Cauda Equina Syndrome
Correct answer: Central Cord Syndrome
Central Cord Syndrome is common in elderly patients with pre-existing degenerative spine disease following a hyperextension injury. It characteristically causes motor weakness that is more pronounced in the upper extremities than the lower extremities, with variable sensory loss.
Question 4: When managing a 78-year-old trauma patient, which of the following principles is most important to consider?
- A normal blood pressure reading reliably rules out the presence of shock.
- The mechanism of injury is the most reliable predictor of injury severity.
- A ground-level fall should be treated with a high index of suspicion for severe injury. (Correct answer)
- Geriatric patients require larger volumes of IV fluids to compensate for dehydration.
Correct answer: A ground-level fall should be treated with a high index of suspicion for severe injury.
Due to factors like osteoporosis, decreased physiologic reserve, and the presence of comorbidities, a seemingly minor mechanism like a ground-level fall can cause life-threatening injuries (e.g., pelvic fractures, intracranial hemorrhage) in the elderly. Therefore, providers must maintain a high index of suspicion.
Question 5: A 75-year-old patient with multiple rib fractures is at a significantly higher risk for developing pneumonia compared to a younger patient primarily because of:
- A pre-existing higher likelihood of having a smoking history.
- An increased probability that the fractured ribs will puncture the lung.
- Decreased chest wall compliance and an ineffective cough leading to atelectasis. (Correct answer)
- A blunted inflammatory response that cannot fight infection.
Correct answer: Decreased chest wall compliance and an ineffective cough leading to atelectasis.
Geriatric patients have reduced pulmonary reserve and weaker respiratory muscles. Pain from rib fractures causes shallow breathing (splinting) and suppresses the cough reflex. This combination impairs the clearing of secretions, leading to atelectasis (alveolar collapse), which provides an ideal environment for the development of pneumonia.
Question 6: You are treating a confused 88-year-old male with a forehead hematoma after a fall. He is taking warfarin, an anticoagulant. His BP is 100/60 mmHg and his pulse is 110/min. What is the single most critical management priority for this patient in the prehospital setting?
- Administering a 2-liter fluid bolus to treat hypotension.
- Applying a cervical collar and assuming his confusion is his baseline.
- Obtaining a detailed history of his dementia from family members.
- Prioritizing rapid transport to a trauma center capable of managing intracranial hemorrhage. (Correct answer)
Correct answer: Prioritizing rapid transport to a trauma center capable of managing intracranial hemorrhage.
The combination of a head injury (indicated by hematoma and confusion) and the use of an anticoagulant like warfarin creates an extremely high risk for a severe or expanding intracranial hemorrhage. The definitive treatment, which may include reversal of anticoagulation and neurosurgery, is time-sensitive, making rapid transport to an appropriate facility the highest priority.
ITLS - International Trauma Life Support Geriatric Trauma Considerations Questions and Answers 1
An 82-year-old female falls and complains of hip pain.
Her vital signs are BP 110/70 mmHg, pulse 68/min, and respirations 20/min.
Her skin is cool and pale.
Her family states she takes metoprolol for hypertension.
Which finding is most concerning given her medication history?