Prehospital Trauma Life Support

Lesson

12

Trauma in Children and the Elderly

Developed by the

National Association of Emergency Medical Technicians

In cooperation with

The Committee on Trauma, American College of Surgeons

This slide presentation is intended for use only in approved PHTLS courses.

12-1B

Lesson 12 Objectives

Identify injury patterns unique to geriatric and pediatric patients. Identify anatomical differences in pediatric patients, and changes in geriatric patients. Discuss the importance of history in pediatric, and particularly geriatric patients. Discuss management techniques for pediatric and geriatric patients.
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Life Span Development

Our bodies and body systems grow and develop throughout our lifetime. In the young, the systems develop and mature. In the elderly, body systems begin to show the effects of aging.
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Concerns in Common
The anatomical differences in the pediatric airway and respiratory complications in geriatric patients.

Poor compensation and overall response to shock in both the old and young.

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Trauma in Children & the Elderly

Trauma in Children

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Scenario
You respond to a call for an injured child. You arrive and find a 5-year-old boy on the ground next to his bicycle. What are your
concerns for this patient, and where would you begin?

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Assessment
What is the mechanism? What injuries do you expect? ABCs.

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Findings
A BSnoring respirations. Rapid, shallow respirations.

C-

Weak, rapid pulse. No obvious bleeding.

D - Responds to painful stimulus.

E-

No obvious external trauma.

Note: It is 500 F and damp. Does this affect your assessment or treatment?
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Pediatric Trauma
Injury is the most frequent cause of death.

Approximately 20 - 40% may be preventable. Blunt mechanisms are more common, but instances of penetrating trauma have increased to nearly 15% of injuries.

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Mechanisms in Children

Falls: 39% Vehicular: 38%

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Kinematics in Children
Smaller body absorbs energy in more concentrated area. Softer skeleton.

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Airway & Breathing in Children

Smaller airways.

Larger head and tongue.

Potential for immature respiratory muscles, allowing for respiratory fatigue.

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Circulation in Children
Difficult to determine early signs of shock.

Compensate poorly.
Can deteriorate quickly.

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Disability in Children
May be difficult to fully assess level of consciousness. Patients activity level and response to environment may be the best indicators.

Be patient and reassuring.

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Hypothermia in Children
Larger surface area relative to overall body weight and size. Rapid loss of heat.

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Trauma in Children & the Elderly

Trauma in the Elderly

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Geriatric Trauma
Growing part of the population.

Falls are leading cause of trauma deaths; MVCs are second.

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Scenario
You are on scene with a 70-year-old

woman who slipped and fell on an

icy stairway at a local church.

What do you need to know? What do you do?

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Findings
A - Open. B - Rapid with slight wheeze.

C - 78 & regular. No obvious bleeding.

D - Lethargic & unable to move legs due to pain. ENo obvious external trauma.

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Airway & Breathing in the Elderly

Respiratory function declines.

Chest wall less flexible.

Alveoli become smaller.

Less able to clear foreign matter from lungs; limits absorption of oxygen. Lessened elasticity of lung causes decreased ability to exhale, resulting in CO2 retention.
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Circulation in the Elderly

Decreased elasticity, thickening and narrowing of blood vessels limit ability to adapt to changes in blood flow. This causes poor compensation in response to shock.

Condition can deteriorate quickly.

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Disability in the Elderly

Effects of age may present problems in assessing level of consciousness. Alzheimers disease.

Organic Brain Syndrome.

Sensory changes - vision, hearing, etc.
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Pitfalls with the Elderly

The possibility of pre-existing disease increases with age. Medications are a major concern.

Age and general physical condition greatly influence response to injury. When immobilizing, additional padding will be required.
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Managing Pediatrics & Geriatrics

Treat these patients with the same priority considerations: A, B, C, D, E... When making assessments, consider the patients age as a complicating factor. Potential for rapid deterioration mandates frequent re-assessment.
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Children & Elderly Summary

Identify the potential for age-specific complications, while keeping in mind that treatment priorities do not change. Follow patient assessment with continual re-assessment.

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