Chest and pelvic x-rays may be performed as part of the early assessment of a major trauma patient, where available and the patient condition allows. Use of plain films should be liberal as long bones easily fracture and older patients do not always have the same sensation of pain relative to the injury.
Where an older patient has suffered a low impact fall with head strike a lower threshold for CT scanning of brain and cervical spine should be adopted. Any patient who is on oral anticoagulation is at high risk of developing a significant intracranial haemorrhage from even minor head injury mechanisms.
In multi-system trauma, consideration should be given to whole body CT scanning, especially where there is a distracting injury. If likely transfer to a MTS, decisions regarding timing of CT scanning should be discussed with ARV so as to avoid it being repeated. Careful consideration of the risks versus benefits may need to occur prior to contrast-enhanced radiological investigations.
Patients who are unable to comply with immobilisation for assessment and imaging should be reviewed early by a senior clinician who will consider the following:
eFAST should be performed in all elderly patients with trauma from moderate to severe mechanisms, especially in "unstable" patients. eFAST does readily detect intraperitoneal/pleura bleeding and should be performed as part of the primary exam.
An electrocardiogram should be completed on all older trauma patients to identify any pre-existing abnormalities or whether the trauma was related to a cardiac event. Hypotension in the context of trauma may exacerbate the potential for cardiac / cerebral ischaemia - chest pain may in fact be an anterior infarct as opposed to related to the insult of injury.
Due to a decreased respiratory reserve, it is vital to optimise oxygenation in this cohort of patients. Older patients are more prone to complications of hospitalisation such as hospital acquired pneumonia, so methods should be implemented early on in the course of treatment to improve oxygenation and ventilation. The goal of treatment should focus on maintaining adequate oxygenation levels while considering baseline function. Encouraging deep breathing and coughing to avoid regions of atelectasis and adequate pain control.
Avoidance of hypovolaemia in trauma is a cornerstone of management. Close monitoring and caution should be taken with the elderly patients with a history of CCF on diuretics.