Elderly Trauma Patients (also see Chapter 62 )

Equivalent traumatic injuries will have a markedly more serious outcome in elderly than in younger victims.^[213] Decreased cardiopulmonary reserves lead to a higher incidence of postoperative mechanical ventilation in older trauma patients and a much greater risk for MOSF after hemorrhagic shock. Greater care must be taken with intraoperative positioning to avoid pressure injuries. A higher hematocrit with tighter control of administered fluid is generally recommended to maintain maximized tissue oxygen delivery. Post-traumatic myocardial dysfunction is a significant risk, particularly if the heart rate is elevated secondary to blood loss, pain, or anxiety. Complex operations or large amounts of blood loss should encourage the use of TEE or pulmonary artery catheterization to guide fluid and inotropic therapy.^[214] Although prophylactic β-antagonist therapy has been recommended for elderly patients undergoing major elective surgery,^[215] its role in the early management of elderly trauma patients is unknown. Elderly patients will have diminished requirements for postoperative analgesia and may respond to sedative medications with inappropriate agitation. Prophylaxis against deep venous thrombosis is particularly important in patients who cannot be immediately mobilized in the postoperative period, as is aggressive pulmonary physiotherapy.