1. Rachel Quintela Posted Date May 26, 2022, 7:06 AM Unread
Rachel QuintelaPosted DateMay 26, 2022, 7:06 AMUnreadOlder adults who experience
traumatic injuries have cardiovascular systems and baroreceptors that produce a tempered
response to the release of catecholemines needed to increase heart rate and cardiac output
when physiologically stressed (Denke, 2020). Many geriatric trauma patients have
comorbidities such as CHF, COPD, ESRD, and DM, to name a few, and common treatments
such as beta blockers, cardiac glycosides, and pacemakers further limit the body’s reply to
injuries. Therefore, vital signs may not be the best indicator of shock or volume status in
geriatric trauma patients. Additionally, reduced urine output may occur from preexisting
renal insufficiency (rather than poor tissue perfusion from hypovolemia), altered mental
status may be caused by dementia, and poor capillary refill time may be the result of
peripheral vascular disease (Plummer, 2020). Lactate levels and base deficit can be used as
measurements of adequate tissue perfusion and should assist in determining if fluid
resuscitation is sufficient among elderly trauma patients (Plummer, 2020). Smaller fluid
boluses, with frequent reassessment for signs of fluid overload (crackles in lungs or
increased work of breathing) after each bolus, early administration of PRBCs to maintain
tissue perfusion, and prompt reversal of anticoagulants are some interventions conducive
to successful, safe fluid resuscication and correction of coagulopathies in geriatric trauma
patients (Denke, 2020). On the other hand, inadequate fluid resuscitation may prolong
periods of hypovolemia and hypoperfusion, thus increasing morbidity and mortality
(Plummer, 2020). In general, isotonic crystalloids such as NS are administered in traumatic
brain injured patients (and dextrose-containing fluids are avoided) with the goal of
achieving normal or slightly higher than normal sodium and osmolality levels to prevent
volume from moving out of the intravascular space and exacerbating cerebral edema. The
most recent data supports the administration of only half to one liter of crystalloid fluid in
hypotensive trauma patients, even those who are actively bleeding. Acidosis, coagulopathy,
and hypothermia (known as the “trauma triad of death”) exacerbates hemorrhage and can
lead to trauma-induced coagulopathy (TIC). The use of NS in trauma resuscitation has been
shown to exacerbate the first two aspects of this phenomenon (metabolic acidosis and
coagulopathy), as well as effect blood concentration (by causing hemodilution) and induce
blood vessel dilation, all of which have the potential to worsen patient outcomes (Fisher &
Carius, 2018). A damage control resuscitation strategy combats this and is comprised of
permissive hypotension, hemostatic resuscitation, and damage control surgery (DCS).
Plasma, platelets, and RBCs in a ratio of 1:1:1 as well as the use of antifibrinolytic agents

2. such as tranexamic acid in addition to limiting the use of crystalloids are mainstays of this
approach (Fisher & Carius, 2018). Massive transfusion protocol (MTP) should be activated
in patients requiring continued resuscitation and started as early as possible to avoid rapid
administration of crystalloids and post-injury complications such as organ failure and
abdominal compartment syndrome (Fisher & Carius, 2018). ReferencesDenke, N. J. (2020).
Special populations: The geriatric trauma patient. In Emergency Nurses Association,
(Ed.)., Trauma nursing core course (8th ed., pp. 261-277). Jones and Bartlett
Learning. Fisher, A. D. & Carius, B. M. (2018). Three reasons not to use normal saline or
crystalloids in trauma. Journal of Emergency Medical Services. March 14,
2018. https://www.jems.com/patient-care/three-reasons-not-to-use-saline-or-
crystalloids-in-trauma/.Plummer, E. (2020). Trauma in the elderly. In K. A. McQuillan and
M. B. F. Makic’s (Eds.)., Trauma nursing: From rehabilitation to resuscitation (5th ed., pp.
704-718). Elsevier.