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Geriatric Trauma: Selected Medications & Trauma Resuscitation

Geriatric Trauma: Selected Medications & Trauma Resuscitation. Purpose.

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Geriatric Trauma: Selected Medications & Trauma Resuscitation

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  1. Geriatric Trauma:Selected Medications & Trauma Resuscitation

  2. Purpose This presentation will discuss four categories of medications commonly prescribed for geriatric patients, the effects of these drugs in trauma resuscitation and modifications in the resuscitation process that may be essential to improve patient outcomes. Geriatric Trauma

  3. Objectives • List the four categories of medications that may have an effect on trauma resuscitation in the elderly patient. • Select one medication from each category and describe its deleterious effects on elderly patient trauma resuscitation. Geriatric Trauma

  4. POLYPHARMACY 30%of all U.S.A. Rx are for geriatric pts. 12-30%geriatric hospital admissionsinvolve drug reactions/interactions “The average American over age 65 takes 8 Rxs daily + OTC & home remedies.”(AARP) Geriatric Trauma

  5. Aging Cardiovascular System Blood vessels stiffen Heart rate decreases Heart muscle stiffens Heart enlarges slightly Baroreceptors less sensitive Geriatric Trauma

  6. Cardiovascular Medications & Trauma Diuretics Anti-arrhythmic drugs Anti-coagulation drugs Anti-hypertensive drugs Geriatric Trauma

  7. ANTICOAGULATION MEDICATIONS Traumatic Brain Injury Plavix Heparin Lovenox Pradaxa Coumadin Geriatric Trauma

  8. COUMADIN 4thmost commonly prescribedcardiovascular medication 11thmost commonly prescribedmedication in the U.S.A. Anti-coagulated elderly patient with TBI has much higher mortality rate Geriatric Trauma

  9. Coumadin & TBI One study showed an anti-coagulated patient presenting with a GCS < 15 is 42 times more likely to have an abnormal CT. Anti-coagulation patients at risk for TBI must be identified promptly. Geriatric Trauma

  10. Coumadin & TBI Mortality in anti-coagulated patients with a TBI is diminished ONLY when rapid reversal of the medication is achieved. Geriatric Trauma

  11. COUMADIN & TBI *Reverse Coumadin anticoagulation ASAP *Reversal achieved through one or more: Fresh Frozen Plasma (FFP) Vitamin K Specific Clotting Factors • Prothrombin Complex Concentrate (PCC) • NovoSeven (recombinant activated factor VIIa) Geriatric Trauma

  12. COUMADIN & TBI • May modify Coumadin response : • Antibiotics • Amiodorone • Statins • Anticonvulsants • Herbals (St. Johns Wart) • Alcohol • Vitamin K deficiency in elderly Geriatric Trauma

  13. Pradaxa • Indicators for use: Atrial fibrillation and prevention of VTE (Venous Thromboembolism) • Reversal Agent: Activated Prothrombin Complex Concentration (FEIBA) or Recombinant factor VIIa. Both are in experimental studies only.

  14. THE AGING LIVER • Diminished • Blood flow • Clearance of medications • Metabolism of medications • Capacity to regenerate liver cells Geriatric Trauma

  15. AGING KIDNEYS • Diminished: Blood flow Diluting ability Bladder capacity Medication clearance Glomerular filtration rate • Less hormone response to volume loss • Serum creatinine does not change • Drug dosing Geriatric Trauma

  16. Medications & Falls • 80% of falls Medication related • antidepressants • psychotropic agents • anti-epileptic agents • glaucoma medications • anti-hypertensive agents Geriatric Trauma

  17. PAIN MANAGEMENT • Blunted pain response • Exaggerated Response to: • Sedatives • Analgesics • Start low, go slow Geriatric Trauma

  18. GERIATRIC TRIAGE • Consider: • poly-pharmacy • physiology of aging • age related anatomic changes • key medications related to trauma • vital sign variables related to medications • Exaggerated response to minor injuries Geriatric Trauma

  19. REFERENCES Colwell, Chris M.D., P.M., T.B. Geriatric Trauma. The elderly trauma patient can pose unique challenges for providers. Accessed from www.emsresponder.com May 2010. Plummer, Ellen CCRN. Geriatric Trauma: The Next Generation of Trauma Patients. Accessed from www.AACN.org May 2010. Stress, Health and Aging. Normal Change of Aging. Accessed from 222.ageworks.com May 2010.

  20. REFERENCES Geriatric Trauma: What to think about before assessing, treating, & packaging the elderly. Accessed from www.jems.com May 2010. Victorino, G. M.D. & T.C. Trauma in the Elderly Patient. Accessed from www.archsurg.ama-assn.org May 2010.

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