2017 geriatric trauma critical care

Fred A Luchette Jay A Yelon Editors Geriatric Trauma and Critical Care Second Edition https://t.me/Anesthesia_Books 123 Geriatric Trauma and Critical Care Fred A Luchette  •  Jay A Yelon Editors Geriatric Trauma and Critical Care Second Edition Editors Fred A Luchette Department of Surgery Stritch School of Medicine Loyola University of Chicago Edward Hines, Jr Veterans Administration Medical Center Maywood, IL USA Jay A Yelon Professor of Surgery Hofstra School of Medicine Medical Director for Surgical and Perioperative Services Southside Hospital/Northwell Health Bay Shore, New York USA ISBN 978-3-319-48685-7    ISBN 978-3-319-48687-1 (eBook) DOI 10.1007/978-3-319-48687-1 Library of Congress Control Number: 2017943694 © Springer International Publishing AG 2017 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Contents 1 Changing Demographics of the American Population �������������������������������������������   1 Stephanie Gordy 2 Effect of Aging on Cardiac Function Plus Monitoring and Support���������������������   9 Martin D Avery, R Shayn Martin, and Michael C Chang 3 Pulmonary Anatomy���������������������������������������������������������������������������������������������������  17 Joseph S Hanna, Marissa DeFreese, and Vicente H Gracias 4 Renal Function in the Elderly�����������������������������������������������������������������������������������  27 Randi Smith and Lewis J Kaplan 5 The Gastrointestinal Tract�����������������������������������������������������������������������������������������  35 Young Kim and Timothy A Pritts 6 Skin, Soft Tissue, and Wound Healing in the Elderly���������������������������������������������  45 David G Greenhalgh 7 Immunologic���������������������������������������������������������������������������������������������������������������  57 Jeffrey A Claridge and Brenda M Zosa 8 Hematological Changes with Aging �������������������������������������������������������������������������  69 Peter E Fischer, Thomas G DeLoughery, Gail Gesin, and Martin A Schreiber 9 Geriatric Psychology and the Injured Elderly���������������������������������������������������������  77 Robert D Barraco and Joseph J Stirparo 10 Frailty���������������������������������������������������������������������������������������������������������������������������  89 Cynthia L Talley and Andrew C Bernard 11 Health-Care Economics and the Impact of Aging on Rising Health-Care Costs�������������������������������������������������������������������������������������������������������  99 Preston B Rich and Noran Barry 12 Operative Risk Stratification of the Geriatric Patient��������������������������������������������� 107 Jason A Luciano, Brian S Zuckerbraun, and Andrew B Peitzman 13 Appendicitis����������������������������������������������������������������������������������������������������������������� 121 Dirk C Johnson and Kimberly A Davis 14 Biliary��������������������������������������������������������������������������������������������������������������������������� 131 Marko Bukur and Ali Salim 15 Diverticulitis ��������������������������������������������������������������������������������������������������������������� 153 Chasen Croft and Frederick Moore 16 Intestinal Obstruction������������������������������������������������������������������������������������������������� 161 Andrew H Stephen, Charles A Adams Jr., and William G Cioffi v vi 17 Intestinal Hemorrhage in the Elderly����������������������������������������������������������������������� 169 Leslie Kobayashi, Todd W Costantini, and Raul Coimbra 18 Acute Abdomen����������������������������������������������������������������������������������������������������������� 181 David A Spain 19 Necrotizing Soft Tissue Infections����������������������������������������������������������������������������� 187 D Dante Yeh and George Velmahos 20 Acute Vascular Insufficiency in the Elderly������������������������������������������������������������� 201 Michael J Sise 21 Thoracic Diseases in the Elderly for Geriatric Trauma and Emergency Care ������������������������������������������������������������������������������������������������� 223 Matthew Benns and J David Richardson 22 Prehospital Care��������������������������������������������������������������������������������������������������������� 239 Eric Campion and Lance Stuke 23 Epidemiology of Injury in the Elderly ��������������������������������������������������������������������� 247 Steven R Allen, Nicole Krumrei, and Patrick M Reilly 24 Injury Prevention������������������������������������������������������������������������������������������������������� 255 Jeffrey Nicastro 25 Outcomes for Surgical Care in the Elderly�������������������������������������������������������������� 261 Michael D Grossman 26 Geriatric Neurotrauma���������������������������������������������������������������������������������������������� 273 Jack Wilberger 27 Chest Wall Injury: In Geriatric Trauma and Emergency Care����������������������������� 285 Eileen M Bulger 28 Solid Organ Injury����������������������������������������������������������������������������������������������������� 291 Cherisse Berry and Rosemary Kozar 29 Pelvic Fracture ����������������������������������������������������������������������������������������������������������� 297 Sharon Henry and Jay A Yelon 30 Extremity Injury��������������������������������������������������������������������������������������������������������� 305 Charles Cassidy 31 Penetrating Injury in the Elderly ����������������������������������������������������������������������������� 327 Elizabeth Benjamin, Kenji Inaba, and Demetrios Demetriades 32 The Elderly Burn Patient������������������������������������������������������������������������������������������� 333 Tina L Palmieri 33 Geriatric Medicine ����������������������������������������������������������������������������������������������������� 337 Tatyana Kemarskaya and Catherine M Glew 34 Critical Care Epidemiology and Outcomes/Resource Use in the Elderly������������� 355 Samantha L Tarras and Lena M Napolitano 35 Cardiovascular/Invasive Monitoring������������������������������������������������������������������������� 367 Jay Menaker and Thomas M Scalea 36 Pulmonary Critical Care and Mechanical Ventilation ������������������������������������������� 375 Ajai K Malhotra 37 Renal Replacement Therapy������������������������������������������������������������������������������������� 383 Brian K Yorkgitis and Zara R Cooper Contents Contents vii 38 Nutrition Support������������������������������������������������������������������������������������������������������� 395 Michael Pasquale and Robert D Barraco 39 Common Pharmacologic Issues��������������������������������������������������������������������������������� 405 Jason P Hecht and Wendy L Wahl 40 Nursing Consideration����������������������������������������������������������������������������������������������� 415 Alice Gervasini 41 Rehabilitation Concerns in Geriatric Trauma��������������������������������������������������������� 423 Bellal Joseph and Ahmed Hassan 42 End-of-Life Care��������������������������������������������������������������������������������������������������������� 431 Mary Condron and Karen Brasel 43 Ethics in Geriatric Trauma ��������������������������������������������������������������������������������������� 443 Christine S Cocanour and Kathleen S Romanowski Index������������������������������������������������������������������������������������������������������������������������������������� 453 Contributors Charles A Adams Jr., MD  Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA Steven R Allen, MD, FACS  Division of Trauma, Acute Care and Critical Care Surgery, Penn State Hershey Medical Center, Hershey, PA, USA Martin D Avery, MD  Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA Robert D Barraco, MD, MPH, FACS, FCCP   Chief Academic Officer, Lehigh Valley Health Network, Associate Dean for Educational Affairs, USF Morsani College of Medicine - Lehigh Valley, Allentown, PA, USA Noran Barry, MD  Department of Surgery, Division of Acute Care Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA Elizabeth Benjamin  Department of Surgery, Division of Trauma, University of Southern California Medical Center, Acute Care Surgery and Surgical Critical Care, Los Angeles, CA, USA Matthew Benns, MD  Department of Surgery, University of Louisville, Louisville, KY, USA Andrew C Bernard, MD  Division of General Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY, USA University of Kentucky, Lexington, KY, USA Cherisse Berry, MD  Shock Trauma Center, University of Maryland, Baltimore, MD, USA Karen Brasel, MD, MPH  Department of Surgery, Oregon Health and Science University, Portland, OR, USA Marko Bukur, MD, FACS  Associate Professor of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Medical Director, Surgical Intensive Care Unit Bellevue Hospital Center, New York University School of Medicine, New York, NY, USA Eileen M Bulger, MD  Chief of Trauma, Professor of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA Eric Campion, MD  Assistant Professor of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO, USA Charles Cassidy  Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA Michael C Chang, MD  Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA William G Cioffi, MD  Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA ix x Jeffrey A Claridge, MD, MS, FACS  Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA Christine S Cocanour, MD  Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA Raul Coimbra, MD, PhD, FACS  Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego Health Sciences, San Diego, CA, USA Mary Condron, MD  Department of Surgery, Oregon Health and Science University, Portland, OR, USA Zara R Cooper, MD, FACS, MSc  Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, MA, USA Todd W Costantini, MD  Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego Health Sciences, San Diego, CA, USA Chasen Croft  Clinical Surgery, Weill Cornell Medical College, Bayside, NY, USA Kimberly A Davis, MD, MBA  Section of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, CT, USA Marissa DeFreese, MD  Associate Clinical Professor, Department of Surgery, The Stamford Hospital, Columbia University Medical Center, Stamford, CT, USA Thomas G DeLoughery, MD, MACP, FAWM  Division of Hematology/Medical Oncology Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA Demetrios Demetriades  Department of Surgery, Division of Trauma, University of Southern California Medical Center, Acute Care Surgery and Surgical Critical Care, Los Angeles, CA, USA Peter E Fischer, MD, MS  Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA Alice Gervasini, PhD, RN  Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA Gail Gesin, PharmD, FCCM  Trauma and Surgical Critical Care, Pharmacy Services, Carolinas Medical Center, Charlotte, NC, USA Catherine M Glew, MD, BM, BS, CMD  Department of Geriatric Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine-Lehigh Valley, Allentown, PA, USA Stephanie Gordy, MD, FACS  Baylor College of Medicine, Ben Taub Hospital, Houston, TX, USA Vicente H Gracias, MD  Professor of Surgery and Senior Vice Chancellor of Clinical Affairs, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA David G Greenhalgh, MD, FACS  Department of Surgery, University of California, Davis Medical Center, Shriners Hospitals for Children Northern California, Sacramento, CA, USA Michael D Grossman, MD, FACS  Vice Chair, VA Affairs, Professor of Surgery, Department of Surgery, Stritch School of Medicine, Loyola University of Chicago, Chief of Surgical Services, Edward Hines, Jr Veterans, Administration Medical Center, Maywood, IL, USA Contributors Contributors xi Joseph S Hanna, MD, PhD  Assistant Professor, Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA Ahmed Hassan, MD  Department of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA Jason P Hecht, PharmD, BCPS  Saint Joseph Mercy Ann Arbor, Ann Arbor, MI, USA Sharon Henry, MD  Program in Trauma University of Maryland Medical Center R A Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA Kenji Inaba  Department of Surgery, Division of Trauma, University of Southern California Medical Center, Acute Care Surgery and Surgical Critical Care, Los Angeles, CA, USA Dirk C Johnson, MD  Section of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, CT, USA Bellal Joseph, MD  University of Arizona, Department of Surgery, Division of Trauma, Critical Care, and Emergency Surgery, Tucson, AZ, USA Lewis J Kaplan, MD, FACS, FCCM, FCCP  Perelman School of Medicine, Department of Surgery, Division of Trauma, Surgical Critical Care and Emergency Surgery, Philadelphia, PA, USA Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA Tatyana Kemarskaya, MD, BSN  Department of Geriatric Medicine, Lehigh Valley Health Network, USF Morsani College of Medicine-Lehigh Valley, Allentown, PA, USA Young Kim, MD, MS  Clinical Instructor in Surgery, University of Cincinnati, Department of Surgery, Cincinnati, OH, USA Leslie Kobayashi, MD  Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego Health Sciences, San Diego, CA, USA Rosemary Kozar, MD, PhD  Shock Trauma Center, University of Maryland, Baltimore, MD, USA Nicole Krumrei, MD  Division of Acute Care Surgery, Rutgers-Robert Wood Johnson University Hospital, New Brunswick, NJ, USA Jason A Luciano, MD, MBA  Resident in General Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Ajai K Malhotra, MD, FACS  Division of Acute Care Surgery, Department of Surgery, University of Vermont Medical Center, Burlington, VT, USA R Shayn Martin, MD  Department of Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA Jay Menaker, MD  Department of Surgery, Division of Surgical/Critical Care, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School Of Medicine, Baltimore, MD, USA Frederick Moore  Professor of Surgery, University of Florida, Gainsville, FL, USA Lena M Napolitano, MD, FACS, FCCP, FCCM  Department of Surgery, University of Michigan Health System, 1C340A-UH, University Hospital, SPC 5033, 1500 E Medical Center Drive, Ann Arbor, MI, USA 43  Ethics in Geriatric Trauma (autonomy) If the patient’s wishes are unknown, then the surrogate should advocate for the patient’s best interests (beneficence) Many surrogates are unaware of the patient’s preferences Covinsky et al found that a surrogate’s understanding of the patient’s preference for cardiopulmonary resuscitation was only moderately better than chance [21] There is often a disconnect between surrogate expectations and what medical care can realistically provide [22], leading to the potential of nonbeneficial surgery or treatment In reality, surrogates also consider other factors such as their own preferences, interests, emotions, experiences, and religious beliefs in making decisions regarding the patient’s health care [23] Ideally the patient has chosen a potential surrogate in advance In the absence of a designated surrogate, laws vary from state to state in terms of who can serve in this role; but, in general, the order is the spouse, adult children, parents, siblings, and other relatives All states recognize a pre-­ identified surrogate or legal guardian to make decisions about life-sustaining treatment; however some states limit their authority by medical precondition requirements or need for a witness when a surrogate consents to forego treatment [24] Do Not Resuscitate Based on the ethical principle of autonomy, patients and their surrogates have the right to refuse any medical procedure or treatment as long as they are deemed competent, have been adequately informed, and are not coerced into making the decision Physicians should not allow their personal value judgments to obstruct implementation of the refusal A patient’s refusal of medical procedures may involve either withholding or withdrawing treatment This can also include refusing cardiopulmonary resuscitation (CPR) A Do Not Resuscitate (“DNR”) order refers to the withholding of CPR which generally includes the withholding of chest compressions, defibrillation, intubation, and pharmacologic interventions to stimulate the heart Based on television’s depictions of CPR, the general public has an unrealistic view of patient survival believing that three-quarters of patients survive CPR [25] Unfortunately in reality, less than 20 % of patients survive CPR, and 10–44 % of those patients who survive have permanent neurologic impairment CPR was never intended for use in patients dying an expected death from a chronic, fatal medical illness, and a physician is under no obligation to perform CPR when it is futile or contraindicated Some patients with a Do Not Resuscitate order become candidates for surgery Many of these procedures, such as treating intestinal obstruction in patients with advanced malignancy or traumatic injuries, fall into the purview of the 449 acute care surgeon When they undergo surgery, they are subject to potentially correctable risks of cardiopulmonary arrest In addition, many of the medications and procedures used as an integral part of routine anesthesia management are employed in resuscitation (intubation, vasoactive medications) The American College of Surgeons “Statement on Advance Directives by Patients: “Do Not Resuscitate” in the Operating Room” recommends a policy of required reconsideration of the existing DNR orders [26] Required reconsideration means that the patient or their surrogate and the physicians who will be responsible for the patient’s care should discuss the intraoperative and perioperative risks associated with the surgical procedure, the patient’s treatment goals, and an approach that is consistent with the patient’s goals of care The patient or surrogate may agree to suspend the DNR order during surgery and the perioperative period, retain the DNR order, or modify the DNR order Once a decision is reached on the patient’s DNR status following the required reconsideration conversation, the surgeon must document and convey the patient’s advance directive and DNR status to the other members of the operative team, help the operative team members understand and interpret the patient’s advance care directive, and if necessary find an alternate operative team member to replace any individual who has an ethical or professional conflict with the patient’s advance directive instructions Policies that lead to the automatic enforcement of all DNR orders or to disregard or automatically cancel such orders not respect the patient’s autonomy Futility In medicine, interventions that are unlikely to produce any significant benefit for the patient are defined as futile Futility does not apply to treatments globally (“it is futile to continue to treat this patient”) but only to a single intervention in a specific patient at a particular time (“CPR would be medically futile for this patient”) Although the definition of ­futility appears simple, it is actually quite complex There is no consensus or guideline to determine futility Maerz et al describe a futility concept using the effect-benefit principle [27] An effect of an intervention is limited to a specific portion of a patient’s body, whereas benefit improves the person as a whole Futile care defines treatment that does not provide benefit to the patient whether it produces its desired effect or not Quantitative medical futility is goal directed If surgery or the treatment cannot meet the accepted therapeutic goal, then it is deemed to be futile Qualitative medical futility is whether the surgery or intervention can meet the patient’s goals of care; if not, it is deemed futile It is because of uncertainty of prognosis or outcome and lack of knowledge 450 of the patient’s goals of care that make determining futility difficult This becomes even more challenging when the patient is unable to communicate and surrogates are either not available or unsure of the patient’s wishes An algorithmic approach to futility has been described by McCullough [28] Step is physiological futility Will the clinical intervention produce its usually intended physiologic effect? If no, then it is physiologically futile Step asks whether the clinical intervention produces clinical benefit enabling the patient to interact with the environment and develop as a human being If no, it is considered clinically futile Step asks whether the patient will die without regaining consciousness before discharge If the answer is yes, it is further clinical futility Step asks whether the intervention will be physiologically and clinically effective, but with significant risk of disease-related or iatrogenic morbidity, loss of function, and unacceptable quality of life If the answer is no, then the criteria for qualitative futility are met Medical care has reached a point where in our attempt to preserve life, we are often only prolonging dying The American Medical Association states in the Code of Medical Ethics that “physicians are not ethically obligated to deliver care that, in their best professional judgment, will not have a reasonable chance of benefiting their patients” [2] This must be discussed with the patient or surrogate, providing a frank explanation of why a particular intervention is not beneficial It must also be emphasized that medical care is never futile but that specific therapies that not advance goals of care are futile C.S Cocanour and K.S Romanowski Summary • Ethics in Western medicine is governed by four basic principles: non-maleficence, beneficence, autonomy, and justice Acutely ill and injured elderly patients often present ethical challenges to the physician as they attempt to balance conflicting ethical priorities • The principle of double effect often occurs in the geriatric trauma population In attempting to restore the patient to their previous functional status (beneficence), the patient may incur pain, suffering, and even complications that cause death (maleficence) • The utilization of scarce resources and access to care are major challenges that may face elderly trauma patients • The rules of confidentiality are the same for the elderly trauma patient as they are for other patients We cannot break confidentiality simply because of their age • Elderly patients should be encouraged to participate in the informed consent process unless they lack decision-­ making capacity In cases where they lack capacity, the informed consent process can be driven either by the patient’s advanced directives or by surrogate decision makers • Specific treatments may be deemed futile by the medical team a patient or their surrogate, but medical care and dignity of the patient are never futile References Conclusion Caring for the injured or acutely ill elderly patient is challenging The increasing presence of dementia, frailty, and aging of physiologic systems increases the vulnerability of this population The treatment of these patients must take into account all four of the basic ethical principles: beneficence, non-maleficence, autonomy, and justice The principle of double effect dictates that if a planned procedure is done with the intention of providing benefit to the patient, then the potential of undesirable effects is acceptable Communication in times of acute illness or injury is fraught with many pitfalls Shared decision making allows active patient involvement, respecting the patient’s autonomy Older adults should be considered capable of making health-care decisions despite age or frailty The information provided during consent must be at the appropriate level of understanding for each patient In the acute illness or injury, advance directives and involvement of the patient’s surrogate can help the physician navigate patient and family through an emotional and potentially devastating time Physicians must assure their patient and surrogate that even if a specific treatment or procedure is deemed futile, medical care is never futile 1 Percival T Medical ethics; or, a code of institutes and precepts, adapted to the professional conduct of physicians and surgeons Manchester, England, J Johnson, 1803 American Medical Association Code of medical ethics of the American Medical Association council on ethical and judicial affairs Chicago: American Medical Association; 2006 Sirois MJ, Griffith L, Perry J, Daoust R, Veillette N, Lee J, et al Measuring frailty can help emergency departments identify independent seniors at risk of functional decline after minor injuries J Gerontol A Biol Sci Med Sci 2015;pii:glv152 [Epub ahead of print] Doyal L Surgical ethics In: Williams NS, Bullstrode CJK, O’Connell PR, editors Bailey and love’s short practice of surgery London: Hodder Arnold 2008 p.119–125 Grossman MD, Miller D, Scaff DW, Arcona S. When is an elder old? Effect of preexisting conditions on mortality in geriatric trauma J Trauma 2002;52(2):242–6 Ingraham AM, Cohen ME, Bilmoria KY, Raval MV, Clifford YK, Nathens AB, et al Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement Surgery 2010;148(2):217–38 Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, et al Frailty as a predictor of surgical outcomes in older patients J Am Coll Surg 2010;210(6):901–8 Jacobs DG, Plaisier BR, Barie PS, Hammond JS, Holevar MR, Sinclair KE, et al Triage of geriatric trauma J Trauma 2003;54(2):391–416 American Hospital Association A patient’s bill of rights Chicago: American Hospital Association; 1992 43  Ethics in Geriatric Trauma 10 Patient self-determination act of 1990, sections 4206 and 4751 of omnibus reconciliation act of 1990 Public law 101–508 1990 11 Evans JG. Rationing health care by age: the case against BMJ 1997;314:822–5 12 Gervais KG et al., editors Ethical challenges in managed care: a casebook Washington, D.C.: Georgetown University Press; 1999 13 Hoadley JF, Cubanski J, Neuman P. Medicare’s part D drug benefit at 10 years: firmly established but still evolving Health Aff (Millwood) 2015;34(10):1682–7 14 Murray PM The history of informed consent Iowa Orthop J 1990; 10:104–9 15 Giampieri M Communication and informed consent in elderly people Minerva Anestesiol 2012;78(2):236–42 16 Moye J, Marson DC Assessment of decision-making capacity in older adults: an emerging area of practice and research J Gerontol B Psychol Sci Soc Sci 2007;62(1):P3–P11 17 Murphy T. Ethics in clerkships; surrogate decision making University of Illinois at Chicago College of Medicine [Cited 27 Dec 2012] Available from: http://www.uic.edu/depts/mcam/ethics/ surrogate.htm 18 Silveira MJ, Kim SY, Langa KM Advance directives and outcomes of surrogate decision making before death N Engl J Med 2010;362(13):1211 19 In re Quinlan, 355 A2d 647 (JN), 429 US 922 1976 20 Teno JM, Gruneir A, Schwartz Z, Nanda A, Wetle T Association between advance directives and quality of end-of-life care: a national study J Am Geriatr Soc 2007;55(2):189–94 451 21 Covinsky KE, Fuller JD, Yaffe K, Johnston CB, Hamel MB, Lynn J, Teno JM, Phillips RS Communication and decisionmaking in seriously ill patients: findings of the SUPPORT project The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments J Am Geriatr Soc 2000;48(5 Suppl):S187–93 22 Cooper Z, Courtwright A, Karlage A, Gawande A, Block S Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution Ann Surg 2014;260(6):949–57 23 Fritsch J, Petronio S, Helft PR, Torke AM Making decisions for hospitalized older adults: ethical factors considered by family surrogates J Clin Ethics 2013 Summer;24(2):125–34 24 Hickman SE, Sabatino CP, Moss AH, Nester JW The POLST (Physician Orders for Life-Sustaining Treatment) paradigm to improve end-of-life care: potential state legal barriers to implementation J Law Med Ethics 2008 Spring;36(1):119–40, 25 Diem SJ, Lantos JD, Tulsky JA Cardiopulmonary resuscitation on television; miracles and misinformation N Engl J Med 1996; 334:1578–82 26 American College of Surgeons Statement on advance directives by patients: “do not resuscitate” in the operating room Bull Am Coll Surg 2014;99(1):42–3 27 Maerz LL, Mosenthal AC, Miller RS, Cotton BA, Kirton OC Futility and the acute care surgeon J Trauma Acute Care Surg 2015;78(6):1216–9 28 McCullough LB, Jones JW Postoperative futility: a clinical algorithm for setting limits Br J Surg 2001;88(9):1153–4 Index A AB103, 198 Abbey Scale, 345–346 Abdominal pain, 218–220 Acalculous diseases, benign acute acalculous cholecystitis, 144–145 biliary motility disorders, 145–146 ACE See Acute Care for the Elderly (ACE) Acetabular fracture mortality, 315 operative vs non operative management, 315 percutaneous fixation, 315 total hip arthroplasty, 315 Activities of daily living (ADLs), 3, 92, 113, 424 Acute abdomen diagnostic imaging, 183 differential diagnosis, 184 history and physical exam, 181–182 laboratory analyses, 182–183 pain, 181 Acute acalculous cholecystitis, 144–145 Acute aortic dissection (AAD), 229 Acute aortic syndrome (AAS), 229 Acute calculous cholecystitis See Calculous cholecystitis, acute Acute Care for the Elderly (ACE), 349, 350 Acute kidney injury (AKI), 176 age-related changes, 385–386 anatomic causes, 387 ARF, diuretics in, 388–389 CKD, 386 definitions, 384 epidemiology, 30, 383–384 ethical issues, 392 etiology, 30–31 evaluation, 388 infection, 387 molecular underpinnings, 31 nephrotoxins, 387 prevention, 387–388 prognosis, 392 risk factors, 384–385 RRT dose, 391 indication, 389 intermittent vs continuous, 390–391 outcomes, 391–392 principles, 389–390 strong ion approach, 31–32 volume status, 386–387 Acute limb ischemia clinical presentation and diagnosis, 203–205 endovascular vs open surgical management, 205 open surgical management, 205–207 pathophysiology, 202–203 Acute mesenteric ischemia causes, 209 clinical manifestations, 210 clinical presentation and diagnosis, 210 etiology, 209 management, 210–213 pathophysiology, 209–210 risk factors, 209 Acute myocardial ischemia, 13 Acute renal failure (ARF) epidemiology, 30 etiology, 30–31 strong ion approach, 31–32 Acute respiratory failure (ARF), 360 Acute tubular necrosis (ATN), 28, 29 Acute vascular insufficiency acute limb ischemia clinical presentation and diagnosis, 203–205 endovascular vs open surgical management, 205 open surgical management, 205–207 pathophysiology, 202–203 acute mesenteric ischemia causes, 209 clinical manifestations, 210 clinical presentation and diagnosis, 210 etiology, 209 management, 210–213 pathophysiology, 209–210 risk factors, 209 calf fasciotomy checklist, 206, 208 muscle compartments, 207–208 postoperative considerations, 208–209 case study, 213–220 educational objectives, 201 emergency department, 201 Adaptive immune system B lymphocytes, 59 inflammaging, 59 T lymphocytes, 58–59 Adenosine diphosphate (ADP) antagonists, 71 Advanced Emergency Medical Technician (AEMT), 240 Advanced glycosylation end products (AGEs), 398 Advance directives, 6, 117, 363, 434, 448 medical ethics, 448 Advanced Life Support (ALS), 241 Advanced Trauma Life Support (ATLS), 38 Adverse drug events (ADE), 344 © Springer International Publishing AG 2017 F.A Luchette, J.A Yelon (eds.), Geriatric Trauma and Critical Care, DOI 10.1007/978-3-319-48687-1 453 454 Affordable Care Act (ACA), 100 Agency for Healthcare Research and Quality (AHRQ), 101 Aging population See also Elderly patients advanced directive decisions, cost of caring, early inpatient rehabilitation, end-of-life issues, organ function's effects, 2–3 prevalence, 1–2 trauma, 3–6 Agitation, 418–419 Airflow measurement, 19 Airway diseases, 20–21 Airway obstruction aspiration, 224 causes, 223 clinical presentation and initial management, 223 diagnosis, 224 Albumin, 397–398 Alcoholism, 86 Alveoli, 21 Alvimopan, bowel function returns, 39 Alzheimer’s disease (AD), 77–79 American Association for the Surgery of Trauma (AAST), 38, 92 American Automobile Association (AAA), 258 American College of Cardiology (ACC), 108, 116 American College of Cardiology and American Heart Association, 108 American College of Chest Physician (ACCP), 396 American College of Surgeons Committee on Trauma (ACS COT), 256 American Heart Association (AHA), 108, 116, 308 American Medical Association (AMA), 103 American Society of Nephrology, 392 Analgesia, 376 Andexanet alfa, 73 Anemia, 69–70 Angiography, GI bleeding, 171–172, 176 Angiotensin II (ANG II), 12 Anorexia, 402 Anti-coagulants, 5, 72, 291, 292, 405–408 Anti-coagulation, 169 Antidiuretic hormone (ADH), 386 Antiplatelet agents, 407–408 Apixaban, 407 Apoptosis, 37 Appendicitis clinical presentation, 122–123 diagnosis, 123–125 epidemiology, 121–122 history, 121 imaging, 123 malignancy, 126–127 morbidity and mortality, 126 mucocele, 126–127 pathophysiology, 122 treatment, 125–126 Arterial insufficiency ulcers, 50 Artificial nutrition, 402–403 Aspiration, 376 Aspiration pneumonitis, 23 Aspirin, hematologic system affected by, 71 Assisted ventilation, 379–380 Assistive technology, 428 Asthma, 21 Index Atelectasis, 376 Atrial fibrillation (AF), 12–13, 210, 213–215, 367–368 Atrial peak velocity (Aa), 10 Automobile industry, 258 Autonomy, 444 Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle, 420 B Bacterial overgrowth syndromes, 37 Baroreflex response, 11–12 Barthel index, 90 Baux score, 334 Beers list, 344 Beneficence, 444 Benign acalculous diseases See Acalculous diseases, benign Benign calculous diseases See Calculous diseases, benign Benzodiazepines, 86 Bereavement, 439–440 Berg Balance Scale (BBS), 90, 94 Beta-adrenergic response, 11 Beta-blocker (BB) therapy, 5, 368, 369, 408–409 Biliary disease benign acalculous diseases acute acalculous cholecystitis, 144–145 biliary motility disorders, 145–146 benign calculous diseases acute calculous cholecystitis, 137–139 biliary pancreatitis, 142–143 cholangitis, 142 choledocholithiasis, 140–142 chronic calculous cholecystitis, 139–140 gallstone ileus, 144 diagnosis, 132–133 biliary scintigraphy, 135 cholangiopancreatography, 136 computerized tomography, 135–136 endoscopic retrograde cholangiopancreatography, 136–137 laboratory testing, 133 magnetic resonance imaging, 136 percutaneous transhepatic cholangiography, 137 plain radiographs, 133–135 gallbladder carcinoma, 146–147 gallbladder polyps, 146 perioperative considerations, 132 physiology and pathophysiologic changes, 131–132 Biliary motility disorders, 145–146 Biliary pancreatitis, 142–143 Bisphosphonates, 306, 313 Blood urea nitrogen (BUN), 28 B lymphocytes/B cell aging, 59 Bone marrow changes, 70 Bowel resection, case study, 40 Brachial artery, 206 British Geriatric Society (BGS), 90, 92 Bronchitis, 21 Bronchoalveolar lavage (BAL), 378, 379 Bureau of Justice Statistics (BJS), 251 Burn injuries case study, 45 comorbidities, 334 epidemiology, 333–334 metabolic response to, 50 mortality rate, 333, 335 Index outcomes, 335 pathophysiology, 334 prevention, 335–336 risk factors, 49–50 skin changes, 334 treatment, 50, 334–335 C Cachexia, 402 Calcitonin, 306 Calcium, 305, 399 Calcium channel blockers (CCB), 368 Calculous cholecystitis, acute clinical presentation and diagnosis, 137–138 treatment, 138–139 Calculous diseases, benign acute calculous cholecystitis, 137–139 biliary pancreatitis, 142–143 cholangitis, 142 choledocholithiasis, 140–142 chronic calculous cholecystitis, 139–140 gallstone ileus, 144 Calf claudication, 215, 216 Calf fasciotomy checklist, 206, 208 muscle compartments, 207–208 postoperative considerations, 208–209 Cancer, 23–24 Capsule endoscopy, GI bleeding, 173 Carbohydrates, 398 Carcinoma, gallbladder, 146–147 Cardiac physiology, 362 Cardiopulmonary resuscitation (CPR), 449 Cardiovascular changes, Cardiovascular disease (CVD), 367 Cardiovascular system atrial fibrillation, 12–13 baroreflex response, 11–12 beta-adrenergic response, 11 cardiac output, 11 heart failure, 13 ischemic heart disease, 13 left ventricle, 10 management, 14–15 monitoring the aging, 13–14 right ventricle, 9–10 surgery, effect of, 12 vascular structures, 10–11 Catheter-associated urinary tract infection (CAUTI), 349 Catheter-directed infusion therapy, 176 Centers for Medicare and Medicaid Services (CMS), 49 Central venous pressure (CVP), 14, 370–371 Certified Centre for Geriatric Trauma Surgery, 350 Cervical spine fracture, 265 Chelsea Critical Care Assessment Tool, 91 Chemotherapy, 48 Chest wall anatomy, 18 injury epidemiology, 285–286 prevention, 286 treatment, 286–289 rib fracture, 20 Cholangiopancreatography, biliary disease, 136–137 455 Cholangitis, 142 Choledocholithiasis clinical presentation and diagnosis, 140–141 treatment, 141–142 Chronic calculous cholecystitis clinical presentation and diagnosis, 139–140 treatment, 140 Chronic diseases, 101 Chronic kidney disease (CKD), 60, 386 Chronic obstructive pulmonary disease (COPD), 20–21, 59 Chronic subdural hematomas (SDH), 264 Civilian ambulance services, 239 Clinical Frailty Scale (CFS), 341–343 Clostridium spp., 189 Cognitive disorders, 77–79 Cognitive failure, 439 Cognitive function, 425 Cognitive impairment delirium, 110–112 dementia, 110, 111 depression, 112–113 nutritional evaluation, 113 substance abuse, 113 Colon anatomy, 153 motility and function, 153–154 Community-acquired pneumonia (CAP), 59, 61 Comprehensive geriatric assessment (CGA), 92, 341, 350 Computed tomography (CT) acute abdomen, 183 acute mesenteric ischemia, 210 appendicitis, 123–124 biliary disease, 135–136 gastrointestinal injury, 38–39 GI bleeding, 172 intestinal obstruction, 164, 166 NSTI, 192–195 superior mesenteric artery, 218 Computed tomography angiography (CTA), 22 Concussion See Traumatic brain injury (TBI) Confidentiality, ethics, 446 Confusion Assessment Method for the Intensive Care Unit (CAM-­ ICU) score, 364, 410, 419 Congressional Budget Office (CBO), 100 Connecticut Collaboration for Fall Prevention (CCFP), 343 Consensus, 314 Consultant palliative care, 435 Continuous central venous oximetry (ScvO2), 369 Continuous positive airway pressure (CPAP), 25, 379, 380 Continuous renal replacement therapy (CRRT), 390–391 Contrast-induced nephropathy (CIN), 387 Coordinating Care for Older People (COPA), 93 Creatinine clearance, 29 Critical care, Critical care medicine, 357 Critical care nurse, 415, 419 CT enterography, 172 Cytokines, 12 D Dabigatran, 406–407 Debilitation, 89 See also Frailty Deep venous thrombosis (DVT), 70, 214–215 Dehydration, 164, 399 456 Delirium, 5, 348, 409–410, 419–420 causes and risk factors, 80–81 clinical features, 111 definition and epidemiology, 80 diagnosis and screening, 81 prevention, 82–83, 364 risk factors, 110–112, 363 screening tool, 364 treatment, 82–83, 112 Dementia, 448 prevalence, 110 screening tests, 78–79, 110, 111 treatments, 79 types, 77–78 Dendritic cells, 58 Denosumab, 306–307 Department of Transportation (DOT), 240 Depression assessment and screening, 84–85 epidemiology, 83–84 prevalence, 112–113 treatment, 85, 113 Dermal appendages, 46 Desmopressin, 71, 408 Deterioration, 377 Diabetes mellitus immune system, infections in, 59–60 by wound healing, 47–48 Diabetic foot ulcer, 48 Diaphragm, anatomy, 18 Diastolic velocity (Ea), 10 Diffusion, 390 Direct medical control, 241 Direct oral anticoagulants (DOACs), 406–408 Disability, 101 Discontinuing renal replacement therapy (CRRT), 391–392 Distal humeral fractures, 318–319 Distal radius fractures, 318 Disulfiram, 86 Diuretics, 389–390 Diverticulitis complicated, 155–157 epidemiology and pathology, 154 free perforation associated with, 157–158 treatment, 155–158 uncomplicated, 155 Dobutamine, 14 Do-not-resuscitate (DNR) status, 6, 434, 449 Drug metabolism, 407 E Eastern Association for the Surgery of Trauma (EAST), 38 Ecarin clotting time (ECT), 73 Echocardiography, 370–371 Edoxaban, 407 Elastin, 10 Elderly patients advance directives, 363 cardiac physiology, 362 critical care outcomes in, 356–357 resource use in, 355–356 delirium, 363–364 frailty and ICU outcomes, 357 geriatric consultation, 360 Index infection prevention, 364 initial trauma evaluation, 360 mechanical ventilation, 361 medication management, 361 nutrition support, 364 pain control and delirium avoidance, 361 performance improvement, 359–360 planned surgery vs unplanned surgical ICU admissions, 357 POLST, 363 population growth, 355, 356 pulmonary physiology, 362 renal function, 362–363 resource utilization, 357–359 special populations ARF, 360–361 NIV, 361–362 super-elderly trauma, 357–359 Emergency medical responder (EMR), 240 Emergency medical service (EMS) history, 239–240 medical control, 241 system design, 241 Emergency Medical Technician (EMT), 240 Emphysema, 21 Empyema, 22, 227 EMS See Emergency medical service (EMS) End-of-life care advance directives, 434 bereavement, 440 communication, 435–436 DNR, 434 epidemiology, 431 family meetings, 436 frailty vs age, 433 futility, 434–435 goals of care, 433–434 grief, 440–441 healthcare power of attorney, 434 palliative care models, 435 planned vs emergent admission ICU, 435 30-day mortality, 432–433 surgical buy-in, 431–432 symptom management cognitive failure, 439 gastrointestinal symptoms, 438–439 life-sustaining treatment, withdrawal of, 439 pain, 436–438 respiratory distres, 438 Endoscopic retrograde cholangiopancreatography, 136–137 Endoscopy, GI bleeding, 171, 175–176 Endotracheal intubation, 379–380 End-stage renal disease, 60 Enteral absorption, 37 Enteral nutrition, 400–401 Enteric nervous system (ENS), 36 Epidemiology of injury description, 247 geriatric population, 247 Haddon phase-factor matrix, 247–248 by intent, 249 mechanism, 249 assault, 251–252 domestic abuse, 251–252 falls, 249–250 motor vehicle collisions, 250 pedestrians hit by motor vehicles, 250–251 Index penetrating injury, 252 risk factors, 248–249 trimodal distribution, 248 Escherichia coli, 61 Esophageal dysmotility/impaction, 231–232 Esophageal perforation causes, 232 clinical presentation, 233 diagnosis, 233–234 etiology, 232–233 management endoscopic, 235, 236 nonoperative, 234 surgical, 234–235 outcome, 236 Esophagus/GI tract esophageal dysmotility/impaction, 231–232 esophageal perforation causes, 232 clinical presentation, 233 diagnosis, 233–234 endoscopic management, 235, 236 etiology, 232–233 nonoperative management, 234 outcome, 236 surgical management, 234–235 PEH clinical presentation and diagnosis, 236 management, 236–237 outcome, 237 patients with, 236 perforation, 232–236 Estimated glomerular filtration rate (eGFR), 29 Estrogen, 306 Extremity injury osteoporosis acetabular fractures, 314–316 femoral neck fractures, 310–311 functional status, 314 hip fractures, 309–310, 313 intertrochanteric fracture, 311–312 non-pharmacologic interventions, 305 periprosthetic fractures, 315–316 pharmacological interventions, 305–307 subtrochanteric fractures, 312–313 treatment, 307–309 upper extremity fractures, 318–320 F Factor VII, 71, 72 Factor VIII, 71 Falls death due to, 249–250 injuries due to, 343–344 Family meetings, 436, 437 Fasciotomy, 207–208 Femoral artery, 216 Femoral neck fractures, 310–311 Fibula fracture, 17 FIM See Functional Independence Measure (FIM) FloTrac™, 370 Fluoride therapy, 307 Focused rapid echocardiographic examination (FREE), 371 4-factor prothrombin complex concentrate (4-PCC), 72 Fournier's gangrene, 189, 191 457 Frailty vs age, 433 assessment, 114–115 case study, 89 CFS, 341–343 clinical evaluation, 341 definition, 89–90 diagnosis and measurement, 90–92, 341 and ICU outcomes, 357 management and treatment, 92–93 nursing consideration, 416–417 outpatient care, 93 phenotype-based approaches, 341 physiologic impairments, 114 preoperative optimizatio, 93–94 prevalence, 341 research in, 94 surgical patients, 114 Frailty index (FI), 90, 341, 417 Fresh frozen plasma (FFP), 175 Frontal lobe dementias, 78, 79 Functional Independence Measure (FIM), 91, 361, 424, 425 Futility, 434–435, 449–450 G Gallbladder carcinoma, 146–147 Gallbladder polyps, 146 Gallstone ileus, 144 Gas exchange, 18–19, 376 Gas gangrene, 189 Gastrointestinal (GI) bleeding angiography, 171–172 capsule endoscopy, 173 causes, 170–171 CT, 172 endoscopy, 171 management, 173–177 angiography, 176 elderly, aspiration risk in, 174 endoscopy, 175–176 fluid resuscitation, 174–175 initial evaluation, 173–174 medications, 175 surgery, 176–177 MRI, 172–173 nuclear medicine, 172 Gastrointestinal (GI) hemorrhage See Gastrointestinal (GI) bleeding Gastrointestinal (GI) tract enteral absorption, 37 enteric nervous system, 36 gastrointestinal ileus, 39 gastrointestinal injury, 38–39 gastrointestinal motility, 35–36 gut mucosa, 36–37 mucosal immunity, 37 Ogilvie syndrome, 39–40 symptoms, 438–439 Genetic Epidemiology Research on Adult Health and Aging (GERA), 339 Geriatric(s) delirium, 348 falls, 343–344 frailty, 341–343 geriatric medicine, 340–341 458 Geriatric(s) (cont.) hospitalized older adults ACE programs, 350 geriatrician role, 349–350 management, 348–349 traditional consultation model, 349–350 pain management, 345–348 polypharmacy, 344–345 Geriatric Depression Scale, 84 Geriatric neurotrauma See Traumatic brain injury (TBI) Geriatric trauma See Trauma elderly Geriatric trauma consultation service (GTCS), 359–360 Geriatric trauma management guidelines, 340 Geriatric Trauma Outcome Score (GTOS), Geriatric trauma patient care protocols, 359 Geriatric trauma service, 359 Gerontology, 339–340 Glasgow Coma Scale (GCS) 12–15 See Traumatic brain injury (TBI) Global Initiative for Chronic Obstructive Lung Disease (GOLD), 20–21 Glomerular filtration rate (GFR), 29, 362, 386 Glutamine, 399 Graduate Medical Education National Advisory Committee (GMENAC), 103 Gunshot injury incidence of, 327 intent of, 328 Gut microbiome, 37 Gut mucosa, 36–37 H Harris-Benedict equation, 395 Hartmann’s procedure, 158 Healthcare-acquired pneumonia (HCAP), 62 Health-care economics administrative costs, 100 adverse selection, 103 aging population, 104 barriers to entry, 103 chronic disease and disability, 101 competition, imperfect, 103 end-of-life care, 101–102 externalities, 104 health-care pricing, 102 information asymmetry, 102–103 insurance, 99–100 market failures, 102 medical malpractice liability, 100–101 moral hazards, 103 Patient Protection and Affordable Care Act, 100 physicians as agents, 103 technology, 100 trends in, 99 Heart failure, 13 Hematological changes anemia, 69–70 bone marrow changes, 70 hemorrhage, response to, 70 hypercoagulability, 70–71 by medication ADP antagonists, 71 anticoagulation reversal protocol, 73–74 aspirin therapy, 71 atrial fibrillation, 71 oral anticoagulant agents, 72 prothrombin complex, 72 Index Hematopoietic stem cells (HSC), 37 Hemodynamic monitoring echocardiography, 370–371 noninvasive methods, 370 pulse contour analysis, 369–370 ScvO2, 369 Hemorrhage, 70 Henderson-Hasselbalch approach, 31 Hip fractures, arthroplasty, 311, 315 epidemiology, 309–310 functional status, 314 hip replacement, 215–217 isolated hip fractures, 265–266 mortality, 314 Home health services, 428 Homeostenosis, 340 Hospital Elder Life Program (HELP), 349, 364 Hospitalization, 348 Hyperbaric oxygen (HBO), 197 Hypercoagulability, 70–71 Hypochlorhydria, 36 Hypovolemia, 386–387 I Identification of seniors at risk (ISAR) screening tool, 340–341 Ileus, 39, 40 Immune system adaptive immunity, 58–59 chronic kidney disease, 60 COPD, 59 diabetes mellitus, 59–60 diagnosis, challenges in, 60–61 end-stage renal disease, 60 innate immunity, 57–58 microbiology, 61 prevention and therapies, 62 respiratory infections, 61–62 traumatic injury, 60 urinary tract infection, 61 Incentive spirometry, 376 Indirect medical control, 241 Inferior mesenteric artery (IMA), 153 Inflammaging, 59 Informed consent, 447 Injury prevention elder abuse, 258–259 geriatric population background and epidemiology, 255 risk factors, 255–256 motor vehicle collisions, 257–258 older adult, 257–258 suicide, 259 trauma centers, 256–257 Injury Severity Score (ISS), 5, 358 Innate immune system dendritic cells, 58 macrophages, 58 natural killer cells, 58 neutrophils, 57 Inpatient rehabilitation facility (IRF), 427 Insurance, 99–100 Intensive care delirium screening checklist (ICDSC), 419 Intensive care unit (ICU) Index ICU triad, 417–418 impaired functions by, Interdisciplinary teams, 415, 418 Intermittent hemodialysis (IHD), 390, 391 Intermittent renal replacement therapy, 390 International Trauma Life Support (ITLS), 242 Intertrochanteric fractures, 311–312 Intestinal hemorrhage GI bleeding causes, 170–171 diagnosis, 171–173 management, 173–177 incidence, 169 mortality, 169 NOA, 169 Intestinal obstruction acute care surgery, 167 causes, 162 CT scan, 166 in elderly, 161 etiology, 161 intervention, 161, 165–166 investigation, 161 operations, 167 postoperative period, 166 radiographic studies, 166 signs and symptoms, 162–163 treatment, 165–166 water-soluble contrast study, 166 workup and evaluation, 163–164 Intra-abdominal hypertension (IAH), 387 Intramedullary nail fixation, 307, 312, 313 Intramural hematoma (IMH), 230–231 Intravenous immunoglobulin (IVIG), 197–198 Intravenous narcotics, 287 Ireton-Jones equation, 395 Ischemic heart disease, 13 Isolated hip fractures (IHF), 265–266 J Justice, as medical ethics, 444–445 K KDIGO AKI stage management, 387, 390 L Lateral locked plating, 317 Left ventricle (LV), 10 Leukocytosis, 163–164 Lewy body dementia, 78, 79 Life Space Assessment (LSA), 91 Lipids, 399 Liver injury, 293 Long-term acute care (LTAC), 428 Lower gastrointestinal bleeding, 170–171 Lung abscess clinical presentation and diagnosis, 226 etiology, 225 management, 226 outcome, 227 Lung, anatomy, 17–18 Lung cancer, 23 Lymphocyte count, 398 459 M Macrophages, 58 Macrovascular disease, 48 Magnetic resonance imaging (MRI) acute abdomen, 183 biliary disease, 136 GI bleeding, 172–173 intestinal obstruction, 164 NSTI, 193 Malnutrition, 47, 396, 397 diagnosis, 398 Massive hemoptysis causes, 224 clinical presentation and diagnosis, 224–225 outcome, 225, 226 therapeutic options, 225 Matter of Balance (MOB), 257 Maximal heart rate (HRmax), 11 Mechanical ventilation, 361, 379–380 Medical ethics, in geriatric trauma access to care, 445–446 autonomy, 444 beneficence, 444 double effect, 445 justice, 444–445 non-maleficence, 444 scarce resources, 445–446 Medicare Improvement and Modernization Act, 446 Medicare payments, Medications, 255–256 Mediterranean diet, 62 Mesenteric ischemia See Acute mesenteric ischemia Mesenteric venous thrombosis, 212–213 Metabolic syndrome, 48 Methicillin-resistant Staphylococcus aureus (MRSA), 189 Microvascular disease, 48 Minerals, 399 Mini-Cog, 78–79, 110, 111 Mini-Mental State Examination (MMSE), 78 Mini Nutritional Assessment (MNA), 397 6-min walk test (6MWT), 91 M-mode echocardiography, Montreal Cognitive Assessment (MoCA), 79 Mood disorders, 425–426 Morphine, 347 Mortality rate, Motor vehicle collisions (MVCs), 250, 257–258 Mucocele, 126–127 Mucosal immunity, 37 Multidetector-row helical computed tomography (MDCT) scanning, 172 Multidrug-resistant organisms (MDRO), 62 Multiple hospitalizations, Muscle relaxants, 348 MyHC2 fiber, 18, 19 Myocardial infarction (MI), 13, 368–369 N N-acetyl-β-D-glucosaminidase (NAG), 29 Naltrexone, 86 Nasogastric tube (NGT) decompression, 165 National Elder Abuse Incidence Study, 251–252 National Incident-Based Reporting System (NIBRS), 251 National Registry of Emergency Medical Technicians (NREMT), 240 National Trauma Data Bank (NTDB), 327, 329, 358 460 National Trauma Data Base (NTDB), 265–266 National Vital Statistics Report, 357 Natural killer (NK) cells, 58 Necrotizing fasciitis, 187 Necrotizing soft tissue infections (NSTI) adjunctive treatments AB103, 198 antibiotics, 197 IVIG, 197–198 amputation rate, 196 diagnosis clinical exam, 190–191 differential diagnosis of, 190, 192 radiology, 192–195 epidemiology history, 187 incidence, 187–188 mortality, 188 etiology classification, 188–189 microbiology, 189 risk factors, 188 location, 189–191 radiology, 190–192 surgical exploration, 193–197 Neer classification, 319 Nephrotoxins, 387 Neurologic diseases, 49 Neuropathy, 48 Neutrophil gelatinase-associated lipocalin (NGAL), 29 Neutrophils, 57 Noninvasive ventilation (NIV), 361–362, 379 Non-opioids, 347 Non-small cell lung cancer (NSCLC), 23–24 Nonsteroidal anti-inflammatory drug (NSAID), 287 Norepinephrine, 15 Novel oral anticoagulants (NOAs), 169 NSTI See Necrotizing soft tissue infections (NSTI) Nurses improving care for healthsystem elders (NICHE), 349, 415 Nursing consideration ABCDE bundle, 420–421 agitation, 418–419 delirium, 419–420 focused assessment, 417 frailty, 416–417 ICU triad, 417–418 knowledge development, 415–416 pain, 418 Nutritional scales, 395–396 Nutrition risk in the critically Ill (NUTRIC), 397 Nutrition support, 364 current state, 395 enteral nutrition, 400–401 ethical decision-making, 402–403 indications, 399–400 metabolic requirements albumin, 397–398 deficiencies, 396–397 lymphocyte count, 398 malnutrition, diagnosis of, 398 monitoring, 397 physiologic changes, 396 prealbumin, 398 risk factors, 397 screening tools, 397 transferrin, 398 Index nutritional requirements calcium, 399 carbohydrates, 398 fluids, 399 glutamine, 399 lipids, 399 proteins, 398–399 vitamins and minerals, 399 nutritional scales, 395–396 palliative care and terminally Ill, 401–402 parenteral nutrition, 401 O Obscure gastrointestinal bleeding, 171 Obstructive sleep apnea (OSA), 24 Ogilvie syndrome, 39–40 Operative risk stratification advanced directives and code status, 117 cardiac evaluation, 108–109 cognitive impairment delirium, 110–112 dementia, 110, 111 depression, 112–113 nutritional evaluation, 113 substance abuse, 113 decision-making capacity, 117 evaluation, 107–113 frailty, 114–115 functional assessment, 113–114 laboratory testing, 115 medications and supplements, 115–116 pulmonary evaluation, 109–110 Opioids, 347, 348, 410 Oral pain medications, 287 Organ injury scale (OIS), 38, 39 Organisation for Economic Co-operation and Development (OECD), 104 Osteoporosis, 244, 301, 302 Otago, 257 P Pain, 418 assessment, 436 management, 286–288, 345–348 medications, 410–411 pharmacologic treatment of, 436, 439 Pain Assessment in Advanced Dementia Scale (PAINAD), 347 Pain, inspiration, cough (PIC) score, 286–287 Palliative care, 278–279, 433 barriers, 432 consultative model, 435 pain, 436–438 surgical ICU culture, 432 symptom management, 436, 438 team based, 435 triggers, 435 Pancreatitis, biliary, 142–143 Paraesophageal hernia (PEH) clinical presentation and diagnosis, 236 management, 236–237 outcome, 237 patients with, 236 Paramedics, 240–241 Parapneumonic effusion, 22 Index Parathyroid hormone (PTH), 306 Parenteral nutrition, 401 Parkland formula, 335 Patient-controlled analgesia, 287 Patient Protection and Affordable Care Act, 100 Patient Self-Determination Act, 448 PEH See Paraesophageal hernia (PEH) Pelvic fracture anatomy, 298 classification, 298–300 diagnostics, 299–301 epidemiology, 297–298 incidence, 297–298 outcome, 303 risk factors, 298 trauma, 297 treatment, 301–302 Penetrating aortic ulcer (PAU), 229–230 Penetrating trauma elderly trauma patient, triage of, 328–329 epidemiology, 327 evaluation, 329 gunshot injury, 327–328 management, 329 pharmacologic changes, 328 physiologic changes, 327–328 Percutaneous fixation, 315 Percutaneous transhepatic cholangiography (PTC), 137 Peridiverticulitis, 154 Peripheral vascular disease, 48 Periprosthetic fractures total hip replacement, 316 total knee replacement, 316–318 Phagocytosis, 58 Pharmacologic issues anticoagulant agents, 405–408 antiplatelet agents, 407–408 BB therapy, 408–409 delirium, 409–410 pain medications and management, 410–411 pharmacokinetic alterations, 405 Phlegmasia cerulean dolens, 207 Physical Function Intensive Care Test (PFIT), 91 Physical violence, 258 Physician orders for life-sustaining treatment (POLST), 363 Physicians, as health-care agents, 103 PiCCO™, 370 Plasminogen activator inhibitor-1 (PAI-1), 71 Platelet transfusion, 407–408 Pneumonia, 22, 59, 61, 62, 219, 378 Pneumothorax, 401 POLST form, Polypharmacy, 344–345 Polyps, gallbladder, 146 Porcelain gallbladder, 140 Positive end-expiratory pressure (PEEP), 380 Positive pressure ventilation (PPV), 387 Post-traumatic stress disorder (PTSD), 86 Prealbumin, 398 Prehospital care certification levels, 240–241 EMS history, 239–240 medical control, 241 system design, 241 geriatric patients challenges 461 airway, 242–243 backboards/cervical collars, 244 breathing, 243 circulatory system, 243 disability, 243 exposure/examine, 243 mechanism of injury, 244 medical history/medications, 244 musculoskeletal injury, 244 primary survey, 242 secondary survey, 243 transportation, 244 trauma centers, 244 golden principles, 245 prolonged transport considerations, 244–245 trauma continuing education, 241–242 Prehospital Trauma Life Support (PHTLS), 242 Preoperative assessments See Operative risk stratification Pressure ulcers, 45, 49–50 Privacy, 446–447 Programmed cell death See Apoptosis Proteins, 398–399 Prothrombin complex concentrates (PCCs), 175, 408 Proximal humerus fractures, 319–320 Psychological disorders delirium, 80–83 dementia, 77–79 depression, 83–85 post-traumatic stress disorder, 86 substance abuse, 86 PTFE interposition graft, 216–217 Pulmonary artery catheter (PAC), 14, 369 Pulmonary critical care aspiration, 376 deterioration, 377 end-of-life care, 381 ethical considerations, 381 gas exchange optimization, 376 principles, 375 pulmonary infection detection and prompt therapy, 378 failure of therapy, 379 prevention, 377 respiratory physiology, 375 tracheostomy, 380–381 ventilation endotracheal intubation, 379–380 noninvasive, 379 ventilator weaning, 380 Pulmonary embolism (PE), 21–22 Pulmonary function tests, 20 Pulmonary physiology, 362 Pulmonary system See Respiratory system Pulmonary toilet, 376 Pulse contour analysis, 369–370 R Radiocontrast nephropathy (RCN), 30 Raloxifene, 306 Randomized evaluation of normal versus augmented level (RENAL), 391 Rapid shallow breathing index (RSBI), 380 Red cell mass (RCM), 70 Regional anesthetics, 287–288 Regional citrate anticoagulation (RCA), 391 462 Rehabilitation assessment, 424–426 assistive technology, 428 barriers, 429 challenges, 429 frailty, 426 functional status, 426 function restoration, 426 home health services, 428 IRF, 427 LTAC, 428 need for different approach, 423–424 outcomes, 424 outpatient therapy, 428 settings, 426–427 SNF, 427–428 telerehabilitation, 428 Renal blood flow, 31 Renal function, 362–363 acute kidney injury, 30–32 acute renal failure, 30–32 assessment, limitations in, 30 BUN, 28 creatinine clearance, 29 eGFR, 29 fractional excretion of sodium, 29 renal biomass, 27–28 Scr, 28 urea nitrogen, 29 urinalysis, 28 urinary biomarkers, 29 urine electrolytes, 28 Renal injury, 293–294 Renal replacement therapy (RRT) comparison, 390 dose, 391 indication, 389 intermittent vs continuous, 390–391 outcomes, 391–392 principles, 389–390 Renin-angiotensin-aldosterone system, 386 Respiratory distress, 438 Respiratory system airway diseases, 20–21 anatomy diaphragm, 18 lungs, 17–18 aspiration pneumonitis, 23 cancer, 23–24 chest wall anatomy, 18 rib fracture, 20 effects of aging, 19–20 elements, 375 immune system, infections by, 61–62 infections, 22–23 physiological functions, 18–19 pulmonary embolism, 21–22 sleep disorders, 24–25 Respiratory therapy, 288 Respiratory tract AAD, 229 AAS, 229 airway obstruction aspiration, 224 causes, 223 Index clinical presentation and initial management, 223 diagnosis, 224 aorta, 228 empyema, 227 IMH, 230–231 lung abscess clinical presentation and diagnosis, 226 etiology, 225 management, 226 outcome, 227 massive hemoptysis causes, 224 clinical presentation and diagnosis, 224–225 outcome, 225, 226 therapeutic options, 225 PAU, 229–230 spontaneous pneumothorax classification, 227–228 clinical presentation and diagnosis, 228 management, 228 outcome, 228 TAA, 231 Restrictive lung disease, 21 Reverse total shoulder arthroplasty (RSA), 320 Rib fractures, 20 case study, 17 operative stabilization of, 288–289 RIFLE criteria, 384, 385 Rivaroxaban, 407 RRT See Renal replacement therapy (RRT) S Saint Louis University Mental Status (SLUMS), 79 Scarce resources, 445–446 Scintigraphy, biliary, 135 Score Hospitalier d’Evaluation du Risque de Perte d’Autonomie (SHERPA), 91 Secondary spontaneous pneumothorax (SSP), 228 Senile emphysema, 19 Sensory dysfunction, 37, 46 Serum creatinine (Scr), 27, 28 Short Physical Performance Battery (SPPB), 90–91 Skilled nursing facilities (SNF), 92, 427–428 Skin changes dermal appendage, 46 extrinsic, 46 intrinsic, 45–46 sensation, 46 skin injury, 47 structural changes, 46 ultraviolet light damage, 46 Sleep disorders, 24–25 Small-cell lung cancer (SCLC), 23–24 Sodium, fractional excretion of, 29 Solid organ injury kidney, 293–294 liver, 293 nonoperative management, 291–292 splen, 292–293 Sphincter of Oddi dysfunction, 145–146 Spinal cord injury (SCI), 278 Spirometry, 19 Splenic artery embolization (SAE), 293 Splenic injury, 292–293 Spontaneous pneumothorax Index classification, 227–228 clinical presentation and diagnosis, 228 management, 228 outcome, 228 Standard of care, 158 Stepping On program, 257 Steroids, 48 Stopping Elderly Accidents, Death, and Injury (STEADI), 256, 343–344 Streptococcus pyogenes, 189 Stroke volume variation (SVV), 370 Strontium, 307 Substance abuse, 113 diagnosis and screening, 86 epidemiology, 86 treatment, 86 Subtrochanteric fractures, 312–313 Suicide, 84, 259 Super-elderly patients, 359 Superior mesenteric artery (SMA), 153, 212 Superior mesenteric vein (SMV), 153 Surgical care outcomes cervical spine fracture, 265 geriatric trauma, 261 IHF, 265–266 measurement, 266–268 patient-specific factors, 261–262 systemic factors, 262–264 TBI, 264–265 Surrogate decision making, 448–449 Sustained low-efficiency dialysis (SLED), 390 Synchronous intermittent mandatory (SIMV), 380 Systemic vascular resistance (SVR), T Tai Chi: Moving for Better Balance (TCMBB), 257 Tamm-Horsfall protein (THP), 61 Tangential excision, 335 T-cell receptor (TCR), 58 Team-based palliative management, 435 Telerehabilitation, 428 Telomeres, 339 Teriparatide, 306 30-day mortality, 432–433 Thoracic aortic aneurysm (TAA), 231 Thoracic diseases esophagus/GI tract esophageal dysmotility/impaction, 231–232 PEH, 236–237 perforation, 232–236 respiratory tract AAD, 229 AAS, 229 airway obstruction, 223–224 aorta, 228 empyema, 227 IMH, 230–231 lung abscess, 225–227 massive hemoptysis, 224–226 PAU, 229–230 spontaneous pneumothorax, 227–228 TAA, 231 Thrombolytic therapy, 211 Tibia fracture, 17 Tiered response system, 241 463 Timed up and go test (TUG), 90 T lymphocytes/T cell aging, 58–59 Toll-like receptors (TLR), 37 Total body surface area (TBSA) burn, 52 Total lung capacity (TLC), 19 Tracheostomy, 380–381 Traditional consultation model, 349–350 Transesophageal echocardiography (TEE), 370–371 Transferrin, 398 Trauma center care, 359 Trauma elderly blunt trauma, 3, geriatric consultation, mechanism of injury, 3–4 medications, motor vehicle collisions, physiologic changes, Trauma Quality Improvement Project’s (TQIP), 358, 359 Traumatic brain injury (TBI), 2, 250, 256, 278, 409 anticoagulation, 277 epidemiology, 273–274 in geriatric patients, 273 medical comorbidities, 278 palliative care, 278–279 pathophysiology primary injury, 274–275 secondary changes, 275–276 statins, 278 structural injury, 276 surgical care outcomes, 264–265 treatment/outcomes, 276–277 Traumatic injury, immune system affected by, 60 Tricuspid annular plane systolic excursion (TAPSE), Tuberculosis (TB), 22–23 TUG test, 90 U Ulcers arterial insufficiency, 50 pressure, 49–50 venous ulcers, 50–51 Ultrasound biliary disease, 134–135 intestinal obstruction, 164 NSTI, 192 United Nations Population Division (UNPD), 104 Upper extremity fractures distal humeral fractures, 318–319 distal radius fractures, 318 proximal humerus fractures, 319–320 Upper gastrointestinal bleeding, 170 Urea nitrogen, 29 Uremia, 48 Urinalysis, 28 Urinary biomarkers, 29 Urinary tract infection (UTI), 61 Urine electrolytes, 28 V Vancouver classification, 316 Vascular dementia, 78, 79 Vasodilatory prostaglandins, 386 Vasopressin, 15 Vasopressors, 388 464 Venous stasis disease, 50–51 Ventilated alveolus (V/Q) matching, 376 Ventilator-associated pneumonia (VAP), 377, 378 Ventilator bundle, 377 Ventilator-induced lung injury (VILI), 379 Ventilator weaning, 380 Visceral pleura, 17–18 Vitamin(s), 399 deficiency, 47 vitamin B11, 397 vitamin D, 305–306, 397 vitamin K, 397, 408 Vulnerable Elders Survey-13 (VES-13), 91 W Warfarin, 22, 405–406 rapid reversal protocol for, 72 Index Western Trauma Association (WTA), 156 Wound healing arterial insufficiency ulcers, 50 diabetes mellitus, 47–48 malnutrition, 47 outcomes for, 53 pressure ulcers, 49–50 prevention, 52–53 principles, 51 by therapies, 48–49 venous stasis disease, 50–51 Z Zygomycete, 189 .. .Geriatric Trauma and Critical Care Fred A Luchette  •  Jay A Yelon Editors Geriatric Trauma and Critical Care Second Edition Editors Fred A Luchette... Division of Trauma, Burns and Surgical Critical Care, Brigham and Women’s Hospital, Boston, MA, USA Todd W Costantini, MD  Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery,... and Trauma, Critical Care, and Acute Care Surgery, University of Cincinnati, Department of Surgery, Cincinnati, OH, USA Patrick M Reilly, MD, FACS  Division of Traumatology, Surgical Critical Care