Version June 2024
| What the injured elderly would tell you (if they could) | Related physiology and rationale |
| "I can go from normotensive to hypotensive in a heartbeat." | Profound, life-threatening hypovolemia may occur in the setting of normal blood pressure. Physiologic reserve is minimal, and hemodynamic decompensation can occur quickly. |
| "I respond poorly to too much or too little fluid." | The therapeutic window for cardiac preload is narrow, and inadequate preload monitoring may lead to errors in volume resuscitation. |
| "My subdural hematoma hasn't expanded enough yet to really affect my level of consciousness." | Cortical atrophy, common in the elderly, may act to delay the clinical manifestations of serious intracranial hemorrhage. This hemorrhage may be clinically occult. |
| "Trauma is not really my major problem." | Stroke, myocardial infarction, and seizures may result from falls or motor vehicle crashes and delayed diagnosis of the principal underlying problem. |
| "I only look like I have adequate ventilatory reserve." | Ventilatory failure and respiratory arrest may occur suddenly in conjunction with chest or abdominal injuries despite a benign outward clinical appearance. |
| "I get demand ischemia if I have too much pain or my hematocrit drops below 29." | Myocardial (demand) ischemia may result from severe or prolonged pain or from transfusion thresholds that have not been appropriately liberalized in the setting of coronary artery disease. |
| "I can't stand even a little shock or hypoxia...and neither can my myocardium." | Even minor perturbations in perfusion, oxygenation, or vasoconstriction may lead to major cardiac complications. |
| "My connective tissue just ain't what it used to be..." | Decrease in connective tissue integrity with less "tamponade effect" for hemorrhage into soft tissues. Blood loss into soft tissue spaces, including subcutaneous loss, may be excessive and is often overlooked. |
| "The sensitivity of my abdominal examination is better than flipping a coin...but not much." | Clinical manifestations of serious abdominal injury in elderly patients are often minimal. Reliance on the abdominal examination often leads to missed abdominal injuries. |
| "My bones are brittle...my hip bone, my shin bone, and my aortic bone!" | BAI may occur in the elderly in the absence of conventional signs or symptoms. A low threshold for CT imaging should exist. |
| "A little medication goes a long way with me..." | Failure to adjust medication dosage, particularly sedative-hypnotics and analgesics, may result in serious complications. |
| "I just haven't been eating so well lately." | Chronic malnutrition is common and often undiagnosed. |
| "My injuries weren't accidental." | Elder abuse is common and often unreported and undiagnosed. |
| "Major trauma? Heck, I wouldn't even tolerate a brisk haircut..." | Underestimating and undermanaging comorbidities (eg, chronic obstructive pulmonary disease, coronary artery disease, smoking, ethyl alcohol [ETOH] consumption) may result in preventable morbidity/mortality. |
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