Geriatric Trauma and Critical Care (2nd Edition)

Description

With the expertise of an author panel of leading clinicians in the field of surgery, trauma, critical care and geriatrics the new edition of this text addresses the explosion in knowledge on the impact aging has on injury, acute illness and critical care management. The text covers the physiologic changes associated with aging, as well as the clinical assessment, stratification, and management of acute illness and injury. Furthermore, the new edition discusses the full spectrum of critical care management of the elderly. Part I explores the impact of aging on health and the healthcare system. There will be detailed discussion on the physiologic effects of aging and the impact on clinical management. The management of common surgical emergencies in the elderly is addressed in Part II. Part III addresses the evaluation and management of trauma and injury. Finally, Part IV explores the specific challenges of critical care management, including end-of-life and ethics, in the geriatric population. Updated information, reflective of the expansive literature, is addressed in all sections. New to the second edition are chapters on prehospital care, burns, nursing concerns, and abdominal solid organ injury. Appropriate chapters will include case vignettes and clinical algorithms. All chapters include a bullet-point summary. Geriatric Trauma and Critical Care, 2nd Edition will be of great value to trauma surgeons, acute care surgeons, critical care specialists, emergency medicine physicians, geriatricians, general surgeons, and trainees in surgery, critical care, and emergency medicine. Advanced practice nurses, critical care nurses, and physician assistants will also find this a useful and practical resource.

Table of Contents

1. Changing Demographics of the American Population
2. Introduction
3. The Aging Population
4. The Cost of Caring for the Elderly
5. Effects of Aging on Organ Function
6. Trauma in the Elderly
7. Early Inpatient Rehabilitation
8. End-of-Life Issues
9. Effect of Aging on Cardiac Function Plus Monitoring and Support
10. Introduction
11. Effect of Aging on the Right Ventricle
12. Effect of Aging on the Left Ventricle
13. Effect of Aging on Vascular Structures
14. Effect of Aging on Cardiac Output
15. Effect of Aging on the Beta-Adrenergic Response
16. Effect of Aging on the Baroreflex Response
17. Effect of Surgery on the Geriatric Cardiovascular System
18. Effect of Comorbidities on Cardiovascular Function: Atrial Fibrillation
19. Effect of Comorbidities on Cardiovascular Function: Ischemic Heart Disease
20. Effect of Comorbidities on Cardiovascular Function: Heart Failure with Preserved Ejection Fracti
21. Monitoring the Aging Cardiovascular System
22. Support of the Aging Cardiovascular System
23. Summary
24. Pulmonary Anatomy
25. Introduction
26. Anatomy
27. Lung Anatomy
28. Chest Wall
29. Diaphragm
30. Pulmonary Physiology
31. Effects of Aging
32. Pulmonary Function Testing
33. Chest Wall
34. Rib Fracture
35. Airway Diseases
36. COPD
37. Alveoli
38. Bronchioles
39. Asthma
40. Restrictive Lung Disease
41. Pulmonary Embolism
42. Infections
43. Aspiration Pneumonitis
44. Cancer
45. Sleep Disorders
46. Summary
47. Renal Function in the Elderly
48. Introduction
49. Renal Biomass and Aging
50. Evaluation of Renal Function
51. Urinalysis
52. BUN, Scr, and BUN/Scr Ratio
53. Urine Electrolytes
54. Fractional Excretion of Sodium (FENa) or Urea Nitrogen (FEUN)
55. 24-Hour Creatinine Clearance (CrCl24)
56. eGFR
57. Urinary Biomarkers
58. Limitations in Renal Function Assessment
59. Epidemiology of Acute Kidney Injury and Acute Renal Failure
60. Etiology of Acute Kidney Injury and Acute Renal Failure
61. Molecular Underpinnings of AKI
62. Strong Ions, Acute Kidney Injury, and Acute Renal Failure
63. The Gastrointestinal Tract
64. Introduction
65. Age-Related Changes in Gastrointestinal Physiology
66. Gastrointestinal Motility
67. Enteric Nervous System
68. Gut Mucosa
69. Enteral Absorption
70. Mucosal Immunity
71. Gastrointestinal Injury
72. Gastrointestinal Ileus
73. Ogilvie Syndrome
74. Summary
75. Skin, Soft Tissue, and Wound Healing in the Elderly
76. Introduction
77. Skin Changes with Aging
78. Diseases of the Elderly Affecting Wound Healing
79. Malnutrition
80. Diabetes Mellitus
81. Therapies That Alter Wound Healing
82. Neurologic Diseases
83. Problem Wounds of the Elderly
84. Pressure Ulcers
85. Arterial Insufficiency Ulcers
86. Venous Stasis Disease
87. Principles of Wound Healing of Chronic Wounds
88. Burns in the Elderly Population
89. Prevention
90. Outcomes for Wounds in the Elderly
91. Summary
92. Immunologic
93. Introduction
94. Aging of the Innate Immune System
95. Neutrophils
96. Macrophages
97. Natural Killer Cells
98. Dendritic Cells
99. Aging of the Adaptive Immune System
100. T Lymphocytes
101. B Lymphocytes
102. Inflammaging: Age-Related Subclinical Chronic Inflammation
103. Risk Factors for Infection
104. Chronic Obstructive Pulmonary Disorder (COPD)
105. Diabetes Mellitus
106. Chronic Kidney Disease and End-Stage Renal Disease
107. Traumatic Injury
108. Challenges in Diagnosing Infection in the Elderly
109. Microbiology of Infection in the Elderly
110. Common Infections
111. Urinary Tract Infection
112. Respiratory Infections
113. Prevention and Potential Therapies
114. Summary
115. Hematological Changes with Aging
116. Introduction
117. Anemia
118. Bone Marrow Changes
119. Response to Hemorrhage
120. Hypercoagulability Associated with Aging
121. Medication of an Aged Population That Affects the Hematologic System
122. Geriatric Psychology and the Injured Elderly
123. Introduction
124. Cognitive Disorders/Dementia
125. Types of Dementia
126. Alzheimer’s Disease
127. Vascular Dementia
128. Lewy Body Dementia
129. Frontal Lobe Dementias
130. Cognitive Screening Tests
131. Overview of Treatments
132. Delirium
133. Definition and Epidemiology
134. Causes and Risk Factors
135. Diagnosis and Screening
136. Prevention and Treatment
137. Depression
138. Epidemiology
139. Assessment and Screening
140. Treatment
141. Substance Abuse
142. Epidemiology
143. Diagnosis and Screening
144. Treatment
145. Post-traumatic Stress Disorder
146. Summary/Differentiating Features/Impact on Care
147. Frailty
148. Introduction
149. Definition
150. Diagnosing and Measuring Frailty
151. Using Debility in Management
152. Outpatient Care
153. Preoperative Optimization
154. Future Research
155. Health-Care Economics and the Impact of Aging on Rising Health-Care Costs
156. Trends in US Health-Care Spending
157. Key Drivers of Health-Care Spending
158. Operative Risk Stratification of the Geriatric Patient
159. Introduction
160. Comprehensive Geriatric Assessment
161. Cardiac Evaluation
162. Pulmonary Evaluation
163. Mental Status and Cognitive Assessment
164. Dementia
165. Delirium
166. Depression
167. Substance Abuse
168. Nutritional Evaluation
169. Functional Assessment
170. Frailty
171. Laboratory Testing
172. Medications and Supplements
173. Cardiac Medications
174. Patient P, Decision-Making, and Advanced Directives
175. Decision-Making Capacity
176. Advanced Directives and Code Status
177. Summary
178. Appendicitis
179. Introduction
180. History
181. Epidemiology
182. Pathophysiology
183. Presentation
184. Diagnosis
185. Treatment
186. Outcomes
187. Malignancy and Mucocele
188. Biliary
189. Introduction
190. Biliary Physiology and Age-Related Pathophysiologic Changes
191. Perioperative Considerations
192. Diagnostic Investigation
193. Laboratory Testing
194. Noninvasive Imaging
195. Plain Radiographs
196. Ultrasound
197. Biliary Scintigraphy (HIDA)
198. Computerized Tomography
199. Magnetic Resonance Imaging and Cholangiopancreatography (MRI/MRCP)
200. Invasive Imaging
201. Endoscopic Retrograde Cholangiopancreatography
202. Percutaneous Transhepatic Cholangiography (PTC)
203. Benign Calculous Diseases
204. Acute Calculous Cholecystitis
205. Clinical Presentation and Diagnosis
206. Treatment of Acute Calculous Cholecystitis
207. Chronic Calculous Cholecystitis
208. Clinical Presentation and Diagnosis
209. Treatment of Chronic Calculous Cholecystitis
210. Choledocholithiasis
211. Clinical Presentation and Diagnosis
212. Treatment of Choledocholithiasis
213. Cholangitis
214. Clinical Presentation and Diagnosis
215. Treatment of Cholangitis
216. Biliary Pancreatitis
217. Clinical Presentation and Diagnosis
218. Treatment of Biliary Pancreatitis
219. Gallstone Ileus
220. Clinical Presentation and Diagnosis
221. Treatment of Gallstone Ileus
222. Benign Acalculous Diseases
223. Acute Acalculous Cholecystitis
224. Clinical Presentation and Diagnosis
225. Treatment of Acalculous Cholecystitis
226. Motility Disorders of the Biliary Tree
227. Clinical Presentation and Diagnosis
228. Treatment of Biliary Motility Disorders
229. Neoplasms of the Gallbladder
230. Gallbladder Polyps
231. Clinical Presentation and Diagnosis
232. Treatment of Gallbladder Polyps
233. Gallbladder Carcinoma
234. Clinical Presentation and Diagnosis
235. Treatment of Gallbladder Carcinoma
236. Diverticulitis
237. Anatomy of the Colon
238. Effects of Aging on Colon Motility and Function
239. Epidemiology and Pathology of Diverticular Disease
240. Treatment of Diverticular Disease
241. Uncomplicated (Simple) Diverticulitis
242. Complicated Diverticulitis
243. Diverticulitis Associated with Free Perforation
244. Summary
245. Intestinal Obstruction
246. Background
247. Causes
248. Signs and Symptoms
249. Workup and Evaluation
250. Treatment and Intervention
251. Special Considerations
252. Intestinal Hemorrhage in the Elderly
253. Introduction
254. Causes of Gastrointestinal Bleeding
255. Upper Gastrointestinal Bleeding
256. Lower Gastrointestinal Bleeding
257. Obscure Gastrointestinal Bleeding
258. Diagnosis
259. Endoscopy
260. Angiography
261. Nuclear Medicine
262. Computed Tomographic Scanning
263. CT Enterography
264. Magnetic Resonance Imaging
265. Capsule Endoscopy
266. Management
267. Initial Evaluation
268. Aspiration Risk in Elderly
269. Fluid Resuscitation
270. Medications
271. Endoscopy
272. Angiography
273. Surgery
274. Summary
275. Acute Abdomen
276. Acute Abdomen
277. History and Physical Exam
278. Laboratory Analyses
279. Diagnostic Imaging
280. Differential Diagnosis
281. Pitfalls
282. Necrotizing Soft Tissue Infections
283. Epidemiology
284. History
285. Incidence
286. Mortality
287. Etiology
288. Risk Factors
289. Classification
290. Microbiology
291. Location
292. Diagnosis
293. Clinical Exam
294. Radiology
295. Plain Films
296. Ultrasound
297. Computed Tomography (CT)
298. Magnetic Resonance Imaging (MRI)
299. Laboratory
300. Surgical Exploration
301. Adjunctive Treatments
302. Antibiotics
303. Hyperbaric Oxygen
304. IVIG
305. Other
306. Acute Vascular Insufficiency in the Elderly
307. Educational Objectives
308. Introduction
309. Acute Limb Ischemia
310. Pathophysiology
311. Clinical Presentation and Diagnosis
312. Endovascular vs. Open Surgical Management
313. Open Surgical Management
314. Fasciotomy
315. Postoperative Considerations
316. Acute Mesenteric Ischemia
317. Pathophysiology
318. Clinical Presentation and Diagnosis
319. Management of Mesenteric Ischemia
320. Summary
321. Illustrative Case Presentations
322. Thoracic Diseases in the Elderly for Geriatric Trauma and Emergency Care
323. Introduction
324. Respiratory Tract
325. Airway Obstruction
326. Clinical Presentation and Initial Management
327. Diagnosis
328. Aspiration
329. Massive Hemoptysis
330. Clinical Presentation and Diagnosis
331. Therapeutic Options
332. Outcome
333. Lung Abscess
334. Clinical Presentation and Diagnosis
335. Management
336. Outcome
337. Empyema
338. Clinical Presentation and Diagnosis
339. Management
340. Outcome
341. Spontaneous Pneumothorax
342. Clinical Presentation and Diagnosis
343. Management
344. Outcome
345. Aorta
346. Acute Aortic Syndrome
347. Clinical Presentation and Diagnosis
348. Acute Aortic Dissection (AAD)
349. Management
350. Penetrating Aortic Ulcer (PAU)
351. Management
352. Intramural Hematoma (IMH)
353. Management
354. Thoracic Aortic Aneurysm (TAA)
355. Management
356. Outcome
357. Esophagus/GI Tract
358. Esophageal Dysmotility/Impaction
359. Clinical Presentation and Diagnosis
360. Management
361. Esophageal Perforation
362. Etiologies
363. Clinical Presentation
364. Diagnosis
365. Nonoperative Management
366. Surgical Management
367. Endoscopic Management
368. Outcome
369. Paraesophageal Hernia
370. Clinical Presentation and Diagnosis
371. Management
372. Outcome
373. Summary
374. Prehospital Care
375. History of EMS
376. Certification Levels
377. EMS System Design
378. Medical Control
379. Trauma Continuing Education
380. Prehospital Patient Care
381. Prolonged Transport Considerations
382. Golden Principles and Summary
383. Epidemiology of Injury in the Elderly
384. Introduction
385. Factors that Influence the Pattern of Injury
386. Overview of Injury
387. Injury by Mechanism and Intent
388. Falls
389. Motor Vehicle Collisions
390. Pedestrians Hit by Motor Vehicles
391. Assault and Domestic Abuse
392. Penetrating Injuries
393. Summary
394. Injury Prevention
395. Injury Prevention in the Geriatric Population
396. Background and Epidemiology
397. Risk Factors
398. Trauma Centers and Injury Prevention Programs
399. Falls
400. Motor Vehicle Collisions (MVCs) and the Older Adult
401. Elder Abuse
402. Elder Abuse Prevention (Awareness)
403. Suicide
404. Outcomes for Surgical Care in the Elderly
405. Introduction
406. Factors Affecting Outcome
407. Patient-Specific Factors
408. Systemic Factors
409. Specific Outcome Evaluation
410. Traumatic Brain Injury
411. Cervical Spine Fracture
412. Hip Fractures
413. IHF
414. Considerations Regarding Traditional Outcome Measures
415. Summary/Conclusions
416. Geriatric Neurotrauma
417. Introduction
418. Epidemiology
419. The Pathophysiology of TBI in an Aging Brain
420. Primary Injury
421. Secondary Changes
422. Structural Injury
423. Treatment/Outcomes
424. Special Considerations
425. Anticoagulation
426. Statins
427. Medical Comorbidities
428. Concussion
429. Spinal Cord Injury
430. Palliative Care
431. Chest Wall Injury: In Geriatric Trauma and Emergency Care
432. Introduction
433. Epidemiology
434. Injury Prevention
435. Treatment
436. Hospital Admission
437. Pain Management
438. Oral Pain Medications
439. Intravenous Narcotics
440. Regional Anesthetics
441. Respiratory Therapy
442. Operative Stabilization of Rib Fractures
443. Summary
444. Solid Organ Injury
445. Caveats in the Decision for Nonoperative Management of Solid Organ Injuries in the Elderly
446. Management of Splenic Injuries
447. Management of Liver Injuries in the Elderly
448. Management of Renal Injuries in the Elderly
449. Pelvic Fracture
450. Introduction
451. Epidemiology
452. Risk Factors
453. Anatomy
454. Classification
455. Diagnostics
456. Treatment
457. Outcome
458. Summary
459. Bibliography
460. Extremity Injury
461. Prevention of Osteoporotic Fractures
462. Non-pharmacologic Interventions
463. Pharmacological Interventions
464. Calcium and Vitamin D
465. Estrogen and Estrogen-Related Compounds
466. Bisphosphonates
467. Calcitonin
468. Parathyroid Hormone
469. Denosumab
470. Strontium
471. Fluoride
472. Summary and Conclusions
473. Consideration in Treatment of Osteoporotic Bone
474. Pre-operative Evaluation and Considerations
475. Timing of Surgery
476. Type of Anesthesia
477. Summary
478. Treatment of Specific Fracture Types
479. Hip Fractures
480. Epidemiology
481. Femoral Neck Fractures
482. Summary
483. Intertrochanteric Fractures
484. Subtrochanteric Fractures
485. Mortality After Hip Fractures
486. Return to Functional Status
487. Summary
488. Acetabular Fractures [132–143]
489. Non operative Management
490. Comparison of Operative Versus Non Operative Care
491. Percutaneous Fixation
492. Total Hip Arthroplasty
493. Mortality
494. Summary
495. Periprosthetic Fractures
496. Fractures Around a Total Hip Replacement
497. Fractures Around a Total Knee Replacement
498. Upper Extremity Fractures
499. Distal Radius Fractures
500. Distal Humeral Fractures
501. Proximal Humerus Fractures
502. Penetrating Injury in the Elderly
503. Introduction
504. Epidemiology
505. Special Considerations: Physiologic and Pharmacologic Changes
506. Triage of the Elderly Trauma Patient
507. Initial Evaluation and Management
508. The Elderly Burn Patient
509. Introduction
510. Epidemiology
511. Pathophysiology
512. Treatment
513. Outcomes
514. Prevention
515. Geriatric Medicine
516. Gerontology
517. Geriatric Medicine
518. Frailty
519. Falls
520. Polypharmacy
521. Pain Management
522. Delirium
523. Management of the Hospitalized Older Adults
524. Models of Care and the Role of a Geriatrician
525. Critical Care Epidemiology and Outcomes/Resource Use in the Elderly
526. Growth of the Elderly Population
527. Critical Care Resource Use in the Elderly
528. Critical Care Outcomes in the Elderly
529. Frailty and ICU Outcomes in the Elderly
530. Planned Surgical Versus Medical and Unplanned Surgical ICU Admissions
531. Outcome Measures: Mortality Versus Long-­Term Functional Outcomes
532. Elderly Critical Care Trauma Outcome and Resource Utilization
533. Super-Elderly Trauma Patients
534. Performance Improvement in Elderly Trauma
535. Outcomes in Special Populations
536. Respiratory Failure Requiring Mechanical Ventilation
537. Respiratory Failure Requiring Noninvasive Ventilation
538. Critical Care Resource Utilization and Physiology of Aging
539. Cardiac Physiology
540. Pulmonary Physiology
541. Renal Function
542. Efforts to Improve Elderly Outcomes
543. Advance Directives/POLST
544. Delirium Prevention, Diagnosis, and Management
545. Nutrition Support
546. Infection Prevention
547. Cardiovascular/Invasive Monitoring
548. Introduction
549. Physiologic Changes
550. Atrial Fibrillation
551. Myocardial Ischemia/Infarction
552. Hemodynamic Monitoring
553. Continuous Central Venous Oximetry
554. Pulse Contour Analysis
555. Noninvasive Methods
556. Echocardiography
557. Pulmonary Critical Care and Mechanical Ventilation
558. Age-Related Changes to Respiratory Physiology
559. Principles of Pulmonary Care in the Elderly
560. Optimizing Gas Exchange
561. Preventing Aspiration
562. Prevention of Pulmonary Infections: On or Off Ventilator
563. Early Detection of Deterioration
564. Early Detection and Prompt Therapy of Pulmonary Infection: On or Off Ventilator
565. Identification of Failure of Therapy
566. Assistance with Ventilation If Required
567. Noninvasive Ventilation
568. Endotracheal Intubation and Assisted Ventilation
569. Weaning from Ventilator and Extubation
570. Role of Tracheostomy
571. Ethical Considerations and End-of-Life Care
572. Renal Replacement Therapy
573. Introduction and Epidemiology
574. Definitions
575. Risk Factors
576. Age-Related Changes of the Kidney and Risk of AKI in the Elderly
577. Chronic Kidney Disease and Risk of AKI in the Elderly
578. Volume Status and Risk of AKI in the Elderly
579. Infection
580. Nephrotoxins and the Risk of AKI in the Elderly
581. Anatomic Causes of AKI
582. Preventing AKI
583. Evaluation of AKI
584. Treatment
585. Diuretics in ARF
586. Indication for RRT
587. Principles of Renal Replacement Therapy
588. Intermittent Versus Continuous RRT
589. RRT Dose
590. RRT Modalities and Outcomes
591. Prognosis and Ethical Issues of Treating AKI in the Elderly
592. Nutrition Support
593. Introduction
594. The Current State
595. Nutritional Assessment
596. Nutritional Scales (Walker Review Article)
597. Metabolic Requirements
598. Physiologic Changes
599. Common Deficiencies
600. Nutritional Monitoring
601. Risk Factors
602. Screening Tools
603. Albumin
604. Transferrin
605. Prealbumin
606. Total Lymphocyte Count
607. Diagnosis of Malnutrition
608. Nutritional Requirements
609. Carbohydrates
610. Proteins
611. Lipids
612. Vitamins and Minerals
613. Calcium
614. Fluids
615. Glutamine
616. Indications for Nutritional Support
617. Enteral Nutrition
618. Parenteral Nutrition
619. Nutrition in Palliative Care and the Terminally Ill
620. Psychosocial Aspects
621. Anorexia
622. Cachexia
623. Ethical Decision-Making Regarding Artificial Nutrition
624. Summary
625. Common Pharmacologic Issues
626. Introduction
627. Pharmacokinetic and Pharmacodynamic Alterations in the Elderly
628. Anticoagulant and Antiplatelet Agents
629. Antiplatelet Agents
630. Reversal of Pre-injury Antiplatelet and Anticoagulant Agents (Table 39.1)
631. Beta-Blocker Therapy
632. Delirium and Management in the Elderly
633. Pain Medications and Management
634. Summary
635. Nursing Consideration
636. Introduction
637. Knowledge Development
638. Frailty
639. Focused Assessment
640. ICU Triad
641. Pain
642. Agitation
643. Delirium
644. Management Strategies: The “ABCDE Bundle”
645. Rehabilitation Concerns in Geriatric Trauma
646. Introduction
647. Understanding Rehabilitation
648. Rehabilitation and the Need for a Different Approach
649. Rehabilitation Assessment
650. Rehabilitation Outcomes
651. Assessment Instruments
652. Functional Status and Frailty
653. Function Restoration
654. General Principles for Rehabilitation Intervention Therapy
655. Functional Restoration Team
656. Rehabilitation Settings
657. Acute Inpatient Rehabilitation Facility (IRF)
658. Skilled Nursing Facilities (SNF)
659. Long-Term Acute Care (LTAC)
660. Home Health Services
661. Outpatient Therapy
662. Telerehabilitation
663. Assistive Technologies
664. Challenges and Barriers to Rehabilitation
665. End-of-Life Care
666. Epidemiology
667. Surgical Buy-In
668. Day Mortality
669. Frailty vs. Age
670. Establishing Goals of Care
671. Terms and Definitions
672. Advance Directives
673. Do Not Resuscitate (DNR)
674. Healthcare Power of Attorney
675. Futility
676. Planned vs. Emergent Admission ICU
677. Palliative Care Models
678. Consultative
679. Triggers
680. Team Based
681. Communication and Family Meetings
682. Symptom Management
683. Pain
684. Respiratory Distress
685. Gastrointestinal Symptoms
686. Cognitive Failure
687. Withdrawal of Life-Sustaining Treatment
688. Bereavement and Grief
689. Ethics in Geriatric Trauma
690. Introduction
691. Basic Principles of Medical Ethics
692. Non-maleficence
693. Beneficence
694. Autonomy
695. Justice
696. Principle of Double Effect
697. Scarce Resources and Access to Care
698. Confidentiality and Privacy
699. Informed Consent
700. Decision-Making Capacity
701. Advance Directives
702. Surrogate Decision Making
703. Do Not Resuscitate
704. Futility
705. Summary
706. Erratum to: Extremity Injury.