Intervention Paper: Treatment Paradigm of Elderly Trauma Patients
Darren J Hunt, RN
College of Nursing
University of New Mexico
As the population of our world grows older on average, the question of how to care for them becomes increasingly complex. With the longer life expectancy there exists a kind of Achilles heal regarding elderly trauma patients and the response to treatment for life-threatening injuries. The older trauma patient is often times a victim of slow trauma (occurring over years of injuries and illnesses) before they are made victims of the trauma that gets them admitted to the hospital. Just because we are getting older before we die does not mean we are any healthier. We may last longer but the quality of our health and lives is in question when we sustain an injury or insult that would be serious even in a much younger and healthier patient. So the question is: “What, if anything , can we do to improve overall outcome of trauma in the elderly?”. The situation presented in this paper asks the question as applied to a younger elderly patient with multiple co-morbidities prior to sustaining a multi-system trauma.
JR is a 64 year-old female who was transported by EMS to the Emergency Department after she was a restrained driver in a motor vehicle collision where her vehicle reportedly rear-ended another car. She was originally not a trauma alert protocol. She was admitted to the Emergency Room. However, she was noticed to be hypotensive in the ED, and Trauma Surgery was called for consultation. At the time of examining the patient, the patient was complaining of left knee pain. She denies shortness of breath or chest pain, no abdominal pain, nausea or vomiting. She was complaining of abdominal wall tenderness in her mid abdomen and on her pannus.
The patient was alert and complaining of left lower extremity pain and abdominal wall pain. Advanced imaging revealed complex abdominal wall hematoma without gross contrast extravasation, and no distinct intra-thoracic or intra-abdominal injury. Shortly after returning to the ED from CT scan, the patient developed a respiratory arrest followed by profound bradycardia. ED staff intubated her, and ACLS resuscitation initiated. Three rounds of medications and electricity were given and JR showed signs of ROSC. She also received transfusion of PRBCs. She was taken to the TSI for further resuscitation and consultation with Cardiology.
JR remained in the hospital for another 32 days after admission. She remained critically ill and had complications associated with her pre-existing issues more so than her admitting diagnoses. She continued to have episodes of a-fib requiring chemical as well as electrical cardioversion. JR was placed on continuous EEG on three separate occasions, all showing seizure activity. Forecasting for a prolonged rehabilitation, JR had a tracheostomy and a G-tube placed. Over the next few weeks she showed marginal improvement and underwent more surgical interventions to deal with abdominal infection and traumatic injury resolution. The patient developed supraventricular tachycardia, which was treated with chemical and electrical interventions. As the frequency and refractoriness of the condition increased we were able to finally convince the family to de-escalate care and provide comfort measures. After the decision was made the patient expired approximately four hours later. PAST MEDICAL HISTORY:
1. Chronic ischemic heart disease with a myocardial infarction in April 2011. 2. Congestive heart failure.
3. Sick sinus syndrome with a pacemaker.
4. Paroxysmal atrial fibrillation.
5. Diabetes mellitus, type 2.
7. Chronic kidney disease, stage IV.
10. Chronic low back pain.
13. Chronic iron deficiency anemia.
14. Bilateral lower extremity venous insufficiency.