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RESEARCH PRODUCT

Principles of Damage Control in the Elderly

subject

description

A steadily increase of severely injured elderly patients may be expected. Comorbidities are present in the majority of these patients and negatively influence outcome. Blunt trauma is the leading cause of high-energy injuries in the elderly. Motor vehicle accidents, either as driver or as pedestrian hit by a car, and falls from height are the most important mechanisms of polytrauma. The principles of advanced trauma life support (ATLS) should also apply for elderly persons. Underestimation of the severity of injury is a common problem leading to undertriage. A basic rule of primary care is to avoid the lethal triad of hypothermia, coagulopathy and acidosis. Emergent invasive monitoring reduces mortality. In the primary operative phase, the surgeon should be guided by two directives: “treat first what kills first” and “do not harm”. The main goals of emergent treatment of fractures are controlling major instability, stopping contamination and reducing pain. Second look surgery and reconstructive procedures must be scheduled in intense cooperation with the intensivist. Although the majority of elderly patients survive damage control measures, outcome of management shows higher mortality levels. Surviving patients experience in-hospital morbidity measures, which are comparable to younger patients. This supports damage control procedures in severely injured elderly patients.