Geriatric Critical Care Transport They are not just old kids

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Geriatric Critical Care Transport They are not just old kids

Transcript Of Geriatric Critical Care Transport They are not just old kids

Geriatric Critical Care Transport They are not just old kids
Charles W (Chuck) Sheppard Medical Director Mercy Life Line Medical Director Mercy Kids Transport [email protected]
@chucksheppard

• None • Nada • Nein • Nyet

Disclosures

Goals for today
• Safely transport/treat us old guys/gals • Understand the physiologic changes of aging that make #1 difficult • Avoid the pitfalls we will throw in your pathway • Be able to take good care of us without necessarily using all the high tech
“fun” stuff
• Deal with more “ethical” issues

Why are we talking about this????
• Older patients make up 12% of the population and rapidly growing • They account for way more of the “sick” patients and that is growing • United States, approximately 42% to 52% of ICU admissions are geriatric
patients
• largest increases in trauma deaths were in patients in their 5th and 6th decades
of life
• Why? Because medicine has gotten very good at “fixing” acute killers • Degenerative/chronic diseases are getting more common • So we are transporting lots more “acute exacerbation of>>>>” • Even when it is a “trauma” case is affected by the chronic underlying conditions

Trauma?
• Riding into the golden years: injury patterns and outcomes of advanced-age
motorcycle trauma Muratore Am J Surg 2016

So Why are the “age enhanced” difficult??
• No 1 of course • “The good die young” • Changes in physiology • Co Morbidities increase • Medications they are on

Aging
• Has actually 2 aspects
• Chronologic • Physiologic
• Both of these affect both:
• Presentation of and • Response to treatment of Everything
• Finally the elderly are more prone to complications of both trauma, illness
and treatment

Effects of Aging
• “immunosenescence” waning of the ability to prevent infections
and response to those infections.
• The ageing immune system is characterised by a decline in stem cells,
alterations in T lymphocyte production, blunting of the B-cell led antibody response and reduced phagocytic activity of neutrophils, macrophages and natural killer cells
• Prevention: • Skin becomes “fragile” portal of entry • Immune cells are old and less responsive

Response:
• Aging decreases the tachycardic response • Blood pressure response is blunted as well • heart becomes less responsive to sympathomimetics • Increasing diastolic failure • More dependence on atrial “kick” • Blood vessels become “stiff” so more dependent on BP
for flow
Care TransportInfectionsResponsePatientsCells