Welcome to the bed. We'll go ahead and give you
the story. This is all going to happen super
fast. Welcome to the emergency room. Okay, let's
get into it. We're seeing, right now, one of
the biggest social transformations of this century.
The world is, well, it's getting older. Fast,
and this isn't some abstract idea, right? Not
at all. It's probably the defining challenge
that's reshaping our entire healthcare system
as we speak. Yeah, and the sources we're looking
at today make that demographic shift. I mean,
it's just... It's crystal clear. It's staggering,
really. You're talking about the fastest growing
part in the US population. And if you look globally,
the numbers are just massive. How massive? Well,
by 2050, something like half the world is going
to be living in a country where one in five people
is over the age of 60. One in five, wow. Yeah.
I mean, that's a revolutionary shift in how we
live, but also in what our trauma centers are
going to be facing every single day. And that's
exactly what we're here to talk about. This deep
dive is all about geriatric trauma. We've designed
this as a critical review guide for you, the
learner, to really zero in on that crucial 20
% of information that gives you 80 % of the clinical
understanding you need. The Pareto principle
for trauma. Exactly. We're focusing on the unique
physiology, the management priorities, really
hitting on the nursing implications and what
you need to do in those first critical minutes.
And the stakes are just. They couldn't be higher.
Yeah. Injury is now the fifth leading cause of
death in the elderly. The fifth. And the data.
It's totally unequivocal. An older adult will
have a much higher mortality rate, even when
their injuries, by the standard scores, look
exactly the same as a younger patient's. So if
the injury itself isn't the only thing driving
that mortality, we have to be looking somewhere
else. It's not just the crash or the fall. That's
the whole point. What's driving this? Yeah, what
is it? It's this complex mix. The sources call
them host factors. So the aging of their organ
systems, the burden of all the diseases they
already have, frailty, and this is a big one.
Our failure to triage them correctly in the acute
setting. So we miss the signs. We miss the subtle
signs. And if we do, the outcome is just devastatingly
different than it would be for a 40 -year -old
with the same injury. OK. So it's a race against
the patient's own body. A race against their
limitations. Exactly. All right. Let's start
with the absolute core concept here. The thing
that explains almost everything else we're going
to talk about. Decreased physiologic reserve.
What does that phrase actually mean when we're
standing in a loud chaotic trauma bay? It's the
body's safety margin. That's the easiest way
to think about it. OK. I mean, in a practical
sense, aging just means that cellular function
is declining everywhere in all the systems. Right.
So as those cells get less efficient, the big
systems, the heart, the lungs, the kidneys, they
lose their ability to perform above just their
normal baseline. So they have no surge capacity.
Exactly. They have no surge. So when that elderly
patient gets hit with a major trauma, their body's
adaptive mechanisms, the very things designed
to cope with massive stress like blood loss,
they're just impaired. They lack that safety
margin to fight back. So a younger person has
this like deep reserve tank they can pull from
to compensate for shock or fight off an infection
for hours. But the older patient's tank is It's
already running on fumes. That's a perfect analogy.
The tank is almost empty to begin with. So how
much warning do we actually get before they crash?
Very, very little. That's the terrifying part.
The sources really stress that insults that a
younger patient would just tolerate. you know,
a minor fracture, a little bit of blood loss.
Right. That can lead to just devastating, often
fatal results in an elderly patient. Their adaptive
response is blunted and it's instantaneous. They
start so much closer to that failure point. So
once they tip over that edge into real shock.
Recovery is incredibly difficult. Their mechanisms
for adaptation are already exhausted or they
just don't work anymore. That completely changes
the urgency. It means we have to treat even what
looks like mild instability as a code red event.
Absolutely. And that brings us right to the next
factor. Pre -existing conditions. PECs. Right.
The compounders. The sources highlighted five
that really, really impact outcomes. What are
the five we have to be screening for immediately?
OK. So the five high impact PECs from the research
are cirrhosis, coagulopathy, COPD, That's chronic
obstructive pulmonary disease, ischemic heart
disease, and diabetes. OK, that's a big list.
It is. And the presence of any one of these just
tanks their already limited reserve and totally
changes the patient's prognosis. Let's break
down why these five are so bad in a trauma. I
mean, beyond just having the diagnosis. For sure.
Let's think of it as failing defenses. So cirrhosis.
That compromises the liver. The liver makes clotting
factors. It metabolizes waste. Post -trauma,
that patient is at huge risk for just bleeding
out. They can't clot. And they can't clear all
the inflammatory toxins that get released during
shock. OK, what about coagulopathy if they already
have a bleeding problem? That's just a catastrophic
risk multiplier from second one, especially with
hidden bleeding in the head, which we'll get
to. And COPD. That's a direct attack on their
respiratory reserve. These patients already have
trouble getting air out. Their lungs are stiff.
Their functional reserve is tiny. So there's
no wiggle room. Zero. Yeah. A little bit of pain
from a rib fracture that makes them breathe shallow.
That can cause a complete respiratory collapse.
Fast. OK. And ischemic heart disease? That means
their heart muscle is already weak. So when you
hit it with the massive stress of trauma, the
need for high cardiac output. It can't keep up.
It can't. They're a huge risk for a heart attack
right there in the trauma bay, which can just
trigger the whole collapse into irreversible
shock. And finally, diabetes. Diabetes messes
with everything. Immune function, vascular health.
They're a much higher risk for infection, for
poor wound healing, and the stress of the trauma
itself. sends their blood sugar into chaos, which
just accelerates all the bad outcomes. That list
covers a huge number of people. Do we know how
common this kind of stacked risk is? The data
is pretty wild. In one study, a full one -fourth
of all trauma patients over 65 had at least one
of these five packs. A quarter of them. And here's
the real need -to -know takeaway from that. Patients
with one or more of these conditions were nearly
two times more likely to die after their trauma
than patients who had none. Two times? Yeah.
This isn't just, you know, statistical noise.
This is a fundamental driver of who lives and
who dies. So it's an exponential increase in
risk just based on who the patient is before
we even get to the injury. Exactly. Let's dig
into that relationship between age, the pecs,
and mortality. The data visualization and the
source material really drives this home. It's
not a straight line, is it? No, it's a compounding
effect, a stacking effect. Your mortality risk
doesn't just go up because you're old. It goes
up significantly by decade 70s, 80s, 90s. Right.
But then it gets compounded by how many of those
pecs the patient is carrying? Zero, one to two,
or three or more? So it's a multiplier. A seven
-year -old with zero pecs has a manageable risk.
But a 70 -year -old with three or more pecs might
have a risk profile that's actually worse than
someone in their late 80s with fewer conditions.
That's it. Exactly. It's about their physiological
age, not their chronological age. And their physiological
age is defined by these conditions. Right. The
expert insight here is that while the injury
severity is, of course, the primary driver, a
catastrophic injury is always bad. These host
factors play a huge additive and often exponential
role. It's a severe trauma plus zero reserve.
So you have to manage the injury and the host.
You have to. That vulnerability really sets the
stage. But how does that fragility actually play
out when they get injured? Let's talk about the
mechanisms. Okay. We often think of big car crashes,
but the sources point to falls as the single
most common fatal mechanism. That's a really
important distinction. Not just common, but the
most common killer. It is. The risk of falling
just goes up dramatically with age. sensory decline,
balance problems, medications, and it's often
a seemingly simple ground -level fall. You know,
tripping on a rug. But the consequences are anything
but simple. And what's the specific risk from
falls we absolutely have to hammer home? Traumatic
brain injury. TBI. Falls are the number one cause
of TBI in the elderly. Wow. And get this, nearly
half of all the deaths from ground -level falls
are a direct result of a TBI. Half? Why is that?
It's because of cerebral atrophy. As you age,
your brain shrinks a little bit. That leaves
a bigger space between the surface of the brain
and the inside of the skull. Right. So during
a minor fall, the brain has more room to move
around and tear the tiny little bridging veins
that connect it to the skull. That leads to a
subdural hemorrhage. Low impact, catastrophic
result. And beyond the TBI risk, there's another
really devastating outcome related to falls,
specifically hip fractures. This one speaks to
the long term cost. This is a heartbreaking one.
The loss of independence is huge. The sources
say that one half of elderly patients who suffer
a hip fracture will no longer be able to live
independently. Half of them. That means months
of rehab. And often it means a permanent move
to assisted living. The focus has to be on fall
prevention in the first place. OK, let's shift
to motor vehicle crashes. The sources say older
people are generally safer drivers. They drive
less. They drive slower. Right. On familiar roads.
So when fatalities do happen, what's the context?
What are the clues we need to look for? It's
interesting. The fatalities usually happen during
the day. on weekends and they typically involve
other cars. That points to issues at intersections
or complex moves that need quick reaction times.
And what are the underlying physical things that
contribute? Slower reaction time is a huge one.
Vision and hearing impairment too. But one that's
really underappreciated is limited neck mobility.
From arthritis. Yeah, from arthritis in the neck.
If an older patient can't turn their head easily,
they can't scan traffic, they end up with these
huge functional blind spots, they never see the
other car coming. That makes so much sense. And
is there a hidden medical cause we should be
thinking about? Yes. And this is critical for
your differential diagnosis. You always have
to consider that the crash itself might have
been caused by a physiological event. Like a
heart attack. Exactly. A heart attack, a stroke,
a cardiac dysrhythmia. Yeah. You can't just treat
the trauma from the crash. You have to look for
the medical crisis that made them lose control
in the first place. So assume they had a medical
event until you prove otherwise. You got it.
Let's talk about burns. The sources are really
clear that burns are just devastating for the
elderly. Why is the mortality so high here? It
comes right back to that loss of physiologic
reserve and the physical changes in their skin.
How so? An older patient's body just can't meet
the immense demands of a burn injury. The hypermetabolism,
the massive fluid shifts, the constant threat
of infection. It's too much for their systems.
Their reaction times are also slower, so they're
exposed to the heat for longer. And there is
a fascinating little detail, a smallest detail,
about how their skin itself changes. This is
a great clinical pearl. A common mechanism is
spilling hot liquid on their leg. In a younger
person, that might be a partial thickness burn
that can heal on its own, because they have a
lot of hair follicles that act as reservoirs
for new skin cells. But in older patients, because
they have fewer of those follicles in their skin,
that same spill often results in a full thickness
burn. Which needs surgery. Exactly. Extensive
surgery, grafting, a long recovery. All things
that just hammer their already tiny physiologic
reserve. That's a brilliant example. Finally,
penetrating injuries. Blunt trauma is more common,
but where does this fit in? It's the fourth most
common cause of traumatic death in people over
65. But the critical implication here is often
psychological. How do you mean? A lot of the
deaths from gunshot wounds in the elderly are
related to intentional self -harm or suicide.
Ah. So as clinicians, we have to recognize that
hidden aspect and make sure we're getting mental
health and social services involved right away
if the patient survives. We've set the stage
with the vulnerabilities and the mechanisms.
Let's move into the acute management. The core
principles are still ATLS, right? But we have
to adapt them. Yeah, the structure of ABCDE is
the same. But how you interpret the findings
and, crucially, your threshold for intervention,
that changes dramatically. So this is where we
need to know what looks normal but is actually
a disaster waiting to happen. Exactly. That table
from the source, table 11 -1, that details the
system changes. That's the Rosetta Stone for
adapting ATLS to a geriatric patient. Let's start
with A for airway. What are the key challenges
here? It's twofold, really, anatomically. First,
they lose their protective airway reflexes, so
the aspiration risk is sky high. You have to
make the decision to intubate much sooner. And
the second part? The second is the arthritis
in their jaw, in their neck. It can make just
opening their mouth difficult, let alone manipulating
the cervical spine for intubation. So a difficult
procedure gets even harder. What's a really practical
hands -on tip for managing the airway right away,
especially with mask ventilation? The big one
is about dentures. OK. If the dentures are not
in the way, leave them in during bag mask ventilation.
They provide structure and help you get a much
better seal with a mask. And if they don't have
any teeth? intubating might be easier, but bagging
them is way harder because their cheeks just
collapse in. The trick is to place some gauze
between their gums and their cheek to create
that seal you need. That's a great tip. What
about the medications for RSI, that rapid sequence
intubation? This is a huge, smallest detail.
You have to reduce the doses of your sedatives,
barbiturates, benzodiazepines by 20 to 40 percent.
20 to 40? Why so much? Because of their reduced
reserve and slower metabolism. If you give them
a standard adult dose, you risk causing immediate,
profound, and possibly fatal hypotension. Got
it. Okay, on to B for breathing. The source talks
about insidious failure here. What's going on
with their respiratory mechanics? Everything
is working against them. Their chest, wall, and
lungs are stiffer, so it's more work to take
a breath. gas exchange is less efficient. And
critically, their functional residual capacity,
the FRC, is much smaller. And the FRC is what,
the air left in your lungs after you breathe
out? Exactly. It's your buffer. When that shrinks,
you have zero room for error. A small injury,
pain from a rib fracture, even just lying flat
for a CT scan can cause their small airways to
collapse. And the hidden danger here is in the
vital signs, right? Yes. This is so important.
Aging suppresses the heart rate response to a
lack of oxygen. So they don't get tachycardic
when they're hypoxic. They might not. That critical
warning sign might be completely absent. So respiratory
failure can present insidiously. You look at
the monitor, the heart rate is fine, but their
O2 sat is plummeting. So the implication for
us is... Be aggressive. Don't wait for the classic
signs. Exactly. Your threshold for intubating
has to be much, much lower. And you have to manage
rib fractures like your hair is on fire. Older
patients just do not tolerate them well at all.
It's a fast track to pneumonia. OK, let's go
to C for circulation. This feels like the biggest
pitfall in geriatric trauma failing to recognize
shock because the vitals look OK. It's probably
the most common and most deadly mistake. What's
the physiology behind this masked response? It's
what we call the fixed response. Age -related
changes mean they often have a fixed heart rate
and a fixed cardiac output. They can't speed
up. So unlike a younger person who gets tachycardic
when they're bleeding. The older patient's response
is to clamp down their peripheral blood vessels.
They increase their systemic vascular resistance,
or SVR, to try and maintain their blood pressure.
And if they're on beta blockers? It's even worse.
Up to 20 % of them are. The beta blocker just
makes it physiologically impossible for the heart
to speed up, even if they're bleeding to death.
So if tachycardia, the classic sign of shock,
is gone, how do we spot it? This is where the
source flags a huge shift in our assessment.
What is the new definition of hypotension for
this group? This is the number you need to burn
into your brain. A systolic blood pressure of
110 millimeter Hg should be your threshold for
identifying hypotension in anyone over 65. 110.
110. Because so many of them have high blood
pressure to begin with, a BP of 12 ,880 might
actually be profound shock for them. If they
hit 110, you have to assume they're in significant
shock and act immediately. Wow. That one number
changes everything. So the new mantra is, do
not equate BP with shock. What's the clinical
implication for managing that? If you see any
evidence of circulatory failure, Even if it looks
mild, you have to assume they are bleeding, period.
And you need to look for definitive evidence
of tissue hypoperfusion that bypasses those masked
vital signs. With labs. Like labs. You have to
use serum markers, like lactate and base deficit.
A high lactate is a five alarm fire. It tells
you that cells are starving for oxygen, no matter
what the blood pressure cuff says. So what's
the plan for treatment? You go fast to aggressive,
balanced resuscitation. blood products early.
And you need to consider advanced monitoring
sooner. A central line, a focused cardiac ultrasound
to guide your fluid resuscitation. You have to
walk this tightrope between giving them enough
fluid, but not so much that you put their already
stiff heart into failure. Okay, let's move to
D for disability. Neurological assessment. This
is complicated by brain atrophy and, of course,
medications. Right. That cerebral atrophy creates
what we call the silent space. It allows a bleed
in the head, like a subdural, to get pretty big
before it starts causing symptoms. So a normal
neuro exam, a normal GCS, it doesn't mean they're
okay. It absolutely does not. It could be a deadly
deception. But the number one highest priority
here seems to be their coagulation status. This
is the single most actionable life or death point
in the D assessment. So many older patients are
on anticoagulants or antiplatelets. Blood thinners.
Right. Warfarin, xarelto, eliquis, plavix, aspirin.
This puts them at an incredibly high risk for
intracranial hemorrhage. Early identification
and timely, aggressive reversal of those drugs
is the single most important thing we can do
to improve their outcome. Let's get into the
weeds on reversal, the smallest details. What
about those newer drugs, the DOACs? Okay, so
for warfarin, it's pretty straightforward. You
give prothrombin complex, concentrate, PCC, plasma,
and vitamin K. PCC is the fastest, but here's
the really scary part. With the newer drugs,
the DOACs, their standard coagulation labs, like
an INR, might look perfectly normal. Wait, so
the lab test is normal, but they're still at
high risk of bleeding. Exactly. It's a terrifying
clinical moment. The lab is lying to you. There
are specific reversal agents for some of these
newer drugs, but they're not always available.
The bottom line is you have to find out what
drug they're on and start the reversal protocol
immediately if you even suspect a head injury.
You can't wait for a lab test that might be falsely
reassuring. Okay, last one in the primary survey,
E for exposure and environment. The priority
here is preventing hypothermia. Why are they
so at risk for getting cold? multiple reasons.
They have less subcutaneous fat to insulate them,
nutritional issues, chronic conditions. All of
it just dramatically increases their risk for
hypothermia. And hypothermia is bad in trauma
because it messes up your ability to clot, creating
a vicious cycle of bleeding, and it increases
the risk of lethal cardiac arrhythmias. And what's
the nursing priority? Balancing the need for
a quick exam with preventing other problems.
You have to do the exam. But the priority is
early liberation from spine boards and c -collars
once you've cleared the spine. To prevent pressure
sores, pressure injuries, and delirium. You have
to pad their bony prominences immediately and
be relentless about keeping them warm with forced
air warmers and warm fluids. Let's circle back
and really synthesize some of the system changes
from that table and the source material. Let's
start with cardiac again. What does that fixed
output really mean when we're trying to give
fluids? It means you have a tiny, tiny therapeutic
window. If you don't give enough fluid, they
crash from hypovolemia. If you give too much,
their stiff, weak heart can't handle the volume,
and you push them into congestive heart failure
and pulmonary edema. It requires exquisite, careful
titration. Okay, and the renal system. You mentioned
a paradox where normal labs don't mean normal
function. This is a huge spot for medication
errors. Kidney function goes down with age, but
because they also have less muscle mass, they
don't produce as much creatinine. So their serum
creatinine level might look normal, but it's
not reflecting their true underlying kidney dysfunction.
So you have to assume their kidneys are worse
than the labs say they are. Always. You have
to assume renal insufficiency and adjust your
drug doses accordingly, especially for drugs
cleared by the kidneys. And how does the kidney
also mask hypovolemia? This is another tricky
one. The aging kidney doesn't respond as well
to the hormone that tells it to hold on to water
when the body is dehydrated. So they keep making
urine even if they're in shock? They can, yeah.
Urine flow might look normal or even high, despite
the patient being profoundly hypovolemic. So
you can't use urine output alone as a reliable
guide for your resuscitation. Let's move to three
specific injuries that the source's flag is being
extra high -risk, starting with rib fractures.
The source calls it the pneumonia trap. It's
a perfect name for it. It is the single most
common cause of early problems after chest trauma
in this group. The incidence of pneumonia can
be as high as 30%. And the mortality risk goes
up with every single additional rib that's broken.
So the goals are pain control and pulmonary hygiene.
But the source warns about the narcotic pitfall.
What's that? This is critical. You have to give
them pain medicine so they can take deep breaths
and cough. But if you give them too much... You
cause respiratory depression and delirium. So
you make the problem worse. Exactly. You get
the opposite of what you want. They stop breathing
deeply, and that just accelerates the collapse
into pneumonia. It's a vicious cycle. So what
are the strategies to avoid that? First, you
have to be vigilant, watching their breathing,
not just their O2 sat. Second, when you do use
narcotics, use smaller doses of shorter acting
ones. They clear faster. Third, and this is key,
prioritize non -narcotic options, regional nerve
blocks, epidurals. They provide great pain relief
without the systemic side effects. Okay, next,
traumatic brain injury. We know it's common in
falls. What's the core challenge here? The challenge
is that their high mortality isn't just because
of the injury itself, but because of their inability
to recover. And making the diagnosis is incredibly
difficult. Why? Because of their baseline. Pre
-existing dementia or delirium makes it really
hard to tell if a change in their mental status
is from the TBI or something else. You just can't
rely on the GCS score alone. So the management
priority is? Liberal use of CT scans. You just
have to have a very, very low threshold to scan
them, especially if they're on any kind of blood
thinner. And again, if you find a bleed, the
absolute priority is aggressive early reversal
of that anticoagulant. Lastly, pelvic fractures.
In younger people, these aren't always a huge
deal unless there's major bleeding. What's different
here? The risk profile just skyrockets. They're
usually from ground level falls onto osteoporotic
bone. And mortality from a pelvic fracture is
four times higher in older patients than in younger
ones. Four times? Wow. Is there a hidden risk
even with stable looking fractures? Yes. The
need for blood. The sources show that the need
for blood transfusion is much, much higher in
the elderly, even for fractures that look stable
on the x -ray. You have to have a low threshold
to start your massive transfusion protocol if
they're unstable at all. And the long -term outcome
is, again, about independence. Absolutely. They're
much less likely to return to an independent
lifestyle after a pelvic fracture. It really
reinforces that fall prevention is the absolute
mainstay of reducing the death and disability
from these injuries. Let's move into a few special
circumstances, starting with a revisit to medications.
Beta blockers. You mentioned them, but let's
just hammer this home. We have to. Up to 20 %
of elderly patients are on them. They physiologically
block the heart rate response to shock. It makes
your standard trauma assessment totally unreliable.
You have to know if they're on one, and if they
are, you have to switch your brain to looking
at lactate and base deficit instead of heart
rate. And for anticoagulants, what's the action
plan the second they roll through the door? Zero
tolerance for delay. You have to immediately
find out which drug they're on, talk to the family,
call the pharmacy, and start the specific reversal
agent immediately. Every minute you wait, especially
with a head injury, is brain tissue being lost.
Okay, let's talk about elder maltreatment. This
is a tough topic, but one the sources say is
dangerously under -recognized. It's hugely underestimated.
The data suggests it might be as common as child
maltreatment. but only a fraction of cases ever
get reported. Physical maltreatment shows up
in as many as 14 % of geriatric trauma admissions.
And it's not just physical abuse, right? It's
neglect, too. Right. And the signs of neglect
can be really subtle. You have to look for things
like poor hygiene, dehydration, malnutrition,
or a caregiver who just won't leave the patient
alone with the staff. And if we do suspect physical
abuse, what are the specific physical findings
we should be looking for? What's the checklist?
Okay, so you're looking for injuries that just
don't match the story of the simple fall. Things
like bruises in weird places, the inner arms
or thighs, the scalp behind the ears, on the
buttocks, areas that don't get hit in a normal
fall. Right. You're also looking for multiple
bruises clustered together, or bruises shaped
like an object, like a belt or a hand. What else?
Abrasions from restraints, usually around the
armpits or on the wrists and ankles. Untreated
pressure sores in places other than their lower
back. And maybe the biggest red flag is injuries
in different stages of healing. that points to
repeated trauma over time. That's a very clear,
actionable list. So what's the bottom line, ethically,
if the story and the injuries don't add up? You
have to report it immediately to the appropriate
authorities. And if maltreatment is confirmed
or even just suspected, your primary ethical
duty is the removal of that patient from the
abusive situation. Which brings us to the final
and maybe most important piece of this, establishing
goals of care. Given the scats, They're 12 %
of the population, but almost 30 % of trauma
deaths. This feels like a conversation that needs
to happen early. It has to happen early. The
chances of them returning to their prior level
of independence after a severe trauma are frankly
low. So an early honest conversation with the
patient, if possible, and their family about
their goals is essential. It's not about giving
up. It's about respecting their autonomy. So
why is it so crucial to do this in the middle
of a chaotic trauma resuscitation? Because the
default in trauma is aggressive, maximal care.
And without knowing the patient's wishes, we
might start down a path of surgeries, ventilators,
pressers. Things that might only prolong their
suffering without actually improving their quality
of life. So you bring in palliative care? You
bring in palliative care early. They are the
experts at navigating these conversations, at
managing symptoms, and at making sure the care
we provide is actually aligned with what the
patient would have wanted. This has been an incredibly
important deep dive. To recap, I think the central
lesson for anyone listening is that geriatric
trauma demands a totally different way of thinking.
It really does. You cannot look for the classic
signs of shock. You have to assume it's there,
even with a normal heart rate. You have to look
for that evidence of tissue hypoperfusion, that
systolic BP of 110, the high lactate, the base
deficit. And you have to reverse anticoagulation
aggressively and immediately. And the focus has
to be on managing the host. the pecs, the frailty,
that fixed cardiac response, just as much, if
not more, than the injury itself. Absolutely.
All those small details, the gauze for the adential
is patient. Knowing that a normal creatinine
is a lie, cutting your RSI drug doses, that's
what makes the difference between recovery and
a catastrophic outcome. And that leads us to
our final thought for you to chew on. The sources
note that today's elderly are more active and
mobile than ever, which puts them at higher risk.
Right. So if we think about the specific vulnerabilities
we've discussed, the massive TBI risk from a
simple fall, the devastating mortality from small
burns, what societal or infrastructure changes
things outside the hospital might have the biggest
public health impact here. That's a great question.
I mean, Is it safer driving technology in cars
that accounts for slower reaction times? Is it
massive community -wide fall prevention programs
that actually go into people's homes and fix
the loose rugs and poor lighting? Or changing
building codes to prevent the kind of minor scald
burn that turns fatal? Exactly. It forces us
to look beyond the trauma bay and into the world
these patients are living in every day. A profound
thought to end on as we close out this deep dive.