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Self-Assessment Questions

Emergency Medicine

Geriatric Trauma: Review Questions

David B. Levy, DO, FAAEM, FACEP

Dr. Levy is Residency Program Director, Division of Emergency Medicine, Temple University Hospital; and Associate Professor of Medicine, Temple University School of Medicine, Philadelphia, PA.

Choose the single best answer for each question.

1. Which of the following statements concerning the epidemiology of geriatric trauma is most accurate?
  1. Advances in burn therapy have limited the disparity between mortality in younger adults and that in geriatric burn patients
  2. Blood pressure usually proves a reliable parameter during monitoring for shock
  3. Diminished physiologic reserve capacities of the heart and lungs contribute considerably to the unexpectedly high morbidity and mortality rates associated with geriatric trauma
  4. The initial Injury Severity Score generally correlates well with predictions of morbidity and mortality in geriatric trauma
  5. Only 10% of previously healthy elderly patients with major trauma will eventually return to independent living
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2. An 80-year-old man sustains multiple contusions and abrasions following a fall in his apartment building. He appears somewhat confused. Which of the following steps is most appropriate during the initial assessment and stabilization of this patient?

  1. Administer supplemental oxygen to him only if he is in obvious respiratory distress to avoid suppression of the hypoxic drive
  2. Consider early invasive monitoring of arterial blood pressure, central venous pressure, and pulmonary oxygen saturation
  3. Employ less aggressive resuscitation measures than would be used for younger patients
  4. Interpret normal blood pressure and heart rate values as indicating satisfactory tissue perfusion
  5. Remove dentures to facilitate bag-mask ventilation
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  3. A 78-year-old female, lap-belted driver sustains blunt chest trauma following a single-car collision. Her medical history includes well-controlled hypertension and mild chronic obstructive pulmonary disease. Vital signs include a blood pressure of 156/84 mm Hg, pulse of 88 bpm, respiratory rate of 26 breaths/min, temperature of 98.7°F, and pulse oximetry reading of 88%. On examination, respirations seem splinted. Palpation reveals tenderness, but no crepitus, along the posterolateral aspect of the midright chest wall. A chest radiograph shows 3 nondisplaced rib fractures, but there are no signs of pneumothorax or hemothorax. Which of the following management plans is best for this patient?
  1. Apply a rib belt for comfort, and if the patient gains sufficient pain relief, discharge with a ß-agonist inhaler and arrange follow-up within 48 hours
  2. Order a computed tomographic scan of the chest, and if signs of aortic injury or pneumothorax are absent, discharge the patient and arrange follow-up within 48 hours
  3. Order an arterial blood gas evaluation, and admit for observation, incentive spirometry, and aggressive pulmonary toilet
  4. Perform an intercostal nerve block, observe the patient for 6 hours, repeat the chest radiograph, and discharge if there are no new radiographic changes
  5. Prescribe pain medication, and arrange a follow-up visit within 48 hours
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