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Emergency Medicine

Answer 2
  1. Consider early invasive monitoring of arterial blood pressure, central venous pressure, and pulmonary oxygen saturation. Geriatric patients tend to be more sensitive to and dependent on preload volume than are their younger counterparts, leaving fewer margins for error. Significant hemodynamic compromise can exist in a geriatric trauma patient despite apparent stability of noninvasive parameters (eg, heart rate, blood pressure, urine output). Early invasive monitoring not only assists evaluation but can markedly improve outcome in managing geriatric trauma patients. As physiologic reserves diminish with age, older patients become less tolerant of hypoxemia. Increasing the fraction of inspired oxygen may raise Paco2 in elderly patients with chronic obstructive pulmonary disease, not because the extra oxygen decreases the hypoxic drive but because the supplemental oxygen alters the ventilation-perfusion ratio within the lungs. Age often mistakenly biases caregivers against rendering aggressive care for elderly trauma patients. Escalating occurrence of hypertension and stiffening of blood vessels (eg, pseudohypertension) account for deceptively high readings in older patients. Even with satisfactory blood pressure and heart rate values, many geriatric trauma patients may still endure occult shock. Well-fitting dentures facilitate bag-valve-mask ventilation and should be left in place to improve the mask seal. Remove the dentures immediately only if they are loose-fitting or when intubation is imminent.

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