Thoracic

Abstract

Elderly patients pose a great challenge to the trauma practitioner. They often present with significantly reduced physiologic reserve and a host of medications. Standard triage criteria used for the general population may be misleading in the elderly. Diagnoses can be delayed and they do not tolerate complications as well as their younger counterparts. This chapter will discuss the care of the elderly patient with thoracic trauma. General considerations to include mechanisms of injury, the general effect of aging on patient function, and outcomes after trauma will be examined. The initial trauma management of patients will be reviewed from A to E with special considerations for the elderly patient. Diagnostic tests, from chest radiographs to chest computed tomography, will be reviewed. Specific injuries will then be carefully considered: pulmonary contusions, pneumothorax, hemothorax, empyema, tracheobronchial injury, blunt cardiac injury, blunt aortic injury, diaphragmatic injury, thoracic duct injury, and esophageal injury. Understanding the physiologic changes attendant with age and their impact in the care of an elderly patient with thoracic trauma will hopefully help all practitioners care for these challenging patients.