Aged / Geriatric Trauma
Modified primary and secondary survey for patients ≥65 years.
No review date recorded
GeriatricNelson scoreRib fracturesOn this page3 sectionsHide sections
No local AHS protocol — general educational reference only. Use with attending guidance and institutional policy.
🔍Primary Survey Modifications
▼C
Circulation: SBP <110 = Level 1
Vital signs unreliable. Beta blockers/ACE-I can mask compromise. "Normal" BP may be relative hypotension.
D
Disability: Depressed LOC = intracranial until proven otherwise
Activate code stroke if concern for CVA. Higher risk cervical fractures.
E
Exposure: Hypothermia risk
Warm blankets, Bair Hugger, fluid warmer. High risk skin tears — careful with tape/lines.
🦴Rib Fracture Pain Management
▼Always:
- Scheduled APAP
- Lidoderm patches (watch total lidocaine)
- Consider IV magnesium sulfate
Consider carefully:
- Low-dose NSAIDs (Cr ok, not on AC)
- Low-dose gabapentin
- Oxycodone 2.5–5mg PO PRN
- PCA; Precedex gtt
⚠️
Avoid: Ketamine gtt, Benzodiazepines, High-volume IVF
🏥Admission & Nelson Score Calculator
▼- Multiple system injuries → Trauma Service
- Medically complex, minor injuries: Nelson Score ≥6 → consider medicine admit. Must discuss with trauma attending first.
- Goals of care / code status / POLST within 24h
- ICU for ≥2 rib fractures unless attending decides otherwise
ℹ️
Nelson criteria help screen whether a low-acuity geriatric trauma patient may be appropriate for nonsurgical admission. It does not replace trauma attending review or local admission policy.
Reference: Nelson criteria as described in Lee et al., American Surgeon 2022, and ACS PIPS nonsurgical admission review context. Use as a screening aid only.
- Status
- General Educational Reference
- Source
- shared-admin
- Last reviewed / updated
- Needs review date