what happens to body systems with age?
decreased ability to maintain homeostasis
decreased ability to regulate blood volume
Changes in body composition
What are some changes in body tissue experienced by the elderly?
decreased lean body mass
increased fat tissue
decreased total body water
what happens in the resp system when you get old af
decreased cough and gag reflexes leading to impairment of defence against inhaled bacteria
loss of cilia in airways
decrease in pulmonary defense leads to increased infections
increased chest wall stiffening and decreased compliance
joints are stiffer
decreased elastic fibres - loss of elastic recoil
increased weakening of resp muscles
decreased surface area for gas diffusion at alveolar level due to decrease in alveolar wall tissue and capillaries
-> leads to decrease in o2 uptake
decreased resp reserve
what are some resp trauma considerations with elderly?
- thoacic trama to chest is potentially lethal
- less elastic thorax has an increased susceptibility to injury
- diseased lungs are less elastic and more susceptible to pneumothorax
- pulmonary system has marginal reserve
- decreased VC & PaO2
- organs have less tolerance to hypoxia
- ability to compensate during shock is impaired (resp rate may not be able to increase to compensate)
what are the changes in the cardiovascular system for elderly?
- coronary atherosclerosis
- arterial stiffening occurs leading to increase in systolic BP
- internal thickening of arteries leading to risk of AMI & CVA and arrythmias
- increased cholesterol leading to CAD and PVD
- decrease in resting CO by 30% from ages 30 - 80
What are the myocardial changes in elderly?
- hypertrophy
- decreased compliance of ventricle
- increased duration of contraction
- anastomoses
- decreased responsiveness to catecholamine
- > leads to decreased CO due to decreased HR, decreased exercise tolderance, increased workload
What are the cardiac conduction changes in elderly?
- decreased # of pacemaker cells
- arrythmias
what are the cardiac trauma considerations with elderly?
- chest injuries increase risk of heart/aorta/major vessels
- > calcified aortic arch, less flexible.
- consider disecting aortic aneurism
- impaired coronary response to o2 demands - decreased response to hypovolaemia
- may require increased arterial pressure to perfuse organs
- hypovolaemia and hypotension are poorly tolerated
What are the renal considerations for the elderly?
- decrease renal flow by 50% between 30 - 80
- proportional decrease in glomerular filtration by 8ml/min/decade
- 30 - 50% decrease in nephrons by age 75
- decreased ability to excrete concentrated urine
what are the renal trauma considerations with the elderly?
- decreased kidney function makes pt at greater risk of renal failure and renal hypoperfusion
- decreased ability to compensate for fluid changes
- metabolising medication
what are the nervous system changes in elderly?
- decreased # of neurons
- decrease brain size and weight
- increased sub arachnoid space
- increased adherence of dura mater to skull
- fibrosis and thickening of meninges
- decreased cerebral blood flow
- decreased reaction time & motor responses
- increased pain threshold
- decreased thermoregulatory mechanisms
what are the nervous system trauma considerations with the elderly?
shrinking brain sign - easier to tear and make sub dural bleeding
what immune system changes are seen in elderly?
decreased t cell response
decreased immune response
what happens in the joints with elderly?
- cartilage rigidity and fragility increased
- decreased range of movement
what is sarcopenia?
age related loss of skeletal muscle
what happens to the liver in elderly?
decreases in size and weight
- decreased blood flow to liver means potential increase in medication toxicity
what are some physiologic considerations for paediatric patients?
- more susceptible to multiple injuries and more severe given the same force
- force more widely distributed
- proportionally larger surface area
- capacity to maintain normal BP despite blood loss of up to 24 -30%
- changes in HR, RR and peripheral perfusion can indicate immediate cardiopulmonary collapse
- have significantly higher energy requirement when injured (o2/glucose use)
what is the age cut off for the royal children’s hospital
15 - if never been before
18 - if they have a history at the hospital
what are the 3 steps in the paediatric assessment triangle?
Appearance
Work of breathing
Circulation to the skin
what falls under appearance in the paediatric assessment triangle?
tone interactiveness consolability look/gaze speech cry
what falls under work of breathing in the paediatric assessment triangle?
abnormal breathing
abnormal positioning
retractions
nasal flaring
what falls under circulation to skin in the paediatric assessment triangle?
pallor
mottling
cyanosis
why do you put a towel under the shoulders of an infant?
more prominent occipult
why do we ventilate paeds to rise and fall of chest?
- avoid barotrauma
- stop inflation of stomach (causes pressure against diaphragm making ventilating hard)
