Trauma en la población que envejece: abordaje

Trauma en la población que envejece

1. Trauma en la población que envejece Johan Aldair Rodríguez Palacios

2. ¿QUE LO DEFINE? Se refiere a lesiones accidentales o no intencionadas que ocurren en adultos mayores Comúnmente se utiliza la edad de 65 años en entornos clínicos e investigaciones La mortalidad aumenta significativamente a partir de los 70 años cuando se estratifica según el Injury Severity Score Es importante que el médico de urgencias evalúe factores que contribuyen a peores resultados en los pacientes traumatizados, de forma sistemática e individualizada.

3. EPIDEMIOLOGÍA De los pacientes traumatizados son ahora mayores de 65 años La edad media de un paciente traumatizado aumentó Pacientes traumatizados mayores de 75 años aumentó 30- 40% 36-54 años 8-27 %

4. Mecanismos de lesión y patrones de lesión Los pacientes con traumatismos geriátricos presentan una mayor mortalidad en comparación con pacientes más jóvenes Caídas Colisiones de vehículos motorizados Causas comunes Antecedentes de caídas, deterioro cognitivo, discapacidad visual, polifarmacia, peligros en el hogar, hipotensión ortostática, inestabilidad de la marcha Factores de riesgo

5. CONSIDERACIONES ANATÓMICAS Y FISIOLÓGICAS Síntomas atípicos y signos vitales "normales" incluso ante lesiones graves FC >90 lpm y PAS <110 mmHg El Índice de Shock Ajustado por Edad (AASI) también se ha propuesto como un predictor más sensible de mortalidad y necesidad de hemoderivados en esta población.

6. FRAGILIDAD La fragilidad es un estado de reservas disminuidas en múltiples ámbitos Existe una fuerte asociación entre la fragilidad previa al traumatismo y peores desenlaces Evaluar la fragilidad permite identificar a estos pacientes de alto riesgo para movilizar recursos especializados de forma temprana.

7. RESUCITACIÓN INICIAL La resucitación inicial del paciente de trauma geriátrico presenta varias consideraciones importantes: Labios secos, edentulismo y disminución de la movilidad del cuello pueden dificultar el manejo de la vía aérea. Se recomienda la videolaringoscopia como primera opción debido a la posible necesidad de inmovilización cervical. Vías respiratorias Disminución de la reserva fisiológica, mayor sensibilidad a medicamentos y prevalencia de comorbilidades cardiovasculares y respiratorias. Se deben reducir las dosis de medicamentos inductores (40-50%) Cambios mecánicos y fisiológicos predisponen a hipoxemia y disminución de la reserva pulmonar. Mayor susceptibilidad a la aspiración. Cardiovascular/Respiratorio

8. Lactato elevado (>4 mmol/L) y déficit de bases (<-6 mEq/L) se asocian a aumento significativo de mortalidad en pacientes geriátricos traumatizados normotensos. Se debe medir troponina cardíaca como parte del panel inicial Estudios Es necesaria una evaluación inmediata de la gravedad de la lesión, sangrado y extensión, junto con pruebas de coagulación e imágenes para determinar si se requiere la reversión urgente de la anticoagulación en caso de intervenciones quirúrgicas, shock hemorrágico, necesidad de transfusión, hemorragia intracraneal y lesiones traumáticas mayores en pacientes anticoagulados. Reversión de anticoagulación

9. LESIÓN CEREBRAL TRAUMÁTICA Los adultos mayores con LCT tienen mayor morbilidad, mortalidad, recuperación más lenta y peores resultados. La Escala de Coma de Glasgow no es una herramienta confiable debido a comorbilidades y afecciones preexistentes. No existe una guía validada de neuroimagen, pero varias reglas de decisión clínica respaldan el uso rutinario de TC de cabeza en adultos mayores.

10. LESIONES DE COLUMNA Mayor riesgo de lesiones por disminución de la densidad ósea y cambios degenerativos. Alta incidencia de lesiones en unión craneocervical y columna cervical superior. Reglas de decisión como la canadiense consideran a mayores de 65 años de alto riesgo. Se recomienda un umbral bajo para solicitar imágenes (TC, no radiografías) por presentaciones atípicas. Es crítica la limpieza oportuna de la columna para evitar inmovilización prolongada y sus complicaciones. Se debe considerar TC de columna si se realiza TC de cabeza por probabilidad de fractura.

11. FRACTURAS DE COSTILLAS Asociadas a morbilidad y mortalidad significativas en adultos mayores, con aumento del 19% de mortalidad por cada costilla fracturada adicional. Se recomienda TC para un diagnóstico adecuado, ya que las radiografías pasan por alto hasta el 50% de las fracturas. El manejo incluye analgesia multimodal optimizada, estratificación de riesgo con espirometría y posible ingreso en UCI. Protocolos y vías clínicas formalizadas con equipos multidisciplinarios han demostrado mejorar los resultados.

12. FRACTURAS DE CADERA Y PELVIS Comunes en adultos mayores. Cirugía de cadera dentro de las 6-24 horas se asocia con mejores resultados. Manejo agresivo del dolor mientras se espera cirugía definitiva. Enfoque integral e interdisciplinario (geriatras, fisioterapeutas, etc.) disminuye morbilidad y mortalidad. En fracturas pélvicas, mayor riesgo de hemorragia

13. LESIONES DE TEJIDOS BLANDOS Con la edad, la piel pierde elastina, colágeno, la epidermis se adelgaza y disminuye el soporte subcutáneo. Por lo tanto: Los adultos mayores son más propensos a sufrir lesiones en tejidos blandos, incluso con traumatismos menores. El proceso de curación de heridas se prolonga en esta población. Existen ciertas consideraciones particulares en el contexto del traumatismo geriátrico en relación a las lesiones de tejidos blandos.

14. CONSIDERACIONES ADICIONALES Inmovilización prolongada Manejo de desgarros de la piel Maltrato a personas mayores Objetivos del cuidado Prevención del delirio Manejo de medicación Servicio de consulta geriátrica

15. GRACIAS!

16. INTRODUCTION OF ALZHEIMER'S DISEASE Y ou can give a brief description of the topic you want to talk about here. For example, if you want to talk about Mercury, you could say that it’s the smallest planet in the entire Solar System

17. CAUSES OF THE DISEASE Advanced age Family history Mercury is the closest planet to the Sun and the smallest one in the Solar System—it’s only larger than the Moon Venus has a beautiful name and is the second planet from the Sun. It’s hot and has a poisonous atmosphere

18. A PICTURE IS WORTH A THOUSAND WORDS

19. IDENTIFYING THE DISEASE It’s the closest planet to the Sun and the smallest in the Solar System Concentration Despite being red, Mars is actually a cold place. It’s full of iron oxide dust Memory Venus has a beautiful name and is the second planet from the Sun Attention

20. PHASES OF THE DISEASE 1 Initial phase Symptoms First failures of memory, concentration and attention Mood swings, sadness or anxiety 2 Intermediate phase Symptoms Failure to execute simple movements Inappropriate behavior, insomnia and restlessness 3 Final phase Symptoms Complete loss of memory and judgment Loss of sphincter control and immobility

21. DISEASE DAMAGES It’s the closest planet to the Sun and the smallest Reasoning It s name has nothing to do with the liquid metal Circulation Earth is the third planet from the Sun Stability Saturn is a gas giant and has several rings Organs It was named after the Roman god of the skies Mobility It has a pretty name and is the second planet Joints

22. OTHER SYMPTOMS Despite being red, Mars is actually a cold place Dialogue Earth is the planet where we all live on Coordination It’s terribly hot, even hotter than Mercury Disorientation Mercury was named after the Roman messenger god Recognize

23. EVOLUTION OF ALZHEIMER'S DISEASE Follow the link in the graph to modify its data and then paste the new one here. For more info, click here . Mercury is the closest planet to the Sun and the smallest one in the Solar System—it’s only a bit larger than the Moon Risk factors

24. DIAGNOSIS OF THE DISEASE It’s the closest planet to the Sun Jupiter is the biggest planet of them all It’s composed of hydrogen and helium Venus Mars is actually a very cold place It’s the farthest planet from the Sun Mercury Venus is the second planet from the Sun Jupiter Saturn Mars Neptune

25. AWESOME WORDS

26. Treatments You can enter a subtitle here if you need it 03.

27. PATIENT MEDICAL HISTORY 2018 Mars is actually a very cold place 2020 It’s the farthest planet from the Sun 2019 Venus is the second planet from the Sun 2021 It’s composed of hydrogen and helium

28. MEDICAL TREATMENT Mercury is the closest planet to the Sun, also is the smallest one in the Solar System Mercury Earth is the third planet from the Sun and the only one that harbors life in the Solar System Earth

29. CONTRAINDICATIONS & INDICATIONS Indications Contraindications You can describe a reason to stop the treatment here You can describe a reason to stop the treatment here You can describe a reason to stop the treatment here You can describe a reason to stop the treatment here You can describe a reason to start the treatment here You can describe a reason to start the treatment here You can describe a reason to start the treatment here You can describe a reason to start the treatment here

30. WORLDWIDE NUMBERS P eople living with dementia worldwide 50 M Americans under 65 suffering from disease P eople aged 65 years and older are affected 200,000 6%

31. —Someone Famous “This is a quote. Words full of wisdom that someone important said and can make the reader get inspired”

32. Preventive measures Routines Venus is the second planet from the Sun 01. Search for help It’s the biggest planet in the Solar System 03. Avoiding risks Despite being red, Mars is a cold place 02. Brain exercises Saturn is a gas giant and has several rings 04.

33. SPECIALIZED HOSPITALS It’s the closest planet to the Sun Mercury It’s considered a dwarf planet Pluto It’s located in the main asteroid belt Ceres It’s a gas giant and has several rings Saturn

34. 3,584,154 Big numbers catch your audience’s attention

35. BEHAVIORAL CHANGES Personality changes It’s the closest planet to the Sun and the smallest in the Solar System Social isolation Jupiter is a gas giant and the biggest planet in the Solar System Irritability and aggressiveness Earth is the third planet from the Sun and the one where we live on

36. STUDIES IN PROGRESS Study 2 It's composed of hydrogen and helium. It was named after the Roman god of wealth and agriculture Study 1 Neptune is the fourth-largest object by diameter in the Solar System 20% 33%

37. CONCLUSIONS It’s the closest planet to the Sun and the smallest in the Solar System Adapt the routine 01. Reduce stress It’ s the third planet from the Sun and the only one that harbors life 02. Organize the home It’s the second-brightest natural object in the night sky after the Moon 03.

38. OUR THERAPY WORKERS Susan Bones You can talk a bit about this person here Timmy Jimmy You can talk a bit about this person here

39. VISIT OUR WEB You can replace the image on the screen with your own work. Just right-click on it and select “Replace image”

40. TABLET MOCKUP You can replace the image on the screen with your own work. Just right-click on it and select “Replace image”

41. MOBILE APP You can replace the image on the screen with your own work. Just right-click on it and select “Replace image”

42. THANKS! Do you have any questions? [email protected] [phone] yourcompany.com Please keep this slide for attribution

43. ALTERNATIVE RESOURCES

44. ALTERNATIVE RESOURCES Photos Retirement home concept with happy people Old man holding hat and cane with copy space Nurse holding senior man's hands for comfort Storyset Doctors Bipolar disorder Personality disorder

45. RESOURCES Photos Older man in nursing home Doctors at hospital Vectors Medical infographic template with human body Hand-painted brain infographic Storyset Feeling Blue Schizophrenia Depression World Hepatitis Day Photo album Alone Grandma Medicine

46. In order to use this template, you must credit Slidesgo by keeping the Thanks slide. You are allowed to: - Modify this template. - Use it for both personal and commercial projects. You are not allowed to: - Sublicense, sell or rent any of Slidesgo Content (or a modified version of Slidesgo Content). - Distribute Slidesgo Content unless it has been expressly authorized by Slidesgo. - Include Slidesgo Content in an online or offline database or file. - Offer Slidesgo templates (or modified versions of Slidesgo templates) for download. - Acquire the copyright of Slidesgo Content. Instructions for use For more information about editing slides, please read our FAQs or visit Slidesgo School: https://slidesgo.com/faqs and https://slidesgo.com/slidesgo-school

47. Instructions for use (premium users) In order to use this template, you must be a Premium user on S lidesgo . You are allowed to: Modify this template. Use it for both personal and commercial purposes. Hide or delete the “Thanks” slide and the mention to Slidesgo in the credits. Share this template in an editable format with people who are not part of your team. You are not allowed to: Sublicense, sell or rent this Slidesgo Template (or a modified version of this Slidesgo Template). Distribute this Slidesgo Template (or a modified version of this Slidesgo Template) or include it in a database or in any other product or service that offers downloadable images, icons or presentations that may be subject to distribution or resale. Use any of the elements that are part of this Slidesgo Template in an isolated and separated way from this Template. Register any of the elements that are part of this template as a trademark or logo, or register it as a work in an intellectual property registry or similar. For more information about editing slides, please read our FAQs or visit Slidesgo School: https://slidesgo.com/faqs and https://slidesgo.com/slidesgo-school

48. This presentation has been made using the following fonts: Barlow ( https://fonts.google.com/specimen/Barlow ) Lato ( https://fonts.google.com/specimen/Lato ) Fonts & colors used #ffffffff #f afafa #f0f0f0 #000000 #71569c #9f7cd4 #b6a1d4 #8a71d4 #ded0f3 #f4edff

49. Create your Story with our illustrated concepts. Choose the style you like the most, edit its colors, pick the background and layers you want to show and bring them to life with the animator panel! It will boost your presentation. Check out How it Works. Pana Amico Bro Rafiki Cuate Storyset

50. You can easily resize these resources without losing quality. To change the color , just ungroup the resource and click on the object you want to change. Then, click on the paint bucket and select the color you want. Group the resource again when you’re done. You can also look for more infographics on Slidesgo. Use our editable graphic resources...

51. JANUARY FEBRUARY MARCH APRIL PHASE 1 Task 1 Task 2 JANUARY FEBRUARY MARCH APRIL MAY JUNE PHASE 1 PHASE 2 Task 1 Task 2 Task 1 Task 2

52. You can resize these icons without losing quality. You can change the stroke and fill color ; just select the icon and click on the paint bucket/pen . In Google Slides, you can also use Flaticon’s extension , allowing you to customize and add even more icons. ...and our sets of editable icons

53. Educational Icons Medical Icons

54. Business Icons Teamwork Icons

55. Help & Support Icons Avatar Icons

56. Creative Process Icons Performing Arts Icons

57. Nature Icons

58. SEO & Marketing Icons