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General Evaluation, Risk Management, and Goals of Care

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Geriatric Trauma and Acute Care Surgery

Abstract

The key drivers of this chapter are the empirical evidence of an ever-growing population of elderly trauma patients and the unmet need for reliable approaches to general evaluation, risk management, and goals of care. We describe herein the general evaluation, risk management, and goals of care of geriatric trauma given the complexities present in this age group. These complexities include age-related changes, chronic diseases, polypharmacy, as well as patient and family adverse perceptions and professional biases towards elderly care. The universal ABCDE trauma language taught by ATLS regarding airway, breathing, circulation, disability, and exposure is reviewed with special consideration for the elderly. We added “F,” for frailty, to emphasize the significance of this functional measure in the general evaluation of elderly trauma. We also provide an interesting insight regarding the role of interdisciplinary approach along with the understanding of “definitive and aggressive care” as lessons learned from the ICU with applications across the continuum of care. As proof of concept, we present G-60 Trauma as a robust elderly care management strategy that improves both the processes and outcomes of elderly patients at level I trauma centers. We conclude that the overall goal of care should aim to reduce the disastrous issue of under-triage in the elderly, aggressively restore health, and optimize functional recovery to preinjury levels. These achievements are optimal and limited only by the unalterable aspects of age-dependent changes in the elderly that occur prior to the traumatic event.

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Authors and Affiliations

  1. Department of Trauma, Honorhealth John C. Lincoln Medical Center, 250 E. Dunlap Avenue, Phoenix, AZ, 85020, USA

    Alicia J. Mangram M.D., F.A.C.S. & James K. Dzandu Ph.D.

  2. Department of Trauma, Honorhealth Deer Valley Medical Center, 19829 N. 27th Street, Phoenix, AZ, 85027, USA

    Joseph F. Sucher M.D., F.A.C.S.

Authors
  1. Alicia J. Mangram M.D., F.A.C.S.
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  2. Joseph F. Sucher M.D., F.A.C.S.
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  3. James K. Dzandu Ph.D.
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Correspondence to Alicia J. Mangram M.D., F.A.C.S. .

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Editors and Affiliations

  1. Allegheny General Hospital, Former Director of trauma, Pittsburgh, Pennsylvania, USA

    Aurelio Rodriguez

  2. Suite 202, Lehigh Valley Health Network Suite 202, Allentown, Pennsylvania, USA

    Robert. D Barraco

  3. Virginia Commonwealth University, RICHMOND, Virginia, USA

    Rao R. Ivatury

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Mangram, A.J., Sucher, J.F., Dzandu, J.K. (2018). General Evaluation, Risk Management, and Goals of Care. In: Rodriguez, A., Barraco, R., Ivatury, R. (eds) Geriatric Trauma and Acute Care Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-57403-5_3

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