Management of brain trauma in the elderly

The proportion of the population of the old to the entire population is one eighth in the US in 2018, will reach to one fifth in 2030 .Alongside with the growth of elder population, those who present with trauma are increasing. In elder traumatic patients, due to comorbidities and medications as they are particularly using antiplatelet or anticoagulant medication, as well as reduced physiological capacity, the responses to Stresses are not sufficient and efficient, therefore, they are not probably able to compensate volume loos resulted from hemorrhage, subsequently, it results is increase in morbidity and mortality in older traumatic patients.careful history taking plays a significant role in the evaluation of old patients, as they suffer from cognitive impairment, depression functional impairments, reduction in auditory and visual acuity, also are not able to communicate well, and it is inevitable to take history from their companies or those who take care of them, that sometimes they cannot remember details, especially medications, while it is of utmost importance. Age should be a significant indicator to transfer old patients ton trauma centers, as using triage criteria based on vital signs and the mechanisms of trauma cause old patients with major trauma to be missed.Mechanisms: falling is one of important reasons for injurie on even death in old patients, and the second reason is traffic accident.Anatomical and physiological change in brains in elder patients: brain trauma is common in the elder, even with minor injuries, and could be asymptomatic. Mortality rate is 30-80% in elder patients with TBI. Aging is an independent predictor for disabilities and mortality in elder patient with TBI senile physiological change and taking anticoagulants and antithrombotic increase the severity of TBI in elder patients. The size of brain in old patient reduces 10% and increase the risk of tearing of vessels and ICU. Diagnosis of TBI is much more difficult in older patients, as cognitive impairments are prevalent amongst them and free space in skull allows experience less symptom mentally. Management treatment includes supportive care, controlling anticoagulant effects, surgical interactions.Supportive care provides avoiding from hypoxia and brain hypo perfusion that they can predict unfavorable effects. All patients must receive high flow oxygen to maintain high SIO2. Preventing from brain hypo perfusion should be administered under careful. Observation of hemodynamic parameters (BP and urine output). Eliminating anticoagulant effect is performed by taking a PCC, or FFP if PCC is unavailable.Supportive evidences have shown that immediate administrating of PCC causes significant changes and seduction in the side of hematoma in comparison with administrating Vit k, or FFP. Treatment or reversing antiplatelet effects and other anticoagulant medication, for other anticoagulant medications, for instance low molecular weight heparin, new oral anticoagulant should be taken into consideration by specialist consult. Physicians should collaborate with local Surgeons and neurosurgeons. Factor Xa inhibitors: Rivaroxaban, apixaban, edoxaban are Factor Xa inhibitors, while reversal medications are not available. Current consensus shows that old patients using these medication with Known life threatening hemorrhage should be given PCC 25-50 U/kg(such as _Octaplex or Beriplex), and 5mg vitamin K intravenous, immediately arriving ED. vitamin k does not reverse anticoagulant effects of DOAC, but it can correct each types of coagulopathy resulted from vitamin K deficiency.

کلیدواژه ها:

Management ، Brain Trauma ، Elderly