Transcript SIMI winter caduta Germini

Ancheilrecade,
soprattuttodavecchio.
FedericoGermini
Fondazione IRCCSCa’Granda– OspedaleMaggiore Policlinico
"Maisl'importantn’estpaslachute,c’estl’atterrissage."
HubertKoundé,LaHaine (1995)
“Thegeriatrictraumapatientshouldbeviewed
asbothatraumaandamedicalpatient.”
caduta
Conseguenze
Trattamento
Cause
Prognosi
principi delladinamica
“Theelderlyrequirefarlessmechanismtoproduceinjuries.”
“The elderly often require greater health care resources than
younger patients who have similar injuries.”
“Undertriage of elderly trauma patients occurs twice as
frequently as with younger patients.”
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Parametrivitali
Pressione arteriosa
Frequenza cardiaca
Frequenza respiratoria
Saturazione arteriosa di ossigeno
Temperatura corporea
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Anamnesi
Paziente
Familiari / testimoni visivi
Documentazione/precedenti
Farmaci
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Diagnosidifferenziale
Disordini senza perdita di coscienza
Caduta accidentale
Cataplessia
Drop attack
Disordini funzionali (pseudosincope psicogena)
TIA del territorio vascolare carotideo
Disordini con perdita di coscienza parziale o completa
Sincope
Epilessia
Disordini metabolici
Intossicazioni
TIA vertebro/basilare
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Anamnesi
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Anamnesi
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Anamnesi
www.qtdrugs.org
Esameobiettivo
Si fa perbenino
Ipotensione ortostatica
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Esamistrumentali
ECG
TC encefalo
Radiografie
Eco
TC con mdc
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ECG
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TCencefalo
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TCencefalo
“More liberal indications for CT scanning of the head are justified.”
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Rx rachidecervicale
“Liberalimagingofthecervicalspineingeriatrictrauma
patientsiswarranted.”
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RXtorace
“…moresusceptibletochestinjuries…decreasedabilityto
compensate…higherrateofin-hospitalcomplications”
“Inpatients>65yearsold,theriskforpneumoniaincreasesby
27%andmortalityincreasesby19%foreachribfracture.”
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Eco
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TCmdc
Preexistingrenalinsufficiency,diabetesmellitus,dehydration,
hypotension,heartfailure,andagegreaterthan75yearsare
well-identifiedriskfactorsforcontrast-inducednephropathy
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Esamidilaboratorio
Emocromo
Elettroliti
Glicemia
Funzionalità renale
CPK
Troponina?
D-dimero?
Alcolemia/tossicologico?
EGA?
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Anamnesi
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Stratificazione del rischio
Conclusioni
•
•
Valutare complicanze e cause
Identificare
e
trattare/monitorare
condizioni a rischio
•
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Persone anziane più fragili
Presentazioni atipiche
Bibliografia
Tintinalli’s emergency medicine, 7th Ed
Guidelinesforthediagnosisandmanagementofsyncope
EuropeanHeartJournal(2009)30,2631
Geriatric Trauma
EmergMedClinNAm25(2007)837
Syncope- EvaluationandManagementintheGeriatricPatient
Clin Geriatr Med 28(2012)717
UpToDate
ApproachtotheadultpatientwithsyncopeintheED
Geriatrictrauma/Initialevaluationandmanagement
Fallsinolderpersons/Riskfactorsandpatientevaluation
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