Aged / Geriatric Trauma

Modified primary and secondary survey for patients ≥65 years.

Educational Reference

Updated: Needs review date

GeriatricNelson scoreRib fractures

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No local AHS protocol — general educational reference only. Use with attending guidance and institutional policy.

🔍Primary Survey Modifications

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Circulation: SBP <110 = Level 1

Vital signs unreliable. Beta blockers/ACE-I can mask compromise. "Normal" BP may be relative hypotension.

Disability: Depressed LOC = intracranial until proven otherwise

Activate code stroke if concern for CVA. Higher risk cervical fractures.

Exposure: Hypothermia risk

Warm blankets, Bair Hugger, fluid warmer. High risk skin tears — careful with tape/lines.

🦴Rib Fracture Pain Management

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Always:

Scheduled APAP
Lidoderm patches (watch total lidocaine)
Consider IV magnesium sulfate

Consider carefully:

Low-dose NSAIDs (Cr ok, not on AC)
Low-dose gabapentin
Oxycodone 2.5–5mg PO PRN
PCA; Precedex gtt

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Avoid: Ketamine gtt, Benzodiazepines, High-volume IVF

🏥Admission & Nelson Score Calculator

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Multiple system injuries → Trauma Service
Medically complex, minor injuries: Nelson Score ≥6 → consider medicine admit. Must discuss with trauma attending first.
Goals of care / code status / POLST within 24h
ICU for ≥2 rib fractures unless attending decides otherwise

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Nelson criteria help screen whether a low-acuity geriatric trauma patient may be appropriate for nonsurgical admission. It does not replace trauma attending review or local admission policy.

Nelson Score

Screening aid for low-acuity geriatric trauma patients who may be appropriate for nonsurgical or medicine admission. Discuss disposition with the trauma attending first.

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Nelson Score

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Score <4: generally inappropriate for nonsurgical admission. Trauma service admission/review is favored.

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Reference: Nelson criteria as described in Lee et al., American Surgeon 2022, and ACS PIPS nonsurgical admission review context. Use as a screening aid only.

Status: General Educational Reference
Source: shared-admin
Last reviewed / updated: Needs review date