Theo dõi một cách cẩn thận, và yêu cầu bệnh nhân để ở bàn chân của họ nếu có thể. Vết thương nghiêm trọng bị ô nhiễm cần phải làm sạch đầy đủ trước khi đóng cửa. Vật liệu như dầu mỡ, đất, bụi than | TRAUMA IN THE ELDERLY 235 There is no doubt that prevention of hypothermia and thereby maintaining normal haemostasis is much easier than treating the haemorrhagic state in the presence of hypothermia. Gastro-intestinal system Elderly patients often seem to mask the symptoms and signs of abdominal trauma. Although well recognized it is difficult to quantify loss of gastro-intestinal tract function resulting in an increased reliance on imaging techniques with the need for radiographic contrast and the potential for renal and other organ damage. There is also increased glucose intolerance less muscle mass and hence less nutritional reserve. Renal system As people age there is an ongoing and progressive loss of glomeruli with consequent loss of function. They are less effective at retaining water in the presence of hypovolaemia. These changes are secondary to both decreased antidiuretic hormone ADH secretion and decreased renin-angiotensin activity. There is also a worse outcome with acute renal failure in the elderly. In addition this population is more likely to be taking diuretics for co-morbidities with consequent relative dehydration. Neurological system As we age there is progressive atrophy of brain tissue with consequent increase in the space available in the cranium allowing greater movement of the tissues in the event of mechanical trauma and greater risk of subdural haematoma after relatively minor trauma. Coupled with this is the presence of amyloid plaques and a decrease in the levels of neurotransmitters. This may well lead to a progressive loss of cognitive function memory loss and possibly dementia. Other associated co-morbidities include a higher incidence of Parkinsonism atherosclerosis of the carotid arteries stroke and transient ischaemic attacks. There has often been a progressive decrease in the senses with poor vision and hearing with a greater dependence on glasses and hearing aids. The elderly are often confused just by .
