A 75-year-old man is involved in a motor vehicle accident. Which of the following statement(s) is/are true concerning this patient’s injury and management?

c. The patient would be more prone to a subdural hematoma than a younger patient

Although most principles of management of the elderly trauma patient are similar to their younger counterpart, some important differences must be noted. Evaluating the circulatory system following injury in the elderly, it must be remembered that elderly patients most likely are accustomed to a higher than normal blood pressure. Thus, while a systolic blood pressure of 100 mm Hg is not alarming in a 25 year old, in a 75 year old, this may very well represent hypotensive shock if the “normal” pressure is 150 mm Hg systolic. Recent reports have suggested that pulmonary arterial catheters can be useful in the monitoring of patients with evidence of shock or hypoperfusion or history of intercurrent disease. In patients with a low pulmonary capillary wedge pressure, volume replacement can be provided as needed, however, in the face of an elevated pulmonary capillary wedge pressure, inotropic support may be of benefit. Lactated Ringer’s solution remains the resuscitation fluid of choice in the elderly patient. However, the initial experience with hypertonic solutions have been very favorable. Hypertonic fluids can reduce elevated blood pressures and improve cardiac performance with much smaller volumes when compared to isotonic solutions. Cerebral atrophy accompanies aging. In addition, the cerebral vasculature is fragile, particularly the veins. The combination of these factors make the elderly more prone to develop subdural hematomas, which may initially be subtle.