Geriatrics 1/4 of all trauma admits. MOrtality with sever head injury doubles after age 55 and mormal GCS does not preclude bleed. Higher risk for rib #even with minor mechanism <6 feet fall 50% had # vs less than 1% younger than 65. With rib # come pulmonary contusions in 35% and up to 30% get pneumonias and ICU stays. Mortality directly corelated with # of rib #. more than 6 have mortality of more than 20.

Pregnancy: Trauma physiologic changes relevant (CVS, Pulm, heme) HR increase 10-15, BP decreased in trimester 1/2 and increases slightly in 3 Volume up by 8L: relative anemia therefore more blod loss toelrated up to 35%. Increase in tidal volume and minute vent but decreased FRC so overall lower resting pco2 and resp alkalosis. Can desat fast esp in intubation. Also, fetus more suceptible to hypoxemia than mom. Patients also more coagulable: Increased levels of factors VII, VIII, IX, X, XII and have decreased fibrinolytic activity Also may have WC of 20k normal. LES decreased tone so more aspiration risk. LFT often deranged with known billiary stasis. Ureters may be compressed with hydro

Pearl: DPL needs to be done supraumbilically and directed to the head. Chest tubes go higher as well.

During Trauma: Place patient in left lateral decub. FHR monitoring initialy with fast and look at enough amniotic fluid then via FHR monitor. FHT over 160 and below 120 signify dsitress. If maternal shock and/or impending arrest c section inidcated. Or if significant fetal distress or known uterine injury. Determine fetal age via fundal hieght or history. 20 at umbo or 40 at xipphy.

for CT; rads can damage furing preimplant, organogensis 3-16 weeks, and after 16. Safe dose of rads <5 rad. CT abdo 3.5. Shield abdomen with a lead apron whever possible.

Pelvic # in pregnancy can cause severe bleed given uterine and RP vein dilation. Bullet wounds high risk to fetus while stabs less so.

Any pregnant patient with ISS>9 35 weeks or more preggo or symptomatic with uterine contractions, monitor for 24. otherwise monitor and dc from ED>