Anaesthesia in the elderly

You are a traumatologist in an A&E. It is a Saturday evening. An ambulance has just arrived, the patient is Mr. Acetabul, 75 years old. He felt down on his right hip in the morning. He remembers everything: he hit his head and 2x2 cm haematoma at his nape appeared. He was not able to get up from the floor and call for help. He was found by his daughter after her arrival in the afternoon. He feels the pain in the hip and he is not able to move with the right lower limb. What is your reaction?

I will prescribe analgesics (1 g of paracetamol every 8 hours) and ask him to come for a check in the next week.

Firstly, I will indicate a whole-body CT scan and secondly, I will arrange a transfer to the neurosurgical department.

I will suspect a fracture at the neck of the femur so I will do an X-ray of the right hip and also a head CT scan to exclude traumatic head injury. Blood collection for laboratory tests will be useful too.

years

man

19 /min

65 /min

SpO2

97 %

136/91 (106) mmHg

EKG

rythm: sinus
action: regular

Examination

The neurological examination is slightly limited because of the hip pain but without any pathologies. The pupils are isocoric.