#EMDutch Review – 4

1 Aug

Here is the review from July 2013:


Academic Life in Emergency Medicine: Geriatric Blunt Trauma: Respect the Lactate

Lactate is often elevated as a result of activation of the sympathetic system. A negative lactate certainly doesn’t rule out serious pathology, but a positive lactate, particularly in the elderly, who may not be able to mount a lactate as robustly as younger patients, might indicate serious pathology. Lactate levels in trauma, however, have not been discussed as often. Some patients may be able to compensate enough that their vital signs appear normal, even if they are at high risk for decompensation, or their vitals may be inappropriately normal because they are unable to elevate their heart rate (due to age, cardiac disease, or beta-blockers). An elevated lactate could help identify patients early on who have normal vital signs with occult hypoperfusion.

“The data supports the use of arterial lactate and base deficit testing to identify elderly normotensive trauma patients who are at increased risk of death and who might benefit from early monitoring and admission to higher levels of care”



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