**11. Special considerations**

#### **11.1. Advanced age**

Trauma in elderly patients needs special attention as cardiac compliance decreases with age. The heart cannot compensate for blood loss as efficiently as in youngsters. There is a decrease in catecholamine production resulting in manifestation of tachycardia, when in shock. Elderly patients are mostly on multiple medications. Beta blockers worsen hypotension caused by trauma and also mask the tachycardia, which is an early sign of shock. Volume resuscitation must be strictly monitored as most patients have decreased cardiac contractility and can easily go into volume overload [2].

#### **11.2. Athletes**

They may not manifest any signs of shock due to their unusual compensatory mechanism, despite significant amount of blood loss [2].

#### **11.3. Pregnancy**

Pregnant patients would present with signs of shock only after huge volume of blood is lost, due to their physiological maternal hypervolemia [2].
