CH 12 Traumatic diseases

Patho

What is the most common cause of death for individuals between the age of 1 and 44 in the US?

Trauma

What are the types of accidents that cause trauma?

MVA, unintentional accidents at home and in the workplace, physical altercations, domestic violence, and physical abuse

What's the annual cost for traumatic injuries in the US?

$200 billion

Deaths that occur within seconds after injury result from……?

Lacerations of the brain, spinal cord or heart and great vessels

Deaths that occur during the first 4 hours after injury generally result from….?

Intracranial hemorrhage, lacerations of the liver, and spleen or significant blood loss from multiple injuries

Deaths that occur weeks after the injury, which results from……?

Infection and multiple organ failure

When caring for the trauma patient you must do this.

-Clear airway must be established

-Acute bleeding must be controlled

-Immobilization of the spine

-Evaluate patient's level of consciousness

-The vital signs:BP, pulse temperature, motor activity

-Evaluate specific areas of the body/skeletal that are injured

What level of trauma has more services available which provide care for all injuries and are in big cities?

Level I trauma

Level I trauma centers have which kind of techs in house and which on call?

-Radiographer & CT in house

-US, Angio, & Nuc med on call

What is the most common type of trauma facility and usually located in small towns?

Level II trauma

Level II trauma centers have which tech in house and which on call?

-Radiographer in house

-CT, US, Angio, and Nuc med on call

What level of trauma is in rural areas, Rad tech is available most of the day, but on call during night shift?

Level III trauma

What is the first imaging modality used with all trauma patients?

Radiography

What is performed to identify a possible c-spine fracture or basilar skull fracture?

Crossed table lateral

What is performed to identify possible pneumothorax, pleural effusion, atelectisis or hemothorax?

Portable AP Chest

What is done to check for pelvic fractures or free air in the abdomen?

Portable AP pelvis or abdomen

The second preferred imaging modality for traumatic disease

Computed Tomography

CT is good radiographic modality because…….

Speed to acquire images, ability to post-process data

Skull fractures, intracranial bleeding, swelling

Abdominal bleeding, lacerations or ruptures

What ___% of c-spine fractures are present on patients with severe head injuries?

20%

What must be done when there is trauma to the vertebral column?

-Head must be immobilized

-Care is given, during intubation

-Blocks can be used to stabilize the position of the head

How does trauma to the vertebral column result?

Direct trauma or hypertension-flexion injuries or back pain and muscle spasm

What is the most frequent type of injury of a vertebral body, usually in the T-L spine area (T12-L1)?

Compression fractures

What's a fracture of the arch of the second cervical vertebra, which usually also has an anterior subluxation of the 2nd cervical vertebra?

Hangman's fracture

Whats usually involves 1st cervical vertebra compression where vertebra arch is literally bursts?

Spine burst fracture ( Jefferson Fracture)

For fractures of the C-spine when the columns are not align when are they stable or unstable?

One side or the other side= stable

Both sides = Unstable

What is protected by the calavarium, but can still be subjected to severe trauma?

The brain

Head trauma can result in what?

Skull fractures and or brain injuries

What should be assessed first after head trauma?

Brain before skull

Open skull fractures can lead to?

Meningitis or brain abscess

What type of fracture is straight sharply defined, nonbranching lines, which account for 80% of skull fractures?

Linear fractures

What type of fracture appears to be curved, caused by high-velocity impact from small objects and seen in a tangential and lateral view?

Depressed Skull fractures

What is difficult to identify radiographically, except by air-fluid levels in the sphenoid sinus or mastoid air cells, crossed table lateral skull recommended?

Basilar skull fractures

When there's a basilar skull fracture what is done or seen?

-Air fluid level in sphenoid sinus

-Look at mastoid area

-Racoon eyes

A temporary loss of consiousness; symptoms include headache, vertigo, and vomiting

Concussion

An injury to the brain occurs on the same side that the injury was sustained

Coup lesion

A brain injury occurs on the opposite side to the body from where the trauma was received

Contracoup lesion

An edema, neuron damage, some bleeding

Contusion

Collection of blood

Hematoma

What is persistence of loss of consciousness for more than 24 hours?

Coma

What occurs from an acceleration and rapid deceleration of the head?

Blunt trauma brain injuries/ closed head injury

What's the highest mortality rate of 30%, from a torn artery… blood pools between skull and dura mater…..causes early coma, death?

Epidural hematoma

What's between dura mater and arachnoid layer…result from tearing of subdural veins…bleeds slowly…pushes brain away from skull towards midline

Subdural hematoma

-Trauma to frontal and occipital areas of skull

What occurs between arachnoid layer and pia mater results from the tearing of small vessels?

Subarachnoid hematoma

What can result from trauma or nontrauma…. stroke or ruptured hemangioma, with the common sites are frontal, temporal, occipital lobes?

Intercerebral hematoma

A fracture of the fibular head with an ankle or distal tibial fracture, important to obtain both joints.

Maisonneuve fracture

Takes longer than usual to heal

Delay union

Fracture that heals in faulty position

Malunion

No healing, no alignment

Nonunion

What begins to form about 1 week after injury, healing depends on immobilization, proper alignment, blood supply, nutrition, and hormone levels?

Callus formation

What heals in faulty position impairing function or cosmetic appearance?

Fracture malunion

What is most serious and there is no lack of vascularization?

Fracture nonunion

A piece of bone pulled from shaft

Avulsion fracture

Only part of bone fractures with little or no displacement

Incomplete fractures

Long bone injuries involving the growth plate I-VI classification

Growth plate fracture/Salter-Harris classification (SCFE)

Occurs from repetitive motion

Stress fracture

Occurs at maximum strain on a bone (March fx)

Fatigue fracture

A fracture that cannot be detected by radiographic standard examination until several weeks after injury

Occult fracture

Gives clinical signs w/o x-ray evidence

Bone bruise

Distal end of radius fx (posterior)

Colle's fracture

Reverse colles; palmer displacement (anterior)

Smith's fracture

5th metacarpal fracture

Boxer's fracture

Fx of 1st carpometacarpal joint

Bennett's fracture

Fx of proximal ulna and dislocation of radial head

Monteggia's fracture

Fx of both ankle malleoli with dislocation of ankle joint

Pott's fracture

What occurs at proximal radius with a dislocation of the distal radial-ulnar joint, important to include both joints on radiograph?

Galeazzi fracture

What are radiographic fractures signs and best demonstrated on a lateral view of the elbow?

Fat pads

A growth plate injury: posterior & inferior slipping of proximal femoral epiphysis thru the plate

Slipped capital femoral epiphysis

Facial bone fx usually caused by direct blow to the face, CT modality of choice.

Visceral Cranial fractures

What's the slowest healing bone in the body?

Mandibular fracture

What is the separation of mandible from skull?

Maxilla fracture

What results from a direct blow to the front of the orbit that transfers force to the orbital walls and floor?

Blowout fracture

What's the most frequently fractured bone ?

Nasal none fracture

When a bone is out of its joint ?

Dislocation

A partial dislocation

Subluxation

Whats type of dislocation is most common in the shoulder ?

Anterior

What's not a caused by trauma, usually unilateral, shortened extermity?

Congenital Hip dislocations

What's more common in children than adults?

Acromioclavicular (AC) separations

What's associated with physical from child abused, family history, physical signs, radiographic skeletal surveys, shaken baby syndorme?

Battered Children Syndorme

1490 dead in 2004

Battered child syndrome was 1st described in ?

1860

What __% of those that survive suffer permanent injuries?

20%

What are signs of abuse?

Bruises, burns, and abrasions