Neck trauma 1. upper zone 2. middle zone 3. base of neck
1. arteriographic diagnosis and management 2. surgical exploration regardless of symptoms 3. arteriography, esophagogram, esophagoscopy, bronchoscopy before surgery to help decide specific surgical apporach
What is the best way to assess status of cervical spine?
paralysis and loss of proprioception distal to the injury and ipsilateral - loss of pain distal to the injury and contralateral
Anterior cord syndrome
- seen in burst fracutres of the vertebral bodies - loss of motor function and pain/temp on both sides distal to the injury - preservation of vibratory and position sense
central cord syndrome
- elderly, forced hyperextension of neck - paralysis and burning pain in the upper extremities with preservation of most functions in the lower extremities
Management of spinal cord injuries 1. imaging 2. meds?
1. MRI 2. some use high dose corticosteroids
Rib fracture tx
- local nerve block and epidural catheter
When is surgery needed in hemothorax?
- recovering >1500 ml from chest tube - collecting over 600 ml in tube draining over ensuing 6 hours
Sucking chest wound tx
occlusive dressing that allow air out (Taped on 3 sides)
Flail chest tx
- real problem = underlying pulmonary contusion - fluid restriction, diuretics - blood gases monitoring
- deteriorating blood gases - white out of lungs on chest x-ray - can appear immediately or up to 48 hours later
traumatic rupture of diaphgram - diagnosis? - always on what side? - tx?
- physical exam and x-ray (bowel in chest) - left side - evaluated with laparoscpy
Traumatic rupture of aorta - mechanism of injury - when should you be suspicious? - diagnostic tests
- deceleration injury - 1. mechanism of injury 2. presence of fracutres in chest bones that are very hard to break 3. wide mediastinum - TEE, CT angiogram, MRA
subcutaneous emphysema in the chest and lower neck = what injury? how to identify lesion?
traumatic rupture of trachea, major bronchus, esophagus - identify lesion with fiberoptic bronchoscopy (also allows intubation)
DDx of subcutaneous emphysema
rupture of esophagus, tension pneumo thorax
multiple trauma, long bone fractures, petechial rashes, low platelet count, bilateral patchy infiltrates on chest x-ray
gunshot wounds to abdomen --> tx?
when is exploratory laparatomy done in stab wounds to abdomen?
- if it is clear that penetration has occurred (protruding viscera) - hemodynamic instability - peritoneal irritation
Blunt trauma to abdomen -->
requires exploratory laparotomy if signs of peritoneal irritation develop
signs of shock occur with loss of how much blood volume?
3 places in body where 1500 ml of blood can hide?
1. abdomen 2. thighs 3. pelvis
what form of imaging used to most accurately diagnosis bleeding?
most common source of signiciant intraabdominal bleeding in blunt trauma?
spleen - every effort is made to repair rather than remove it --> otherwise need vaccinations again SHiN
when are pelvic hematomas left alone?
if they are not expanding
what organ injuries have to be ruled out in pelvic injury?
rectum, bladder, vagina, urethra
Pelvic fracures with ongoing bleeding - tx (3)
- blood replacement, external fixation, arteriographic embolization for arterial bleeding of iliac arteries
hallmark of urologic injuries =
blood in the urine in someone who has sustained penetrating or blunt abdominal trauma
urethral injury - a/w a ____ fracture and may present with _______. more complicated picture may include a _____ (3)
pelvic blood at the meatus scrotal hematoma, sensation of wanting to void but not being able to, high riding prostate on rectal exam
DO NOT INSERT FOLEY
dx of urethral injury?
retrograde urethrogram done INSTEAD OF FOLEY
bladder injury - dx
retrograde cystogram - must include post void films to see extra peritoneal leaks at the base of the bladder that might be obscured by the bladder full of dye
renal injuries are usually a/w what kind of fracture? dx? tx?
what weird thing can develop after renal injury?
rib fracture CT scan managed without surgical intervention
AV fistula leading to heart failure
tx of fracture of the penis
emergency surgical repair
what determines treatment in penetrating injuries of the extremities?
whether a vascular injury has occurred or not
if penetration of extremity is near major vessels --> dx? tx?
doppler studies or CT angio surgical exploration
combined injuries of arteries nerves and bone in extremities --> order of repair?
1. stabilize the bone 2. delicate vascular repair 3. leave nerve for last