Trauma

Trauma Spring 2011FINAL

Some Trauma StatsMost common cause of death for those 1-44 years of age

Medical costs for trauma200 billion annually

Mostly results from MVA, unintentional accidents, gunshot wounds, stabbing, fights, domestic violence

Trimodal DistributionImmediate Early Late

Immediate Deaths

Lacerations of the _________________Lacerations of the _________________

Early DeathsWithin first __ hours

_______hemorrhage

Lacerations of _____or _________

Significant ____ loss

Liver laceration with extravasation

Late Deaths________after injury

____________ and ______ ____ failure

Level I, II & III Trauma CentersLevel 1Usually in _____ metro areas and serve as both primary and tertiary care institutionsMust be avail _____Must treat ______admissions or ______major trauma patients per year

Level II__________to level I when necessaryServe ________cites and townsMust be avail ___ hrs

Level III__________&____________________ on nights and weekends

Skeletal Trauma

Fracture Classifications

FRACTURE TYPES

_____________ reduction

__________ Reduction

_________ FRACTURES

Open FractureBone has _____________ skin

May lead to infection

Precautions must be taken to _______ ___________from setting into the bone

Closed Fracture__________ is not penetrated

Fractures can be classified by the _______ of the stress that caused the break________________________

*Closed Fracture- Clavicle

Forearm Closed fracture

____________Fracture- WristWhen the fractured bone is ________into the cancellous tissue of another fragment

Impacted Fracture- Hip

Fibular Impacted Fracture

Comminuted FractureDo not represent the full thickness of the bone.

Usually extensively ________________

Particularly apt to be open fractures

Comminuted Fracture

Non-Comminuted Fracture

Non-Comminuted Fracture_________ fracture in which the bone is separated into to fragments

Can be classified according to the direction of its fracture line____________________________

________________ FractureFragment of the bone is __________ from the shaft

Occur around the joints because of ligaments, tendons, muscles, associated with sprain or dislocation

Avulsion Fracture

Incomplete FracturePart of bony structure gives way with ________or no ________________Common example is a _________ fractureTorus fracture

Greenstick :Incomplete FractureCortex breaks on one side without separation or breaking of the opposite cortex

Found almost exclusively in children under the age of 10

Incomplete Fracture

Greenstick Fracture

________: Incomplete FractureAKA _____ Fracture

It is a greenstick fracture

Cortex bulges _______producing a slight irregularity

Torus Fracture

Growth Plate FractureInvolve the end of the long bone

Not visible unless displacement occurs

Classified according to severity____________________I-IVBased on degree of epiphysis involvement

Growth Plate Fracture

_____________ FractureResults from an _________degree of repetitionGenerally found where __________ attachments areEX: runners at tib/fibNot always seen on plain x-ray

Stress Fracture

Occult FractureGives ______________ without radiologic evidence

____ days later may show repairing itself or displacement

Occult Fracture

Colles FractureFracture through distal inch of the __________Distal fragment angled ________on the shaftImpaction along dorsal aspectAvulsion fx of the______________process

Colles Fracture

Boxers Fracture

Monteggias Fracture____________________________________________________

Galeazzi Fracture_________________________________________________________________________________

____________ FractureBoth ____________

____________of the ankle joint

______________fxMedial and post. malleoli of the tibia and lat. Malleolus of the fibula

Potts Fracture

____________ FractureSevere ankle ______

Disruption of the _________________between the distal tibia & fibula Fracture at prox third of the fibula, often missed

Maisonneuve Fracture

______________No definitive fx is seen but the fat pads indicate an underlying fracture

Dislocations

Subluxation

Skeletal Trauma Suspicious for Child AbuseDistal femur, wrist, ankleMetaphyseal corner fractures

MultipleFxs in different stages of healing

Femur, humerus, tibiaSpiral fxs

Battered Child Syndrome

Trauma of Chest and Thorax

PNEUMOTHORAXCommon causes include a penetrating would such as: gun shot stabbing fractured ribs,thoracentesis

AtelectasisRefers to a condition with diminished air within lungs associated with reduced air volume

Incomplete expansion of the lung caused by a partial or total collapse

Often occurs from a penetrating wound in the chest

Abdominal Trauma

Abdominal TraumaCan include GI tract, liver, spleen, kidneys, pancreas, aorta and pelvic organs.

Initially may show minimal symptoms

LLD is best for demonstrating small amounts of air fluid levelsLay on side 10 minutes

CT very valuable to catch subtle abnormalities not detected with x-ray

PneumoperitoneumPresence of air in the peritoneum

LG amounts indicate a colon perforation

SM amounts indicate a duodenal perforation

Can be from trauma rupture or nontraumatic bowel perforation

Has a football sign

Pneumoperitoneum

Imaging ConsiderationsRadiographyFirst imaging modality for traumaPortables often usedPrimary means of evaluating skeletal trauma

MRI For muscle, tendons, ligaments and soft tissue

Imaging ConsiderationsCTIs excellent form imaging acute cerebral hemorrhage & fx's of the skull & facial bonesQuickly replacing x-ray as the standard for evaluating C-spine traumaBetter to visualize transverse processes of L-spine

Blunt trauma to abdomen can use CT or USCT preferred for urinary traumaSometimes angio is used

*Liver laceration with extravasation. An enhanced axial CT scan of the upper abdomen shows a large laceration through the right lobe of the liver (blue arrow), blood in the peritoneal cavity (black arrows) and active extravasation of the intravenous contrast (red arrow). The stomach is labeled "S." *Frontal radiograph of the chest demonstrates multiple rib fractures with callous formation, including a fracture of the left 2nd and 6th ribs posteriorly. Posterior rib fractures are highly suggestive of child abuse (from forceful squeezing) *Refers to a condition with diminished air within lungs associated with reduced air volume. Most commonly this results fro a bronchial obstruction. Air cannot enter that part of the lung supplied by the obstructed bronchus. X-ray commonly demonstrates local increase in density caused by airless lung. Thin plate like streaks to lobar collapse.

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Trauma