Trauma Spring 2010 FINAL Some Trauma Stats 1
- Slides: 74
Trauma Spring 2010 FINAL
Some Trauma Stats 1. Most common cause of death for those 1. 1 -44 years of age 2. Medical costs for trauma 1. 200 billion annually 3. Mostly results from MVA, unintentional accidents, gunshot wounds, stabbing, fights, domestic violence
Trimodal Distribution Immediate Early Late
Immediate Deaths Lacerations of the brain and spinal cord Lacerations of the heart or great vessels
Early Deaths 1. Within first 4 hours 2. Intracranial hemorrhage 3. Lacerations of liver or spleen 4. Significant blood loss Liver laceration with extravasation
Early Deaths 1. Within first 4 hours 2. Intracranial hemorrhage 3. Lacerations of liver or spleen 4. Significant blood loss Liver laceration with extravasation
1. Weeks after injury 2. Infection and multiple organ failure Late Deaths
Level I, II & III Trauma Centers 1. Level 1 1. Usually in large metro areas and serve as both primary and tertiary care institutions 2. Must be avail 24 hrs 3. Must treat 1200 admissions or 240 major trauma patients per year 1. Level II 1. Can transport to level I when necessary 2. Serve smaller cites and towns 3. Must be avail 24 hrs 2. Level III 1. Remote and rural areas 2. On call on nights and weekends
Skeletal Trauma
Fracture Classifications
FRACTURE TYPES
Closed reduction
Open Reduction
OPEN FRACTURES
Open Fracture 1. Bone has penetrated skin 2. May lead to infection 3. Precautions must be taken to prevent infection from setting into the bone
Closed Fracture 1. Skin is not penetrated 2. Fractures can be classified by the mechanics of the stress that caused the break 1. Torsion 2. Transverse linear 3. Spiral
Closed Fracture- Clavicle 17
Forearm Closed fracture
Impacted Fracture- Wrist • When the fractured bone is jammed into the cancellous tissue of another fragment
Impacted Fracture- Hip
Fibular Impacted Fracture
Comminuted Fracture 1. Do not represent the full thickness of the bone. 2. Usually extensively shattered 3. Particularly apt to be open fractures
Comminuted Fracture
Comminuted Fracture
Non-Comminuted Fracture
Non-Comminuted Fracture 1. Complete fracture in which the bone is separated into to fragments 2. Can be classified according to the direction of its fracture line 1. Spiral or oblique 2. Transverse
Avulsion Fracture 1. Fragment of the bone is pulled away from the shaft 2. Occur around the joints because of ligaments, tendons, muscles, associated with sprain or dislocation
Avulsion Fracture
Avulsion Fracture
Incomplete Fracture 1. Part of bony structure gives way with little no displacement 1. Common example is a greenstick fracture 2. Torus fracture
Greenstick : Incomplete Fracture 1. Cortex breaks on one side without separation or breaking of the opposite cortex 2. Found almost exclusively in children under the age of 10
Incomplete Fracture
Greenstick Fracture
Greenstick Fracture
Greenstick Fracture
Torus: Incomplete Fracture 1. AKA Buckle Fracture 2. It is a greenstick fracture 3. Cortex bulges outward producing a slight irregularity
Torus Fracture
Growth Plate Fracture 1. Involve the end of the long bone 2. Not visible unless displacement occurs 3. Classified according to severity 1. Salter-Harris System 1. I-IV 2. Based on degree of epiphysis involvement
Growth Plate Fracture
Growth Plate Fracture
Stress Fracture 1. Results from an abnormal degree of repetition 2. Generally found where muscles attachments are 1. EX: runners at tib/fib 3. Not always seen on plain x-ray
Stress Fracture
Stress Fracture
Occult Fracture 1. Gives clinical symptoms without radiologic evidence 2. 10 days later may show repairing itself or displacement
Occult Fracture
Occult Fracture
Colles Fracture 1. Fracture through distal inch of the radius 2. Distal fragment angled backward on the shaft 3. Impaction along dorsal aspect 4. Avulsion fx of the styloid process
Colles Fracture
Boxer’s Fracture
Monteggia’s Fracture Fx of the proximal 1/3 of the ulnar shaft
Galeazzi Fracture Occurs at proximal radius with a dislocation of the distal radial-ulnar Joint
Pott’s Fracture 1. Both malleoli 2. Dislocation of the ankle joint 3. Trimalleolar fx 1. Medial and post. malleoli of the tibia and lat. Malleolus of the fibula
Pott’s Fracture
Maisonneuve Fracture • Severe ankle sprain • Disruption of the syndemosis between the distal tibia & fibula • Fracture at prox third of the fibula, often missed
Maisonneuve Fracture
Fat Pad Sign • No definitive fx is seen but the fat pads indicate an underlying fracture
Dislocations
Dislocations
Subluxation
Subluxation
Skeletal Trauma Suspicious for Child Abuse • Distal femur, wrist, ankle – Metaphyseal corner fractures • Multiple – Fx’s in different stages of healing • Femur, humerus, tibia – Spiral fx’s <1 year old • Multiple skull fx’s – Occipital bone • Post ribs, avulsed spinous processes, metacarpal & metatarsal fx’s, sternal& scapular fx’s, vertebral body fx’x and subluxation – Unusually naturally occurring fx’s <5 years old • Fx’s with abundant callous formations – Implies repeated trauma with no immobilization
Battered Child Syndrome
Battered Child Syndrome
Battered Child Syndrome
Battered Child Syndrome
Trauma of Chest and Thorax
PNEUMOTHORAX Common causes include a penetrating would such as: gun shot stabbing fractured ribs, thoracentesis
Atelectasis Refers 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 Trauma 1. Can include GI tract, liver, spleen, kidneys, pancreas, aorta and pelvic organs. 2. Initially may show minimal symptoms 3. LLD is best for demonstrating small amounts of air fluid levels 1. Lay on side 10 minutes 4. CT very valuable to catch subtle abnormalities not detected with x-ray
Pneumoperitoneum 1. Presence of air in the peritoneum 2. LG amounts indicate a colon perforation 3. SM amounts indicate a duodenal perforation 4. Can be from trauma rupture or nontraumatic bowel perforation 5. Has a football sign
Pneumoperitoneum
Imaging Considerations 1. Radiography 1. First imaging modality for trauma 2. Portables often used 3. Primary means of evaluating skeletal trauma 2. MRI 1. For muscle, tendons, ligaments and soft tissue
Imaging Considerations 1. CT 1. Is excellent form imaging acute cerebral hemorrhage & fx's of the skull & facial bones 1. Quickly replacing x-ray as the standard for evaluating C-spine trauma 2. Better to visualize transverse processes of spine L- 2. Blunt trauma to abdomen can use CT or US 1. CT preferred for urinary trauma 2. Sometimes angio is used
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