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Blunt Neck Trauma

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1001. Diffuse Axonal Injury

Diffuse Axonal Injury Diffuse Axonal Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Diffuse Axonal Injury Diffuse Axonal (...) Trip Database) Ontology: Diffuse Axonal Injury (C0752219) Definition (MSH) A relatively common sequela of blunt head injury, characterized by a global disruption of axons throughout the brain. Associated clinical features may include NEUROBEHAVIORAL MANIFESTATIONS; PERSISTENT VEGETATIVE STATE; DEMENTIA; and other disorders. Concepts Injury or Poisoning ( T037 ) MSH English Diffuse axonal injury , DIFFUSE AXONAL INJ , AXONAL INJ DIFFUSE , DAI (Diffuse Axonal Injury) , Axonal Injuries, Diffuse

2015 FP Notebook

1002. Marine Injury

Marine Injury Marine Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Marine Injury Marine Injury Aka: Marine Injury , Marine (...) Envenomation , Marine Trauma , Marine Animal Bite II. Causes: Marine Injury Anaphylactic reactions (if allergic) Anemone string sting Marine Envenomation See Anemone Echinoderms Starfish s Sharp spines are filled with venom (blunt spines do not bear venom) s (Chondrichthyes) , water moccasin (Agkistrodon piscivorus) Sea Snake (Southeast Asia, Persian gulf, Malaysia) Octopus (Blue-ringed and spotted) Cone Shell (Australia, New Guinea, California) Candiru (toothpick fish, vampire fish) South American small

2015 FP Notebook

1003. Cadaveric position of unilateral vocal cord: a case of cricoid fracture with ipsilateral arytenoid dislocation Full Text available with Trip Pro

Cadaveric position of unilateral vocal cord: a case of cricoid fracture with ipsilateral arytenoid dislocation We report a case of cricoid cartilage fracture with unilateral arytenoid dislocation following a motorcycle accident. This 25 year old male sustained blunt injury to the head, face and neck. He presented late to the hospital with one week history of dysphonia. Laryngoscopy revealed cadaveric position of the non-functioning left vocal cord. CT and MRI showed laterally displaced left (...) vocal cord. Displaced fractures were noted in the cricoid at the junction of lamina with the anterior arch on the left side and at the right side of the anterior arch, along with dislocated left arytenoid resulting in ipsilateral vocal cord palsy. Medialization thyroplasty was performed to improve his phonation. Laryngeal trauma warrants close monitoring because of the risk of airway compromise. Radiologists play a crucial role in early diagnosis and should always have high index of suspicion

2012 Journal of Radiology Case Reports

1004. Craniofacial injuries from television tip-over. Full Text available with Trip Pro

Craniofacial injuries from television tip-over. Craniofacial injuries caused by television (TV) sets falling on small children are becoming a frequent event seen in emergency departments. Injuries occur primarily to the head and neck regions and range from contusions to intracerebral hemorrhage, which at times can be fatal.Epidemiology and potential complications from TV tip-over injuries are presented.Three cases of craniofacial injuries are described from blunt trauma incurred from TV tip

2012 Pediatric Emergency Care

1005. Articles of the month (February 2015)

. In penetrating trauma, C-collar application was associated with an increase in mortality (OR 8.8), increase scene time, and concealment of neck injuries. In blunt trauma, one study showed that immobilization was associated with worse neurological outcomes. This is balanced by no evidence of benefit. They conclude “there is a clear need for large prospective studies to determine the clinical benefit of prehospital spinal immobilsation.” Bottom line: I can’t imagine anyone changing their practice (...) of consciousness in children with minor blunt head trauma. JAMA Pediatrics 2014; 168(9)837-43. PMID: This is a secondary analysis of the PECARN head injury algorithm. Although overall your chance of clinically important head injury was 2.5% with LOC and only 0.5% without, if you only had LOC and no other PECARN risk factors, your risk of a clinically important injury was the back to baseline at 0.5%. Bottom line: Loss of consciousness, in the absence of other worrisome findings, has a low risk of clinically

2015 First10EM

1006. Articles of the month (September 2015)

criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:(2)94-9. PMID: [ ] Jerry Hoffman. Nexus. This is classic emergency medicine. We should all know the criteria: No midline cervical tenderness No focal neurological deficit Normal alertness No intoxication No painful, distracting injury This was a prospective, multi-centre observational study that included 34,069 patients who had imaging (...) of the cervical spine after blunt trauma and found 818 cervical spine injuries. The decision instrument was 99% sensitive (95%CI 98-99.6%) with a negative predictive value of 99.8% (95%CI 98.0-99.6%). Of course, you do have to accept the specificity of 12.9%. Only 1 of the 8 patients missed had a clinically significant injury that required a surgical intervention. Bottom line: You can remove c-collars quickly and safely in many patients. If you are EMS, you can probably even prevent them from going

2015 First10EM

1007. The surgical treatment of arterial injuries in the civilian population. Full Text available with Trip Pro

The surgical treatment of arterial injuries in the civilian population. During an 8-year period, 191 consecutive patients were treated for arterial injuries. Blunt trauma occurred in 46 patients (24%), low velocity gunshot wounds in 82 patients (43%), shotgun wounds in 22 patients (12%), stab wounds in 20 patients (10%), iatrogenic injury in nine patients (5%), high velocity gunshot wounds in two patients (1%) and other penetrating wounds in ten patients (5%). Preoperative arteriography (...) was performed in 48 patients (25%) who were hemodynamically stable with injuries to major vessels in the thorax, base of neck or extremities and in whom the exact location or extent of injury was unknown. Surgical repair was performed in 184 of 191 patients (96%); seven patients expired intraoperatively before reconstruction could take place. Repair was accomplished in the 184 patients by end-to-end primary anastomosis in 80 patients (44%), lateral sutures in 21 patients (11%), SVG in 71 patients (85

1979 Annals of Surgery

1008. Management of Acute Neurotrauma in Rural and Remote Locations (3rd ed.)

examination. Establish an injury list. Make sure to examine the back of the patient including the head and neck for unsuspected injuries. ? Place a gloved finger in scalp wounds to detect depressed fractures. ? Pay particular attention to the eyes for penetrating injuries. Remove contact lenses. ? Examine the external auditory canals for CSF, blood and ear drum trauma. ? Examine the face for facial fractures and the mouth for dental trauma, tongue and palate injuries and mandibular fractures. ? Examine (...) in children and an isolated recording on the chart may be misleading. 2. It is often difficult to decide whether or not there was loss of consciousness at the time of the impact. Concussion may be very brief and not appreciated by observers. 3. Persistent headache and vomiting in a child should be considered as indicating raised ICP until proven otherwise. 4. Blunt trauma to a child’s head may be followed within a short period by the development of acute brain swelling. This may follow what appeared

2009 Publication 80

1009. Patient Modesty: Volume 65

to privacy. We are the paying customer. It's up to the medical community to seek out those patients who would want to participate. Perhaps if the medical community can't round up enough patients of the opposite gender, then that student might want to consider other options. Why is it a patient's problem or responsibility to give up their privacy, suffer emotional trauma to benefit some student? I would bet if presented to a patient with the idea of participating in the advance of medical education, you'd (...) probably get plenty of people who wouldn't care. It's the arrogance, and lack of communication that creates both emotional trauma and the unwillingness of patients to cooperate. belinda At , Anonymous said... How disappointing We are told to speak up/let our concerns be known/ask for what we want/ and what happens? Here is a perfect example of someone who is getting the message from patients regarding gender preference for care. It's not as if they are silent...in fact they are so clear that he is now

2014 Bioethics Discussion Blog

1010. Red Eye

a risk factor (eg, autoimmune disorder, blunt trauma within previous few days) Possibly decreased visual acuity or pus in anterior chamber (hypopyon) Cells and flare on slit-lamp examination Clinical evaluation Severe pain, often described as boring Photophobia, lacrimation Red or violaceous patches under bulbar conjunctiva Scleral edema Tenderness of globe when palpated Often history of autoimmune disorder Clinical evaluation Further testing by or in conjunction with an ophthalmologist *Unless (...) , photosensitivity Sometimes mucopurulent discharge, eyelid edema, or follicles on tarsal conjunctiva Clinical evaluation Unilateral, asymptomatic focal red patch or confluent redness Possibly prior trauma or Valsalva maneuver Often history of use of anticoagulants or antiplatelet drugs (eg, aspirin , NSAIDs, warfarin ) Clinical evaluation Intense itching, stringy discharge Usually preadolescent or adolescent males Other atopic disorders Waxing in spring and waning in winter Clinical evaluation Corneal disorders

2013 Merck Manual (19th Edition)

1011. Pleural Effusion

in cholesterol. Chyliform effusions are thought to be due to release of cholesterol from lysed RBCs and neutrophils in long-standing effusions when absorption is blocked by the thickened pleura. Hemothorax is bloody fluid (pleural fluid Hct > 50% peripheral Hct) in the pleural space due to trauma or, rarely, as a result of coagulopathy or after rupture of a major blood vessel, such as the aorta or pulmonary artery. Empyema is pus in the pleural space. It can occur as a complication of pneumonia, thoracotomy (...) , abscesses (lung, hepatic, or subdiaphragmatic), or penetrating trauma with secondary infection. Empyema necessitatis is soft-tissue extension of empyema leading to chest wall infection and external drainage. Trapped lung is a lung encased by a fibrous peel caused by empyema or tumor. Because the lung cannot expand, the pleural pressure becomes more negative than normal, increasing transudation of fluid from parietal pleural capillaries. The fluid characteristically is borderline between a transudate

2013 Merck Manual (19th Edition)

1012. Seizure Disorders

are characterized by brief, complete loss of muscle tone and consciousness. Children fall or pitch to the ground, risking trauma, particularly head injury. Tonic seizures occur most often during sleep, usually in children. The cause is usually the Lennox-Gastaut syndrome. Tonic (sustained) contraction of axial muscles may begin abruptly or gradually, then spread to the proximal muscles of the limbs. The neck is often stiff. Tonic seizures usually last 10 to 15 sec. In longer tonic seizures, a few, rapid clonic (...) with anti-NMDA receptor encephalitis. Removal of the teratoma (if present) and immunotherapy control the seizures much better than antiseizure drugs. Table Causes of Seizures Condition Examples Autoimmune disorders , anti-NMDA receptor encephalitis, (rarely) Cerebral edema , Cerebral ischemia or hypoxia , , , near suffocation, , * Birth injury, blunt or penetrating injuries CNS infections , , , , , , , , , viral Congenital or developmental abnormalities Cortical malformations, genetic disorders (eg

2013 Merck Manual (19th Edition)

1013. Vocal Cord Paralysis

evaluation may include enhanced CT or MRI of the head, neck, and chest; thyroid scan; barium swallow or bronchoscopy; and esophagoscopy. Cricoarytenoid arthritis, which may cause fixation of the cricoarytenoid joint, must be differentiated from a neuromuscular etiology. Fixation is best documented by absence of passive mobility during rigid laryngoscopy under general anesthesia. Cricoarytenoid arthritis may complicate such conditions as RA, external blunt trauma, and prolonged endotracheal intubation (...) , or surgical injuries. Paralysis may be Unilateral (most common) Bilateral Unilateral vocal cord paralysis is most common. About one third of unilateral paralyses are neoplastic in origin, one third are traumatic, and one third are idiopathic. Intracranial tumors, vascular accidents, and demyelinating diseases cause nucleus ambiguus paralysis. Tumors at the base of the skull and trauma to the neck cause vagus paralysis. Recurrent laryngeal nerve paralysis is caused by neck or thoracic lesions (eg, aortic

2013 Merck Manual (19th Edition)

1014. Epistaxis

and picking) Drying of the nasal mucosa There are a number of less common causes (see table ). may contribute to the persistence of a nosebleed that has already begun but is unlikely to be the sole etiology. Table Some Causes of Epistaxis Cause* Suggestive Findings Diagnostic Approach Common Local trauma (eg, nose blowing, picking, blunt impact) Apparent by history Clinical evaluation Drying of the mucosa (eg, in cold weather) Usually visibly dry on examination Clinical evaluation Less common Local (...) Which of the following diagnoses is most likely to indicate a disorder of the vestibular system? External otitis Hypertension Nystagmus ​Temporomandibular joint pain NEWS & VIDEOS Mental Health Disorders Up After Head & Neck Cancer Diagnosis THURSDAY, Feb. 28, 2019 (HealthDay News) -- In patients with head and neck cancer (HNC), the prevalence of mental health disorders (MHDs) is significantly higher after cancer diagnosis, according... 3D Model Middle Ear and Inner Ear Video How to Remove

2013 Merck Manual (19th Edition)

1015. Edema

surgery, trauma, immobilization, hormone replacement, cancer) Ultrasonography Chronic edema in one or both lower extremities, with brownish discoloration, discomfort but not marked pain, and sometimes skin ulcers Often associated with varicose veins Clinical evaluation Extrinsic venous compression (by tumor, a gravid uterus, or marked abdominal obesity) Nonpainful, slowly developing edema If tumor compresses the superior vena cava, usually facial plethora, distended neck veins, and absent venous pulse (...) , , chemicals, toxins, blunt trauma) Apparent by history Clinical evaluation Severe (causing vascular endothelial leakage) Obvious sepsis syndrome with fever, tachycardia, focal infection Painless, symmetrical edema Cultures Imaging studies as needed Soft-tissue infection (eg, , necrotizing myofasciitis) If due to cellulitis, usually redder and more painful and tender than that due to angioedema and more circumscribed than that due to DVT With necrotizing infections, severe pain, constitutional symptoms

2013 Merck Manual (19th Edition)

1016. Pericarditis

Dissection SOCIAL MEDIA Add to Any Platform Loading , MD, Case Western Reserve University Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Pericarditis is inflammation of the pericardium, often with fluid accumulation. Pericarditis may be caused by many disorders (eg, infection, myocardial infarction (MI), trauma, tumors, metabolic disorders) but is often idiopathic. Symptoms include chest pain or tightness, often worsened by deep breathing. Cardiac (...) . Etiology Acute pericarditis may result from infection, autoimmune or inflammatory disorders, uremia, trauma, myocardial infarction, cancer, radiation therapy, or certain drugs (see Table: ). Infectious pericarditis is most often viral or idiopathic. Purulent bacterial pericarditis is uncommon but may follow infective endocarditis, pneumonia, septicemia, penetrating trauma, or cardiac surgery. Often, the cause cannot be identified (called nonspecific or idiopathic pericarditis), but many of these cases

2013 Merck Manual (19th Edition)

1017. Tricuspid Regurgitation

ventricular–induced heart failure or atrial fibrillation. Diagnosis is by physical examination and echocardiography. TR is usually benign and does not require treatment, but some patients require annuloplasty or valve repair or replacement. (See also .) Etiology Tricuspid regurgitation may be Primary Secondary (most common) Primary tricuspid regurgitation is less common. It can be due to valvular abnormalities caused by in users of illicit IV drugs, , blunt chest trauma, , idiopathic myxomatous (...) of Aortic Dissection SOCIAL MEDIA Add to Any Platform Loading , MD, North Shore Hospital, Auckland Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Tricuspid regurgitation (TR) is insufficiency of the tricuspid valve causing blood flow from the right ventricle to the right atrium during systole. The most common cause is dilation of the right ventricle. Symptoms and signs are usually absent, but severe TR can cause neck pulsations, a holosystolic murmur, and right

2013 Merck Manual (19th Edition)

1018. Overview of Child Maltreatment

, petechiae on the face and/or neck) . Fractures frequently associated with physical abuse include rib fractures, vertebral fractures, long bone and digit fractures in nonambulatory children, and metaphyseal fractures; in children < 1 yr, about 75% of fractures are inflicted by others. Confusion and localizing neurologic abnormalities can occur with CNS injuries. Lack of visible head lesions does not exclude traumatic brain injury, particularly in infants subjected to violent shaking. These infants may (...) find healed lesions or subtle changes. Emotional abuse In early infancy, emotional abuse may blunt emotional expressiveness and decrease interest in the environment. Emotional abuse commonly results in failure to thrive and is often misdiagnosed as intellectual disability or physical illness. Delayed development of social and language skills often results from inadequate parental stimulation and interaction. Emotionally abused children may be insecure, anxious, distrustful, superficial

2013 Merck Manual (19th Edition)

1019. Pulmonary Contusion

that results from significant blunt or penetrating chest trauma. Patients may have associated rib fracture, pneumothorax, or other chest injuries. Larger contusions can impair oxygenation. Late complications include pneumonia and sometimes (ARDS). Symptoms include pain (mainly due to injury to the overlying chest wall) and sometimes dyspnea. The chest wall is tender; other physical findings are those of any associated injuries. Diagnosis Imaging, typically chest x-ray The diagnosis should be suspected when (...) Withdrawal from which of the following substances is most likely to increase a patient’s heat input? Alcohol Cannabis Cocaine Phencyclidine NEWS & VIDEOS Some Lose Independence After Surgical Tx of Femoral Neck Fx WEDNESDAY, March 6, 2019 (HealthDay News) -- A considerable proportion of older patients with femoral neck fracture are institutionalized or require walking aids 12 months after surgical treatment... 3D Model Musculoskeletal Connective Tissues Video Wrist Extensor Stretch 1. Begin

2013 Merck Manual (19th Edition)

1020. Pneumothorax (Tension)

Pneumothorax DU CANE MEDICAL IMAGING LTD/SCIENCE PHOTO LIBRARY Causes include mechanical ventilation (most commonly) and simple (uncomplicated) with lung injury that fails to seal following penetrating or blunt chest trauma or failed central venous cannulation. Symptoms and Signs Symptoms and signs initially are those of simple pneumothorax (see ). As intrathoracic pressure increases, patients develop hypotension, tracheal deviation, and neck vein distention. The affected hemithorax is hyperresonant (...) to percussion and often feels somewhat distended, tense, and poorly compressible to palpation. Diagnosis Clinical evaluation Tension pneumothorax should be diagnosed by clinical findings. Treatment should not be delayed pending radiographic confirmation. Although also can cause hypotension, neck vein distention, and sometimes respiratory distress, tension pneumothorax can be differentiated clinically by its unilateral absence of breath sounds and hyperresonance to percussion. Pearls & Pitfalls Tension

2013 Merck Manual (19th Edition)

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