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Blunt Neck Trauma

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1061. Thyroid Gland Hematoma After Blunt Neck Trauma Full Text available with Trip Pro

Thyroid Gland Hematoma After Blunt Neck Trauma Hemorrhage of a previously normal thyroid gland as a result of blunt trauma is a very rare condition. We report a case of blunt trauma that caused acute hemorrhage into the thyroid gland and presented with hoarseness. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and carotid angiography. The patient was treated conservatively, had a favorable course without further

2009 Western Journal of Emergency Medicine

1062. Life-threatening carotid haemorrhage following blunt trauma. (Abstract)

Life-threatening carotid haemorrhage following blunt trauma. We report a case of internal carotid arterial damage following blunt neck trauma. This rare mechanism of injury demands a high index of suspicion to enable prompt specialist management.A 22-year-old man presented to hospital after sustaining blunt neck trauma. Rapid onset of stridor necessitated an emergency tracheostomy. Computed tomography angiography demonstrated a tear of the right internal carotid artery, which was repaired (...) surgically.Blunt carotid vessel injury, although rare, has a high mortality rate. Mechanisms of injury include hyperextension and contralateral neck rotation, a direct blow to the vessel, and laceration by adjacent bony structures. The 'gold standard' investigation for suspected blunt carotid vessel injury is catheter angiography, although this carries a small risk of stroke. Computed tomography angiography is a less invasive, alternative investigation which has almost equivalent accuracy. The extent of damage

2009 Journal of Laryngology & Otology

1063. Submandibular gland injury and delayed airway compromise caused by a seat belt. (Abstract)

Submandibular gland injury and delayed airway compromise caused by a seat belt. Isolated blunt injury to the submandibular gland (SMG) is rare owing to the protection afforded by the overlying mandible. Like other causes of submandibular swelling, glandular trauma can lead to life-threatening airway compromise, and this possibility should be considered in patients presenting with acute pain and fullness in the jaw and neck after trauma. We describe a patient with SMG disruption caused by a seat

2009 American Journal of Otolaryngology

1064. Clinical examination in complement with computed tomography scan: an effective method for identification of cervical spine injury. (Abstract)

Clinical examination in complement with computed tomography scan: an effective method for identification of cervical spine injury. The purpose of this study was to prospectively evaluate a protocol that assesses the efficacy and sensitivity of clinical examination in complement with computed tomographic (CT) scan in screening for cervical spine (c-spine) injury.During the 26-month period from March 2005 to May 2007, blunt trauma patients older than 13 years were prospectively entered (...) hundred thirty-three (99%) c-spine injuries were identified by CT scan. The c-spine injury missed by CT scan was a radiologic misinterpretation. For patients with c-spine injury with GCS score >or=14, both sensitivities of clinical examination and CT scan were 99%. Two hundred forty-eight patients had GCS score <14, of which 5 (2.0%) were diagnosed with c-spine injury. CT scan identified all c-spine injuries for patients with GCS score <14.In awake and alert blunt trauma patients, clinical examination

2009 Journal of Trauma

1065. Transoral closure of a perforation of the hypopharynx from blunt trauma. (Abstract)

Transoral closure of a perforation of the hypopharynx from blunt trauma. Hypopharyngeal perforation secondary to blunt trauma is a rare injury. It can be managed operatively or expectantly without clear criteria for either approach. Here, we present a case of a 17-year-old adolescent boy who had a hypopharyngeal tear from direct blunt trauma to the anterior neck received during a high school football game. Physical examination demonstrated cervical crepitus, and neck radiograph revealed air (...) in the retropharyngeal space. Rigid endoscopy diagnosed a 3-cm linear tear in the posterior hypopharynx. The tear was repaired transorally using laparoscopic instruments and visualized by a rigid endoscope, followed by anterior neck dissection and drain placement. Postoperatively, he was kept nil per os and received intravenous antibiotics. He was discharged home and returned to the football field the same fall.

2009 Journal of Pediatric Surgery

1066. Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. (Abstract)

Is the use of pan-computed tomography for blunt trauma justified? A prospective evaluation. Many trauma centers use the pan-computed tomography (CT) scan (head, neck, chest, and abdomen/pelvis) for the evaluation of blunt trauma. This prospective observational study was undertaken to determine whether a more selective approach could be justified.We evaluated injuries in blunt trauma victims receiving a pan-CT scan at a level I trauma center. The primary outcome was injury needing immediate (...) intervention. Secondary outcome was any injury. The perceived need for each scan was independently recorded by the emergency medicine and trauma surgery service before patients went to CT. A scan was unsupported if at least one of the physicians deemed it unnecessary.Between July, 1, 2007, and December, 28, 2007, 284 blunt trauma patients (average Injury Severity Score = 11) underwent a pan-CT after the survey form was completed. A total of 311 CT scans were judged to be unnecessary in 143 patients (27

2009 Journal of Trauma

1067. Complete traumatic laryngotracheal disruption-A case report and review. (Abstract)

Complete traumatic laryngotracheal disruption-A case report and review. Blunt neck trauma is an infrequent cause of injury in the pediatric population; however, significant injury is possible even with minor trauma to the neck. The authors present the previously unreported case of a combined laryngotracheal and esophageal disruption as well as a severe laryngeal crush injury in a pediatric patient following a blunt, clothesline neck injury. Immediate management of laryngotracheal or esophageal

2009 International Journal of Pediatric Otorhinolaryngology

1068. The dangers of kite flying: pseudoaneurysm of the facial artery following blunt trauma. (Abstract)

The dangers of kite flying: pseudoaneurysm of the facial artery following blunt trauma. Pseudoaneurysms of the facial artery are an extremely rare development after blunt trauma. This paper aims to demonstrate the challenges faced during the diagnosis and subsequent management of this unusual cause of neck swelling.We report the presentation, examination, investigation, management and potential complications of a case of facial artery pseudoaneurysm secondary to blunt arterial trauma, sustained (...) from the string of a flying kite. We also review some of the relevant literature on this subject.Although a traumatic pseudoaneurysm is a rare occurrence in the facial region, the inclusion of this lesion in the differential diagnosis of soft tissue lesions caused by blunt trauma is important if the serious consequences of haemorrhage or thromboembolic disease are to be avoided. Prompt access to radiological imaging, and multi-disciplinary team input, are essential for effective diagnosis

2009 Journal of Laryngology & Otology

1069. CTA-based screening reduces time to diagnosis and stroke rate in blunt cervical vascular injury. (Abstract)

CTA-based screening reduces time to diagnosis and stroke rate in blunt cervical vascular injury. Advances in computed tomography capabilities have enabled trauma surgeons to screen for and diagnose the severity of blunt cervical vascular injury (BCVI) using computed tomographic angiography (CTA) alone. We hypothesized that the use of CTA-alone screening and diagnostic methods would reduce the time interval from admission to diagnosis and, hence, also reduce the stroke rates associated (...) with these injuries.All patients admitted to a level I trauma center after December 1999 at risk for BCVI were screened. Until March 2005, patients were screened with cervical catheter angiography (CA). Subsequently, a CTA-alone screening/diagnostic program was initiated simultaneously with standardized interdisciplinary treatment guidelines for BCVI. Data for controls were subsequently obtained by reviewing trauma registry records.Of 3012 trauma service admissions from April 2005 to July 2006, 26 patients were found

2009 Journal of Trauma

1070. Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures. (Abstract)

Modified Judet approach and minifragment fixation of scapular body and glenoid neck fractures. To describe the technique and to determine the outcome of operatively treated displaced scapular body or glenoid neck fractures using minifragment fixation through a modified Judet approach.Retrospective review of scapular or glenoid fractures.Level 1 teaching trauma center.All treated scapular or glenoid fractures over 7 years (1999-2005) were determined. Of a total of 227 scapular or glenoid (...) was paramount for fracture reduction and implant insertion. The 2.7-mm minifragment plates were applied along the lateral border of the scapula.Radiographic assessment of fracture healing and clinical assessment of shoulder function.The majority of patients were males (31 males, 6 females) who sustained blunt trauma. All scapular fractures maintained fixation and reduction. No wound or muscle dehiscence problems were noted. Average range of motion was 158 degrees (range 90-180 degrees). There were

2009 Journal of Orthopaedic Trauma

1071. Screening for blunt cerebrovascular injury: selection criteria for use of angiography. Full Text available with Trip Pro

dissection in 9 of 10 patients. Skull base fractures and unexplained neurological findings were associated with major BCI in 13 (18.3%) of 71 and 11 (16.9%) of 65 patients, respectively.Cervical and facial fractures resulting from blunt trauma were highly associated with BCI. After significant thoracic trauma or soft tissue injury to the neck, angiography should be reserved for patients with unexplained neurological findings or expanding hematomas of the neck. (...) Screening for blunt cerebrovascular injury: selection criteria for use of angiography. Blunt cerebrovascular injury (BCI) to the carotid and vertebral arteries is being recognized with increasing frequency in trauma victims. Yet, only broadly defined criteria exist for the use of screening angiography. In this study, the authors systematically identified the associated injuries that predict BCI and provide guidelines for the types of injuries best evaluated by angiography.Criteria for screening

2009 Journal of Neurosurgery

1072. Disparities in the delivery of pediatric trauma care. Full Text available with Trip Pro

children receive better trauma care than those treated at other hospitals or trauma centers.We reviewed more than 60 published studies on pediatric trauma outcomes. The studies included registry analysis: single and multihospital experience; abdominal, head and neck, and thoracic trauma; as well as functional outcomes.The data show that most injured children are not treated at PTC due to the geographically limited distribution of such specialized care, lack of pediatric surgeons, and other specialists (...) Disparities in the delivery of pediatric trauma care. Trauma is the leading cause of morbidity and mortality in children. During the last few decades, trauma systems have evolved to improve the care of the injured with an ultimate goal of saving lives. As a result, pediatric trauma centers (PTC) have been established to optimize outcomes for injured children. We sought to determine whether injured children treated at PTC or adult trauma centers (ATC) with added qualifications to treat injured

2009 Journal of Trauma

1073. Value of computed tomographic angiography in neck and extremity pediatric vascular trauma. (Abstract)

. For blunt trauma, CTA was 88% sensitive and 100% specific. CTA for blunt trauma had a PPV of 100% and an NPV of 97%. The accuracy for penetrating and blunt trauma was 95% and 97%, respectively.CTA is highly sensitive, specific, and accurate for pediatric neck and extremity vascular trauma. (...) Value of computed tomographic angiography in neck and extremity pediatric vascular trauma. We sought to define the sensitivity and specificity of computed tomographic angiography (CTA) in pediatric vascular injuries.All neck and extremity CTAs performed in pediatric patients at a level 1 trauma center were reviewed from 2001 to 2007.Overall, 78 patients were identified with an average age of 15.0 +/- 4.0 (0-18 years). Males outnumbered females 3.6:1. CTA was performed for 41 penetrating and 37

2009 Journal of Pediatric Surgery

1074. Blunt posterior tracheal laceration and esophageal injury in a child. (Abstract)

Blunt posterior tracheal laceration and esophageal injury in a child. Blunt force trauma to the neck can result in the unusual injury pattern of laceration of the posterior tracheal wall in combination with esophageal injury. We present the report of a 10-year-old child who had blunt cervical trauma because of a bicycle accident and subsequently presented with profound subcutaneous emphysema. This case was addressed with operative management with a good result. The essential management

2009 Journal of Pediatric Surgery

1075. When violence strikes the head, neck, and face. (Abstract)

with the mechanism behind it, the type of injury, and the specific anatomic location.A total of 1,106 victims were examined of whom 83% had HNF injuries. Thirty-seven percent had more than one HNF injury. Injuries around the nose and mouth were significantly associated with male victims, whereas injuries to the neck were significantly more common among female victims. Most injuries were the results of assault with a blunt object, where the men much more frequently had open wounds, whereas injuries (...) When violence strikes the head, neck, and face. The aim of this study was to find characteristics in head-neck-facial (HNF) injuries among victims of violence and to test the hypothesis that the type of injury, location, and mechanism behind it vary between the genders.A 1-year prospective study including all victims of violence attending the Accident & Emergency (A&E) Department or the Institute of Forensic Medicine in Aarhus was conducted. Every violence-related injury was recorded along

2009 Journal of Trauma

1076. Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis. Full Text available with Trip Pro

showed occlusion of the right internal carotid artery consistent with internal carotid artery dissection. He was anticoagulated and nine months later was able to walk independently. An awareness of this injury is needed to diagnose blunt trauma to the internal carotid artery. Even in the absence of obvious neck trauma, carotid artery dissection should be suspected in patients with a neurological deficit in the peri-operative period. (...) Delayed presentation of carotid artery dissection following major orthopaedic trauma resulting in dense hemiparesis. We report a 30-year-old patient who was involved in a high-velocity road traffic accident and developed a left-sided hemiparesis, which was noted in the post-operative period following bilateral femoral intramedullary nailing. CT scanning of the brain revealed infarcts in the right frontal and parietal lobes in the distribution of the right middle cerebral artery. CT angiography

2009 The Journal of Bone and Joint Surgery British Volume

1077. Voice and airway after laryngeal trauma in children. (Abstract)

is presented. Ages range from 6 weeks to 17 years. The diagnostic evaluation and treatment strategies are reviewed with a focus on contemporary techniques.A 15-year-old boy who sustained blunt neck trauma was diagnosed with a vocal fold avulsion on video laryngoscopy with digital image processing and a significant mucosal tear with exposure of the paraglottic space on direct laryngoscopy. Anatomical reapproximation required a combined open and endoscopic repair. A 17-year-old football player developed (...) a glottic hematoma after blunt cervical trauma. This was managed conservatively with serial chip tip video laryngoscopy that provided high fidelity images and facilitated proper and timely diagnosis and treatment. A 6-week-old male suffered vocal fold avulsion from a traumatic intubation. Laryngofissure with reattachment of the vocal fold resolved his aspiration and reconstructed the laryngeal anatomy.Enhanced imaging via chip tip video laryngoscopy, compared to conventional fiberoptic endoscopy, might

2009 Laryngoscope

1078. Early management of traumatic pancreatic transection by spleen-preserving laparoscopic distal pancreatectomy. (Abstract)

Early management of traumatic pancreatic transection by spleen-preserving laparoscopic distal pancreatectomy. Pancreatic trauma is a common cause of acute pancreatitis in children and is often treated by conservative measures alone. Conservative measures are more likely to fail when there is complete pancreatic duct disruption. We report a case of complete transaction of the pancreatic neck following blunt trauma in a 14-year-old boy. Complete duct disruption was confirmed by endoscopic

2009 Journal of Pediatric Surgery

1079. An uncommon cause of throat pain. Full Text available with Trip Pro

An uncommon cause of throat pain. Throat pain is a common presenting complaint in the pediatric emergency department and often occurs secondary to non-life-threatening conditions. Certain etiologies may initially appear benign, but if not recognized and treated, may result in airway compromise. Patients with blunt trauma to the neck may present with throat pain. This is an uncommon pediatric injury usually due to a sharp blow to the anterior neck. This injury is rarely seen in isolation. We (...) present a case of laryngeal injury due to blunt trauma to the neck. This case illustrates the potentially serious consequence after an apparently minor traumatic injury.

2009 Pediatric Emergency Care

1080. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

, or neck as described by the following: * Heartbeat sensations that feel like pounding or racing * An unpleasant awareness of heartbeat * Feeling skipped beats or a pause 7 Hemodynamically unstable Presyncope Patient reports presyncope as described by the following: * Dizziness * Lightheadedness * Feeling faint * ‘Graying out’ 7 Syncope Sudden loss of consciousness with loss of postural tone, not related to anesthesia, with spontaneous recovery as reported by the patient or observer. Patient may

2006 European Society of Cardiology

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