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Blunt Neck Trauma

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1101. Pseudoaneurysms of the superficial temporal artery: treatment options. (Abstract)

Pseudoaneurysms of the superficial temporal artery: treatment options. Pseudoaneurysms of the superficial temporal artery present as slowly growing masses of the face or scalp. They may arise as a result of infection or autoimmune disease but most commonly are sequelae of blunt, penetrating, or surgical trauma. We describe their clinical presentation and differential diagnosis and compare several treatment options.Observational case series.We retrospectively reviewed the presentations (...) , diagnostic evaluations, and management in three young men who presented with pseudoaneurysms after trauma. A computerized review of the world's literature revealed a variety of methods for the control of head and neck pseudoaneurysms.Surgical resection, ligation without resection, intravascular sclerosis, and coil embolization have all been used to treat these lesions. We treated two lesions by coil embolization and one by surgical resection. Long-term control was achieved in each case.Surgical resection

2004 Laryngoscope

1102. Sebaceous (Epidermoid) Cysts

anywhere on the body but occur most often on the face, scalp, neck, back and scrotum. Pilar cysts (also called trichilemmal cysts) are clinically indistinguishable from epidermal cysts. They contain keratinous material, are usually multiple and there is often an autosomal dominant inheritance. Epidemiology They are both extremely common and probably most people will have at least one over the course of a lifetime. They can often resolve spontaneously. They are around twice as common in men as in women (...) or wearing underwear. They can also interfere with micturition. Epidermoid and pilar cysts appear as firm, round, mobile, flesh-coloured to yellow or white subcutaneous nodules of variable size. A central pore or punctum may tether the cyst to the overlying epidermis and a thick cheesy material can sometimes be expressed. In people with dark skin, the cysts may also be pigmented. Sites affected The sites most commonly affected are, in descending order of frequency, the face, the trunk, the neck

2008 Mentor

1103. Lipoma

developed following blunt trauma. It is thought that at least some of these are due to herniation of fat through torn fascia. The resulting swelling is referred to as a 'pseudo-lipoma'. [ ] Liposarcoma Malignancy is rare but can be found in a lesion with the clinical appearance of a lipoma. Liposarcoma presents in a fashion similar to that of a lipoma and appears to be more common in the retroperitoneum, on the shoulders and lower extremities. Some recommend complete excision of a lipoma to exclude (...) disturbances as other prominent features. [ ] Madelung's disease This is also known as benign symmetric lipomatosis. It is lipomatosis of the head, neck, shoulders and proximal upper extremities. Madelung's disease, often presents in men who drink excess alcohol, who may present with the characteristic 'horse collar' cervical appearance. Rarely, these patients experience swallowing difficulties, respiratory obstruction and even sudden death. [ ] Post-traumatic lipomas Lipomas have been reported that have

2008 Mentor

1104. Laryngitis

world, mycobacterial and syphilitic infection. Fungal Infection: Candidiasis. Immunosuppression and the use of steroid inhalers are risk factors. Trauma: Trauma due to voice misuse - screaming, yelling, loud singing. Trauma due to excessive voice use - more common in certain professions such as teachers, actors and singers. Coughing. Penetrating or blunt external force. Habitual throat clearing. Chronic laryngitis Allergy - allergic rhinitis, asthma. Laryngopharyngeal reflux. Trauma (as above (...) , progesterone. Immunosuppressant therapy - consider candida. Inhalation treatments - thermal baths. Surgical history: History of intubation - recurrent laryngeal damage, particularly likely in thoracic and abdominal surgery. Surgery leading to anatomical alterations predisposing to GORD (again, thoracic and abdominal). Neck trauma. Ingestion of caustic substances. Travel history (for the possibility of parasitical infections). Family history: Autoimmune diseases (eg, amyloidosis, systemic lupus

2008 Mentor

1105. Mediastinitis

to: ingestion. Spontaneous oesophageal rupture. Local neoplastic spread. Iatrogenic causes including: . . Cardiothoracic surgery (most cases of mediastinitis in the developed world follow cardiothoracic surgery). [ ] . Blunt trauma to the chest/abdomen can cause mediastinitis. [ ] There may be direct spread of infection into the mediastinum from: Pulmonary infection. of the sternoclavicular junction. Granulomatous disease (including ) in the mediastinal lymph nodes. Descending necrotising mediastinitis (...) the fascial planes in the neck (eg the carotid space, the prevertebral space). This descending infection is known as descending necrotising mediastinitis. A rare fibrotic reaction to granulomatous diseases such as . This is known as fibrosing mediastinitis. Epidemiology Mediastinitis is a relatively rare phenomenon in patients who have not undergone cardiothoracic surgery or another intervention. The rate of mediastinitis following cardiothoracic surgery was around 1% in one study of 10,000 patients

2008 Mentor

1106. Ulnar Nerve Disorders

scanning may also be useful. [ ] Electromyography (EMG) tests and nerve conduction studies to confirm the area of entrapment. [ ] Management Conservative treatment [ ] Is most successful when paraesthesiae are transient and caused by malposition of the elbow or by blunt trauma. Resting on the elbows at work, using the elbows to lift the body from bed and resting the elbows on car windows while driving are all causes of paraesthesia that can be corrected without surgical treatment. Anterior elbow (...) after careful ultrasound evaluation. [ ] Causes of compression of the ulnar nerve at the wrist include aneurysm of the ulnar artery, thrombosis, synovial inflammation and ganglia, or by repeated trauma at work. Epidemiology Ulnar nerve entrapment is the second most frequent entrapment neuropathy in the upper extremity (the first being the median nerve and its branches). [ ] The elbow is the most common area for entrapment. [ ] The frequency of ulnar nerve compression is increasing, partly due

2008 Mentor

1107. Subdural Haematoma

there is no associated parenchymal injury. A complicated SDH is when there is associated underlying parenchymal injury, such as contusion. Pathophysiology An acute SDH is usually caused by either: Tearing of bridging veins from the cortex to one of the draining venous sinuses – typically occurring when bridging veins are sheared during rapid acceleration-deceleration of the head. Bleeding from a damaged cortical artery. Blunt head trauma is the usual mechanism of injury but spontaneous SDH can arise as a consequence (...) times and blunt head trauma and is a risk factor for SDH. [ ] Alcoholism also causes cerebral atrophy which can put tension on the bridging veins. People on anticoagulation treatment: [ ] Anticoagulation treatment (including with aspirin or warfarin) is another risk factor. [ ] Epidemiology SDH can occur in about one third of people with a severe head injury. [ ] It is more common with increasing age, as described above. One study found a prevalence of 7.35 cases per 100,000 population in those aged

2008 Mentor

1108. Electrical Injuries and Lightning Strikes

the legs and ground. This method of injury may account for the high mortality (30%) of lightning victims with leg burns and for the fact that burns to the arms and trunk are not important predictors of mortality in lightning strikes. Blunt trauma : can occur if the person is thrown by massive skeletal muscle contraction. Flashover effect : the current passes over and around the casualty's body but not through it. Clothes and shoes are torn apart but there are only superficial skin wounds (unless (...) management [ ] After the lightning has struck, the victim is safe to touch - check for responsiveness. Commence immediate cardiopulmonary resuscitation (CPR) - this may prevent the secondary hypoxic cardiac arrest. Carry out CPR even if the casualty appears dead (pupils may be fixed and dilated as a result of muscular paresis - they do not necessarily represent brain death). Be aware of the possibility of a spinal cord injury (evidence of head injury or tenderness or haematomas of the neck or back noted

2008 Mentor

1109. Brown-Sequard Syndrome

or blunt trauma). [ ] MRI scanning can help to define the extent of spinal . It is particularly helpful when evaluating non-traumatic causes. MRI may be needed in traumatic cases when there is neurological deterioration. [ ] CT myelography (useful if MRI is contra-indicated). Management Initially, a thorough evaluation, including neurological examination, is performed to establish the level of injury. Careful cervical spine/dorsal spine immobilisation is necessary. No movement of the neck should (...) with brisk reflexes and a strong leg with loss of pain and temperature sensation. Spasticity and hyperactive reflexes may not be present with an acute lesion. Aetiology The causes of this syndrome are: Most commonly, trauma (penetrating or blunt). [ ] Neoplasia (spinal cord tumour - either metastatic or primary). Multiple sclerosis. Degenerative (such as herniation of discs and cervical spondylosis). [ , ] Cysts and cystic diseases. [ ] Idiopathic spinal cord herniation. [ ] (Spinal cord herniation can

2008 Mentor

1110. Cardiac Tamponade

Postoperative (cardiovascular surgery): haemorrhagic Idiopathic Drugs: eg, hydralazine, isoniazid, minoxidil Diagnostic procedures with cardiac perforation Trauma (incidence of 2% in penetrating trauma, rare in blunt trauma) and surgery Pneumopericardium (mechanical ventilation or gastropericardial fistula) Presentation It may present subacutely with anxiety, fatigue, altered mental status, oedema or waxing/waning if intermittently decompressing. [ ] Dyspnoea, tachycardia, and tachypnoea. Cold and clammy (...) related to trauma or HIV is more common in young adults. [ ] Tamponade due to malignancy and/or chronic kidney injury occurs more frequently in elderly individuals. Causes Often associated with pericarditis: Malignancy, especially breast cancer or lung cancer Acute myocardial infarction and post-infarction (including ) [ ] Infective: viral (including ), bacterial (eg, ), fungal Connective tissue diseases: eg, . [ ] Also, , , systemic sclerosis [ ] Radiation therapy Myxoedema Chronic kidney disease

2008 Mentor

1111. Aneurysms and Dissection of Arteries

localised spread from adjacent structures). Penetrative or blunt trauma. Congenital (eg, berry aneurysm). Cocaine use has been associated with cerebral, aortic, visceral and peripheral aneurysms. Risk factors Aortic aneurysm: Atherosclerosis. Cerebral aneurysms: Anomalous vessels. Coarctation of the aorta. Polycystic kidney disease. Fibromuscular dysplasia. Connective tissue disorders. Vascular malformations and fistulae. Sites of aneurysms Cerebral aneurysms See also the separate article. Unruptured (...) three layers of the artery wall (intima, media and adventitia). The artery wall can balloon out symmetrically to form a 'fusiform' aneurysm or there can be a local 'blow-out' to form a 'saccular' aneurysm. Common sites are: abdominal aorta, iliac artery, popliteal artery, femoral artery. False aneurysms Represent a collection of blood, held around the vessel by a wall of connective tissue. The aneurysm does not involve the vessel wall. May occur following trauma or there may be a slow leak of blood

2008 Mentor

1112. Zygomatic Arch and Orbital Fractures

blunt trauma to the cheek, such as involved in: Assault Road traffic accidents Contact sports (less common) Assessment of potential fractures History Visual symptoms - diplopia can occur due to entrapment of a muscle, neural injury or a haematoma in an external ocular muscle. Other symptoms - trismus is spasm of masseter and it makes chewing difficult and painful. Ask about dental malocclusion. The mucosa of the maxillary sinus may be lacerated and cause epistaxis on that side. Severe pain may (...) significant maxillofacial trauma involving the malar complex too. High-impact, blunt trauma to the cheek causes zygomatic fractures; they are easy to overlook and, if displaced, require treating within 10 days. [ ] Usually, a displaced fracture involves the orbitozygomatic complex: [ ] The inferior orbital rim and orbital floor. The zygomatico-frontal suture. The zygomaticomaxillary buttress. The zygomatic arch. Occasionally, a direct blow can produce an isolated depressed fracture of the arch only

2008 Mentor

1113. Whiplash and Cervical Spine Injury

Suppl):S83-92. doi: 10.1097/BRS.0b013e3181643eb8. ; Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. CMAJ. 2012 Nov 6184(16):E867-76. doi: 10.1503/cmaj.120675. Epub 2012 Oct 9. ; Imaging after trauma to the neck. BMJ. 2008 Jan 19336(7636):154-7. ; NICE Clinical Guideline (January 2014, updated June 2017) ; Conservative treatments for whiplash. Cochrane Database Syst Rev. 2007 Apr 18(2 (...) . Grade 1: indicates neck complaints but no physical signs. Grade 2: indicates neck complaints and musculoskeletal signs. Grade 3: neck complaints and neurological signs. Grade 4: neck complaints and fracture/dislocation: Most cervical spine fractures occur predominantly at two levels - at the level of C2 or at C6 or C7. Most fatal cervical spine injuries occur in upper cervical levels, either at the cranio-cervical junction C1, or at C2. Epidemiology Trauma and sports injuries are more common

2008 Mentor

1114. Gunshot Injuries

, the projectile crushes structures along its track, similar to other forms of penetrating injury. Temporary cavitation causes shearing and compression, sometimes tearing structures (as with solid abdominal viscera) or stretching inelastic tissue (the brain is particularly susceptible), analogous to blunt trauma. As tissues recoil and hot gases dissipate, soft tissue collapses inwards with the permanent cavity being the resultant defect. [ ] Bullets which display greater yaw will be associated with increased (...) . They generate a large number of firearm injuries in England and Wales due to their frequent use. They are usually accidental injuries to boys caused by themselves or other children. Most injuries are relatively minor but fatal injuries do occur. Eye, neck and abdominal injuries are most common but there is also potential for serious brain and chest trauma. [ ] The Violent Crime Reduction Act of 2006 restricted the sale of air weapons to licensed firearm dealers and increased the minimum age for ownership

2008 Mentor

1115. Examination of the Spine

discrepancy: straight leg raising when sitting and when supine not consistent; sitting test performed while distracting the patient. Non-physiological examination: non-dermatomal sensory loss, cogwheel or give-way weakness Other tests have subsequently been developed. [ ] A full may be required. Neck examination Neck problems are common in general practice, either chronic discomfort, such as with cervical spondylosis, or following acute trauma - eg, whiplash injuries following road traffic accidents (...) posture may be due to neck problems but also other causes - eg, weakness of the ocular muscles. Asymmetry (eg, of scapulae) or supraclavicular fossae (eg, Pancoast's syndrome due to a malignant tumour at the apex of the lung). Torticollis (the affected side and chin are often tilted to the opposite side) or sternomastoid 'tumour' in infants. Causes of acquired torticollis include upper respiratory tract infection, and vertebral malalignment or trauma. Arms and hands: for wasting, fasciculation, motor

2008 Mentor

1116. Fractured Humerus

aged <16 years. [ ] Mechanism of injury A Swedish study in 2006 found most are caused by a simple fall. [ ] May be linked to non-accidental injury in children aged <3 years. [ ] Usually direct trauma or torsion injury to an upper limb. Occasionally, a fall on to an outstretched abducted arm. Blunt injury/bending forces usually cause transverse fractures. Torsional force tends to result in spiral fracture. Age group affected The Swedish study found that most fractures occurred in elderly patients (...) . You may find the article more useful, or one of our other . In this article In This Article Fractured Humerus In this article Fractures of the humerus are common and may result from injury. However, they are also associated with pathological fractures and osteoporosis, particularly in the elderly. The anatomy of the humerus The humeral head articulates with the glenoid fossa of the scapula. The anatomical neck separates the greater and lesser tuberosities from the humeral head. The long head

2008 Mentor

1117. Orbital Swellings

such as metastases or lymphoproliferative disease. Inflammatory These may include: Orbital vasculitis [ ] Vascular Vascular abnormalities of the orbit may be present at birth, develop during childhood or appear for the first time in adults. They include cavernous and capillary haemangiomas, arteriovenous fistulae and venous varices. Carotico-cavernous fistula : This occurs when the arterial circulation connects with the venous circulation in the cavernous sinus. Causes include blunt head trauma (80% of cases (...) may find one of our more useful. In this article In This Article Orbital Swellings In this article When you are presented with a patient with orbital swelling, there are three questions you need to answer: What could this be? Is this swelling of something within the orbit (eg, thyroid eye disease)? Is it a bony problem (eg, congenital or trauma)? Could this be a more external soft tissue problem (eg, orbital cellulitis) or even not an orbital problem at all but one adjacent to it that appears

2008 Mentor

1118. Hypothermia to Treat Severe Brain Injury

(Child, Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria ELIGIBILITY CRITERIA FOR EARLY COOLING TO 35°C: Inclusion Criteria: GCS 3-8 on initial evaluation or deteriorates during transport Mechanism of injury consistent with blunt, non-penetrating trauma to head Systolic blood pressure > 110 mm Hg Diastolic blood pressure> 60 mm Hg Heart rate (pulse) < 120 beats per minute Estimated or known age 16-45 No suspicion of pregnancy Esophageal/rectal probe temperature > 35.5°C (...) (Pre-hospital cooling only) Injured < 2 hours prior to arrival of pre-hospital providers No evidence of severe chest trauma (unilaterally absent breath sounds with tracheal deviation or distended neck veins or requiring thoracentesis). Exclusion Criteria: Following commands upon EMS arrival without deterioration to coma or follows command after an initial period of coma. Mechanism of injury GSW or no indication of head injury Systolic blood pressure < 120 mm Hg Diastolic blood pressure < 60 mm Hg

2002 Clinical Trials

1119. Paramedic evaluation of clinical indicators of cervical spinal injury. (Abstract)

Paramedic evaluation of clinical indicators of cervical spinal injury. Standard prehospital practice includes frequent immobilization of blunt trauma patients, oftentimes based solely on mechanism. Unnecessary cervical spine (c-spine) immobilization does have disadvantages, including morbidity such as low back pain and splinting, increased scene time and costs, and patient-paramedic conflict. Some emergency physicians (EPs) use clinical criteria to clear trauma patients of c-spine injury (...) combinations of positive and negative findings, were examined simultaneously by EP-paramedic pairs. Each pair evaluated five randomly assigned patients for six clinical criteria: 1) alteration in consciousness, 2) evidence of intoxication, 3) complaint of neck pain, 4) cervical tenderness, 5) neurologic deficit or complaint, and 6) distracting injury. If any criterion was positive, clinical clearance was considered to have failed, and the simulated patient would have been immobilized. Fifty pairs

1998 Prehospital emergency care Controlled trial quality: uncertain

1120. Tracheal Perforation and Widespread Subcutaneous Emphysema in a Horse Full Text available with Trip Pro

resolved without specific therapy. Blunt trauma was suggested as the cause of the tracheal lesion and subsequent subcutaneous emphysema. (...) Tracheal Perforation and Widespread Subcutaneous Emphysema in a Horse A twelve year old Quarterhorse mare exhibited subcutaneous emphysema of the head, neck, upper forelimbs and thorax, and walked with a stiff gait, characterized by decreased flexion of the forelimbs. Endoscopy of the trachea revealed a small tracheal wound ninety centimeters from the external nares. The location of the lesion corresponded with a seroma present at the base of the neck. The subcutaneous emphysema and the seroma

1984 The Canadian Veterinary Journal

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