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Blunt Neck Trauma

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161. Pneumomediastinum and Subcutaneous Emphysema Unusual Complications of Blunt Facial Trauma Full Text available with Trip Pro

Pneumomediastinum and Subcutaneous Emphysema Unusual Complications of Blunt Facial Trauma We described a rare case of pneumomediastinum following an isolated facial trauma. Traumatic pneumomediastinum is usually secondary to a blunt or penetrating neck, chest or abdominal trauma.

2011 The Indian journal of surgery

162. Pediatric radiation exposure during the initial evaluation for blunt trauma. (Abstract)

Pediatric radiation exposure during the initial evaluation for blunt trauma. Increased utilization of computed tomography (CT) scans for evaluation of blunt trauma patients has resulted in increased doses of radiation to patients. Radiation dose is relatively amplified in children secondary to body size, and children are more susceptible to long-term carcinogenic effects of radiation. Our aim was to measure radiation dose received in pediatric blunt trauma patients during initial CT evaluation (...) and to determine whether doses exceed doses historically correlated with an increased risk of thyroid cancer.A prospective cohort study of patients aged 0 years to 17 years was conducted over 6 months. Dosimeters were placed on the neck, chest, and groin before CT scanning to measure surface radiation. Patient measurements and scanning parameters were collected prospectively along with diagnostic findings on CT imaging. Cumulative effective whole body dose and organ doses were calculated.The mean number

2011 Journal of Trauma

163. Selective Use of Computed Tomography Compared With Routine Whole Body Imaging in Patients With Blunt Trauma. (Abstract)

Selective Use of Computed Tomography Compared With Routine Whole Body Imaging in Patients With Blunt Trauma. Routine pan-computed tomography (CT, including of the head, neck, chest, abdomen/pelvis) has been advocated for evaluation of patients with blunt trauma based on the belief that early detection of clinically occult injuries will improve outcomes. We sought to determine whether selective imaging could decrease scan use without missing clinically important injuries.This was a prospective (...) observational study of 701 patients with blunt trauma at an academic trauma center. Before scanning, the most senior emergency physician and trauma surgeon independently indicated which components of pan-CT were necessary. We calculated the proportion of scans deemed unnecessary that: (a) were abnormal and resulted in a pre-defined critical action or (b) were abnormal.Pan-CT was performed in 600 of the patients; the remaining 101 underwent limited scanning. One or both physicians indicated a willingness

2011 Annals of Emergency Medicine

164. Epidemiology of Sudden Death in Young, Competitive Athletes Due to Blunt Trauma. Full Text available with Trip Pro

Epidemiology of Sudden Death in Young, Competitive Athletes Due to Blunt Trauma. Sudden deaths of young competitive athletes are highly visible events that have a substantial effect on families and communities. Recent attention has focused predominantly on cardiovascular causes, and less on traumatic organ damage.To define the clinical profile, epidemiology, and frequency of trauma-related deaths in young US athletes.We analyzed the 30-year US National Registry of Sudden Death in Young Athletes (...) (1980-2009) by using systematic identification and tracking strategies.Of 1827 deaths of athletes aged 21 years or younger, 261 (14%) were caused by trauma-related injuries, usually involving the head and/or neck (mean: 16 ± 2 years; 90% male) in 22 sports. The highest number of events in a single year was 16 (1986), with an average of 9 per year throughout 30 years. The mortality rate was 0.11 in 100 000 participations (95% confidence interval: 0.08-0.15). The largest number of deaths

2011 Pediatrics

165. Urethral Trauma (Diagnosis)

, 2019 Author: James M Cummings, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS Share Email Print Feedback Close Sections Sections Urethral Trauma Overview Practice Essentials Most urethral injuries are associated with well-defined events, including major blunt trauma such as caused by motor vehicle collisions or falls. Penetrating injuries in the area of the urethra may also cause urethral trauma. Straddle injuries may cause both short- and long-term problems. Iatrogenic injury to the urethra (...) from traumatic catheter placement, transurethral procedures, or dilation is not uncommon. Urethral injuries can be classified into 2 broad categories based on the anatomical site of the trauma. Posterior urethral injuries are located in the membranous and prostatic urethra. These injuries are most commonly related to major blunt trauma such as motor vehicle collisions and major falls, and most of such cases are accompanied by . Injuries to the anterior urethra are located distal to the membranous

2014 eMedicine.com

166. Bladder Trauma (Overview)

, 2019 Author: Bradley C Gill, MD, MS; Chief Editor: Bradley Fields Schwartz, DO, FACS Share Email Print Feedback Close Sections Sections Bladder Trauma Overview Practice Essentials Bladder injuries can result from blunt, penetrating, or iatrogenic trauma. [ , ] The probability of bladder injury varies according to the degree of bladder distention; a full bladder is more susceptible to injury than is an empty one. Although historically, bladder trauma was uniformly fatal, timely diagnosis (...) of intraperitoneal bladder rupture in the setting of blunt or penetrating external trauma" and that "clinicians should perform catheter drainage as treatment for patients with uncomplicated extraperitoneal bladder injuries." [ ] Nevertheless, the literature contains a handful of case reports describing intraperitoneal bladder rupture managed conservatively. Two such reports describe successful treatment of small ruptures in patients with a benign abdomen, using prolonged large-diameter urethral catheter drainage

2014 eMedicine.com

167. Ureteral Trauma (Treatment)

Ureteral Trauma (Treatment) Ureteral Trauma Treatment & Management: Surgical Therapy, Follow-up, Complications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDQwOTMzLXRyZWF0bWVudA== processing > Ureteral Trauma (...) Treatment & Management Updated: Feb 11, 2017 Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS Share Email Print Feedback Close Sections Sections Ureteral Trauma Treatment Surgical Therapy Management of ureteral injuries is dictated by the location, type, extent, timing of presentation, medical history, overall status of the patient, including associated injuries, and prognosis. [ ] The American Urologic Association has released guidelines on imaging and management

2014 eMedicine.com

168. Urethral Trauma (Overview)

, 2019 Author: James M Cummings, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS Share Email Print Feedback Close Sections Sections Urethral Trauma Overview Practice Essentials Most urethral injuries are associated with well-defined events, including major blunt trauma such as caused by motor vehicle collisions or falls. Penetrating injuries in the area of the urethra may also cause urethral trauma. Straddle injuries may cause both short- and long-term problems. Iatrogenic injury to the urethra (...) from traumatic catheter placement, transurethral procedures, or dilation is not uncommon. Urethral injuries can be classified into 2 broad categories based on the anatomical site of the trauma. Posterior urethral injuries are located in the membranous and prostatic urethra. These injuries are most commonly related to major blunt trauma such as motor vehicle collisions and major falls, and most of such cases are accompanied by . Injuries to the anterior urethra are located distal to the membranous

2014 eMedicine.com

169. Facial Trauma, Nasal Fractures

: Problem Nasal fractures occur in a great number of patterns. The complex 3-dimensional anatomy of the nasal bones, upper and lower lateral cartilages, and bony and cartilaginous septum underscores the importance of a precise assessment of the specific injury to maximize the results of treatment. Blunt trauma may occur anteriorly or laterally, and the resulting pattern of fractures reflects this direction of force. Optimum management is particularly important because of the unique forces of contraction (...) that occur on this complex 3-dimensional structure over the ensuing months following injury. External nasal deformities and significant airway obstruction occur in a significant number of patients, and their presentation may be delayed by as many as several months. Previous Next: Etiology Blunt trauma is the most common cause of nasal fractures. Automobile accidents, altercations, and falls account for approximately 85% of nasal fractures. A study by Liu et al of 100 cases of pediatric nasal deformity

2014 eMedicine Surgery

170. Facial Trauma, Nasoethmoid Fractures

posteriorly. These structures are susceptible to comminution, allowing for a medial displacement of the orbital contents after blunt trauma (medial blowout). Superiorly, the thin ethmoid bones form part of the floor of the anterior skull base. In this region, dural injury and resultant CSF leak is possible. The anterior and posterior ethmoid foramina are located at the superior aspect of the ethmoid bone in the frontoethmoid suture. Shearing of the corresponding arteries that traverse these foramina may (...) plate of the ethmoid and reinforced by the midline cribriform plate. The roof of the interorbital space is the skull base, and the posterior border is the sphenoid bone. High-energy blunt trauma to the NOE complex may result in collapse of the interorbital space and concomitant injury to the anterior cranial contents (frontal lobe) or intraorbital contents. The MCT is a crucial soft tissue component of the NOE complex. This structure represents a medial fusion of the superficial and deep heads

2014 eMedicine Surgery

171. Facial Trauma, Maxillary and Le Fort Fractures

: Etiology Maxillary fractures often result from high-energy blunt force injury to the facial skeleton. Typical mechanisms of trauma include motor vehicle accidents, altercations, and falls. [ ] With increased legislation requiring seat belt use, injuries from driver impact with the steering wheel have shifted from chest trauma to facial trauma. Previous Next: Pathophysiology Much of the understanding of patterns of fracture propagation in midface trauma originates from the work of René Le Fort. In 1901 (...) on the lateral buttress than do those caused by a low-velocity impact (ie, impact from a fall from stranding height or an assault with a blunt weapon or closed fist). [ ] Two types of non–Le Fort maxillary fractures of note are relatively common. First, limited and very focused blunt trauma may result in small, isolated fracture segments. Often, a hammer or other instrument is the causative weapon. In particular, the alveolar ridge, maxillary sinus anterior wall, and nasomaxillary junction, by virtue

2014 eMedicine Surgery

172. Facial Trauma, Management of Panfacial Fractures

. . DeMarino DP, Steiner E, Poster RB, et al. Three-dimensional computed tomography in maxillofacial trauma. Arch Otolaryngol Head Neck Surg . 1986 Feb. 112(2):146-50. . Singh M, Ricci JA, Caterson EJ. Use of Intraoperative Computed Tomography for Revisional Procedures in Patients with Complex Maxillofacial Trauma. Plast Reconstr Surg Glob Open . 2015 Jul. 3 (7):e463. . Gillespie JE, Quayle AA, Barker G, Isherwood I. Three-dimensional CT reformations in the assessment of congenital and traumatic cranio (...) , Long J, et al. Sequential surgical treatment for panfacial fractures and significance of biological osteosynthesis. Dent Traumatol . 2009 Apr. 25(2):171-5. . Bellamy JL, Mundinger GS, Flores JM, et al. Facial fractures of the upper craniofacial skeleton predict mortality and occult intracranial injury after blunt trauma: an analysis. J Craniofac Surg . 2013 Nov. 24 (6):1922-6. . Media Gallery Coronal view of patient with panfacial fractures from facial trauma. Close-up view of left zygomatic

2014 eMedicine Surgery

173. Facial Trauma, Sports-Related Injuries

of underlying fractures of the skull base. Previous Next: Soft Tissue Injuries Sports-related facial trauma generally results when direct contact occurs with another player or a piece of equipment, including a projectile or contact against a playing surface. These blunt traumas often result in contusions, abrasions, and burst lacerations. In addition to treating the , the Centers for Disease Control and Prevention (CDC) recommendations for tetanus immunization should be followed. Antibiotic prophylaxis (...) be referred to a specialist for further treatment. Wounds should be closely monitored for signs of infection. Lacerations and avulsions Lacerations represent the most common type of facial injury encountered in the athletic setting. When blunt trauma occurs over a bony prominence of the facial skeleton, a linear or stellate laceration may result. The latter is termed a burst-type laceration and, with its jagged skin edges, repair and a good aesthetic outcome are more challenging. Because of the abundant

2014 eMedicine Surgery

174. Facial Trauma, Frontal Sinus Fractures

nonvertical frontal sinus fractures and 98 vertical fractures with or without frontal sinus involvement. [ ] Previous Next: Epidemiology Frequency Frontal sinus fractures comprise 5-12% of maxillofacial traumas. [ , ] The incidence appears to be approximately 9 cases per 100,000 adults. [ ] Previous Next: Etiology Fractures of the frontal sinus occur most commonly as a result of blunt trauma from a motor vehicle accident; the next most common cause is high-impact sports-related injury. [ , , , ] Frontal (...) sinus fractures may result from low-velocity, high-velocity, blunt, or penetrating trauma. With low-velocity impact, the anterior table may confer some protection to the posterior table and may be the only table to fracture. Conversely, high-velocity or penetrating trauma may cause severe damage to both the anterior and posterior tables, with comminution and significant displacement. [ ] Previous Next: Pathophysiology The force required to fracture the frontal sinus has been reported to be 800-2200

2014 eMedicine Surgery

175. Facial Nerve, Intratemporal Bone Trauma

. JAMA Otolaryngol Head Neck Surg . 2018 Apr 1. 144 (4):315-21. . Nash JJ, Friedland DR, Boorsma KJ, Rhee JS. Management and outcomes of facial paralysis from intratemporal blunt trauma: a systematic review. Laryngoscope . 2010 Jul. 120(7):1397-404. . Patel A, Groppo E. Management of temporal bone trauma. Craniomaxillofac Trauma Reconstr . 2010 Jun. 3(2):105-13. . . Kim J, Moon IS, Shim DB, Lee WS. The effect of surgical timing on functional outcomes of traumatic facial nerve paralysis. J Trauma (...) still have facial paralysis. [ ] Given the propensity in the literature to reference fractures as longitudinal, transverse, and oblique, this traditional classification system is used for discussion purposes. Previous Next: Etiology Temporal bone fracture caused by blunt closed-head trauma is by far the most common cause of traumatic facial paralysis. Motor vehicle accidents are the most common mechanism of injury (31%), followed by assaults, falls, and motorcycle accidents. Blunt extratemporal

2014 eMedicine Surgery

176. Initial Evaluation of the Trauma Patient

anteriorly for evidence of airway or great vessel injury, and palpate posteriorly for bony abnormality or tenderness suggestive of cervical spine injury. In patients with blunt trauma and patients with an unknown mechanism of injury (eg, "found down"), observe full spine precautions until injury to the spinal column is excluded. Chest examination Palpate the chest wall for tenderness, instability, or crepitation, followed by auscultation of the lungs and heart. In the patient with penetrating trauma (...) of chest and endotracheal tubes, which are critical to the resuscitation effort and the primary survey. [ ] This chest radiograph demonstrates bilateral pulmonary contusions in a trauma patient. Courtesy of Kevin Kilgore, MD; Carson Harris, MD; and David Hale, MD, Regions Hospital, St Paul, Minn. For patients with blunt trauma, a portable AP pelvis film can easily be obtained during the resuscitation phase. This film can help confirm the presence of significant pelvic fractures (as depicted

2014 eMedicine Surgery

177. Penetrating Head Trauma (Diagnosis)

Surg . 2009 Apr. 67(4):775-81. . Kazemi H, Hashemi-Fesharaki S, Razaghi S, et al. Intractable epilepsy and craniocerebral trauma: analysis of 163 patients with blunt and penetrating head injuries sustained in war. Injury . 2012 Dec. 43(12):2132-5. . Aarabi B. History of the management of craniocerebral wounds. Aarabi B, Kaufman HH, Dagi TF, George ED, Levy ML, eds. Missile Wounds of the Head and Neck . Park Ridge, Ill: American Association of Neurological Surgeons; 1999. Vol 1: 281-292. Aarabi B (...) Penetrating Head Trauma (Diagnosis) Penetrating Head Trauma: Background, History of the Procedure, Problem Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjQ3NjY0LW92ZXJ2aWV3 processing > Penetrating Head Trauma

2014 eMedicine Surgery

178. Closed Head Trauma (Diagnosis)

, Dicocco JM, Zarzaur BL, Croce MA. Improving the screening criteria for blunt cerebrovascular injury: the appropriate role for computed tomography angiography. J Trauma . 2011 May. 70(5):1058-65. . Raji CA, Tarzwell R, Pavel D, Schneider H, Uszler M, Thornton J, et al. Clinical utility of SPECT neuroimaging in the diagnosis and treatment of traumatic brain injury: a systematic review. PLoS One . 2014. 9(3):e91088. . . Mac Donald CL, Johnson AM, Cooper D, et al. Detection of blast-related traumatic (...) injury: injection of mannitol during hyperventilation. J Neurosurg . 1990 Nov. 73(5):725-30. . Gasco J, Sendra J, Lim J, Ng I. Linear correlation between stable intracranial pressure decrease and regional cerebral oxygenation improvement following mannitol administration in severe acute head injury patients. Acta Neurochir Suppl . 2005. 95:73-7. . Chesnut RM, Gautille T, Blunt BA, Klauber MR, Marshall LF. Neurogenic hypotension in patients with severe head injuries. J Trauma . 1998 Jun. 44(6):958-63

2014 eMedicine Surgery

179. Thoracic Spine, Trauma

spine occur when a vertical force with or without a flexion or rotational sheer force exceeds the weight-bearing strength of the vertebral body. Various diseases, advanced age, and other comorbidities may make compression fractures more likely. Fractures associated with subluxation or dislocation are more commonly the result of high-velocity blunt trauma with an element of flexion or rotational stress. In cases associated with unusual causes of spinal injury, such as child abuse, the mechanism (...) adults. In general, anteroposterior (AP) and lateral radiographs should be obtained in the emergency department while other measures of resuscitation are performed. Multidetector CT scans with intravenous contrast enhancement are indicated in most patients to exclude intrathoracic vascular injury. In patients who have sustained blunt trauma, multidetector CT has been proposed as a screening study for thoracolumbar fracture. [ , , ] MRI of the thoracic spine should be reserved for patients

2014 eMedicine Radiology

180. Thorax, Trauma

with MRI in some situations. Previous comparisons have indicated that a majority of thoracic injuries found on CT (in particular, multi-detector CT) may be missed on chest radiography. Multi-detector CT, therefore, has been established as a critical portion of the initial evaluation of patients in blunt thoracic trauma. [ ] Prolonged observation in a monitored setting is usually not required for patients with suspected myocardial contusion. Patients with a normal electrocardiogram (ECG) and a normal (...) by blunt trauma is a rib fracture, which may be easily missed with suboptimal technique. Overpenetration and a decrease in the kilovolt-peak improve skeletal visualization, although at the expense of lung detail. If available, digital imaging improves visualization, and images may be displayed on a workstation and manipulated. Fractures of the first and second ribs are rare but are often overlooked; they are most often associated with serious vascular and tracheobronchial or spinal injury. Chest

2014 eMedicine Radiology

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