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Management of Severe Head Injury

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10641. Maxillofacial Injuries

mandibular:zygoma:maxillary is 6:2:1. General assessment of maxillofacial injuries First look for associated life-threatening injuries. There may be associated cervical spine and significant head injury. Assess 'Airway, Breathing and Circulation' (ABC) and manage appropriately. History Once stable, relevant history may include: [ ] Mechanism of injury. Whether there was any loss of consciousness. Any visual disturbance, including disturbance of eye movement. Any problems with hearing, including vertigo and tinnitus. Any (...) -ray and CT scanning provide the mainstay of fracture investigation. Specific X-ray views are needed depending on the fracture suspected. Management This depends on injury/fracture (see below). Pain control will be needed. Early photographs may be helpful both to plan treatment and to counsel the patient. Specific fractures Frontal bone fractures [ ] These usually follow a severe blow to the forehead. A dural tear should be considered if the posterior wall of the frontal sinus is fractured

2008 Mentor

10642. Elbow Injuries and Fractures

and require surgical fixation. Elbow dislocation Elbow dislocation is the second most common major joint dislocation. [ ] The 'terrible triad of the elbow' refers to a combination of elbow dislocation and radial head and coronoid process fracture - it is notoriously difficult to manage although a systematic review found that whilst complications are common, functional outcomes are generally satisfactory. [ ] Mechanism of injury Often due to a fall on to an extended elbow. Those without fracture are termed (...) ), and . The mechanism of injury There are a variety of possible injuries because of the presence of three bones and the range of mechanisms of injury. Mechanism of injury in elbow fractures and dislocation Radial head and neck fractures Fall on to an outstretched hand Olecranon fractures Elderly - indirect trauma by pull of triceps and brachioradialis Children - direct blow to elbow Fractures of the coronoid process Fall on to an extended elbow as for elbow dislocation Fractures of the distal humerus Fall

2008 Mentor

10643. Electrical Injuries and Lightning Strikes

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 (...) forget to document the visual acuities. Check tetanus prophylaxis status. Liaise with relevant departments (medical, renal, audiological medicine and ophthalmology) for monitoring of delayed effects. Consider differential diagnoses, including cerebrovascular event, spinal cord injury, seizure, closed head injury, Stokes-Adams attack, myocardial infarction, overdose. Outcome This is generally excellent for those who survive the initial strike. The outcome is coloured by the quantity and severity

2008 Mentor

10644. Bennett's Fracture and other Thumb Injuries

reduction and fixation with K-wires if there is significant displacement/angulation but are often managed conservatively with thumb spica splinting. Fractures of thumb phalanges [ ] Proximal phalanx fractures are fractures of the phalangeal head and shaft. Distal phalanx fractures may occur as: Extra-articular tuft fractures due to crush injury (eg, a hammer blow), often with associated damage to the nail. Intra-articular tendon avulsion injury. Usually treated conservatively, depending on the degree (...) in the assessment of thumb fractures and injuries. There is a classical oblique fracture line at the base of the first metacarpal with a triangular fragment at the ulnar base of the metacarpal. This fragment remains attached to the trapezium and there is proximal displacement of the metacarpal. Management Small avulsion fractures with minimal articular disruption and minimal instability may be treated by closed reduction and, if the reduction is maintained, placement in a thumb spica cast for six weeks or so

2008 Mentor

10645. Brachial Plexus Assessment and Common Injuries

; Brachial plexus anatomy: normal and variant. ScientificWorldJournal. 2009 Apr 289:300-12. ; Brachial plexus anatomy. Hand Clin. 2004 Feb20(1):1-5. ; Are all brachial plexus injuries caused by shoulder dystocia? Obstet Gynecol Surv. 2009 Sep64(9):615-23. ; Temporary Erb-Duchenne palsy without shoulder dystocia or traction to the fetal head. Obstet Gynecol. 2005 May105(5 Pt 2):1210-2. ; Recent advances in the management of brachial plexus injuries. Indian J Plast Surg. 2014 May47(2):191-8. doi: 10.4103 (...) and based on research evidence, UK and European Guidelines. You may find one of our more useful. In this article In This Article Brachial Plexus Assessment and Common Injuries In this article The nerve supply to the arm is from nerve roots C5-T1 via the brachial plexus. The nerves pass under the clavicle and end in the axilla. [ ] Adults Signs and symptoms Traumatic injury mostly occurs in severe road traffic accidents (especially on a motorcycle) and falls from heights. Young men are most commonly

2008 Mentor

10646. Bladder and Urethral Injuries

, it is protected from most external forces. Approximately 4% of patients with pelvic fractures also have significant bladder injuries. The likelihood of the bladder to sustain injury is related to its degree of distention at the time of trauma. Injury may occur if there is a blow to the pelvis that is severe enough to break the bones and cause bone fragments to penetrate the bladder wall. Generally the bladder injury in these cases is associated with other injuries as well, the most common being to the spleen (...) and rectum. Penetrating trauma The most common cause of penetrating trauma is gunshot wounds and stabbings. Penetrating trauma tends to be more severe and less predictable than blunt trauma. Bullets have high kinetic energy and have the potential for greater destruction. They are most often associated with multiple organ injuries. The combination of penetrating trauma to both rectum and the urinary system can be associated with high morbidity and mortality. Obstetric trauma During prolonged labour

2008 Mentor

10647. Cold Injury

find the article more useful, or one of our other . In this article In This Article Cold Injury In this article The severity of cold injury depends on the temperature, duration of exposure, environmental conditions, amount of protective clothing and the patient's general state of health. Exposure to cold can cause localised injury or generalised cooling of the entire body. See separate article. Risk factors [ ] Susceptibility to cold injury is increased by any factor that can increase heat loss (...) or decrease heat production: Lower temperatures - especially windy conditions. Dehydration. Infancy, elderly age, malnutrition, exhaustion. Immobilisation - eg, fracture. Open wounds. Prolonged exposure. Moisture. Peripheral arterial disease. Impaired cerebral function - for example, alcohol, other sedatives, psychiatric illnesses, hypoglycaemia. Smoking, diabetes and Raynaud's disease increase risk due to vasoconstriction. Peripheral neuropathy, autonomic neuropathy, head injury, spinal cord damage. Body

2008 Mentor

10648. Whiplash and Cervical Spine Injury

of the neck. When the head and neck have reached maximum extension, the neck then snaps into flexion. A rapid deceleration injury throws the head forwards and flexes the cervical spine. The chin limits forward flexion but the forward movement may be sufficient to cause longitudinal distraction and neurological damage. Hyperextension may occur in the subsequent recoil. Whiplash-associated disorders (WAD) can be classified by the severity of signs and symptoms: [ ] Grade 0: no complaints or physical signs (...) in young adults. Rates of whiplash are higher in persons using a seatbelt with shoulder restraint than with no restraint but seatbelts often prevent more serious injuries. Poor posture. Poorly-fitted head restraints. Women sustain higher rates of whiplash, probably because their neck muscles are less well developed than men's. Narrowing of the cervical spinal canal due to acquired or congenital disorders predisposes to spinal cord damage with these types of injuries. Risk factors for severe injury

2008 Mentor

10649. Gunshot Injuries

can occur with both low- or high-velocity bullets. Some high-velocity bullets (particularly those from military rifles) are designed to stay intact after impact, limiting wound severity and the need for massive wound debridement. [ , ] However, many low-velocity gunshot wounds can be safely managed with local wound care and outpatient review, dependent on the absence of any bony or vascular injuries. [ , ] High-velocity bullets suck foreign material (normally clothing) through both entry and exit (...) . The most important factors in causing significant injury or death are their placement and projectile path. The head and torso are the most vulnerable areas, with incapacitation due to CNS disruption or massive organ destruction and haemorrhage. [ ] The extent of tissue and organ trauma will depend on terminal ballistics, which are influenced by the type of bullet, its velocity and mass as well as the physical characteristics of the penetrated tissue. Injury is inflicted in a number of ways: Firstly

2008 Mentor

10650. First Aid for Soft Tissue Injuries

should be covered with a sterile dressing whilst awaiting arrival of the ambulance. Sprains and strains [ ] A sprain is an injury to a ligament. It occurs when excessive or abnormal forces are applied around a joint. The ankle and knee are commonly affected. Tenderness, swelling, bruising, loss of function, and joint instability (if it is a severe sprain) can occur. The sprain can be simply graded into: Grade 1 - mild stretching of the ligament: no joint instability. Grade 2 - partial ligament (...) strength will also be present. In a third-degree strain, the muscle tears all the way through, leading to total loss of muscle function. Assessment of the injury Ask about the mechanism of injury, degree of pain and any self-treatment measures already applied. Assess the severity of the injury by examining for deformity, swelling, bruising, range of movement and ability to bear weight. Check for bony tenderness. It can be difficult to distinguish between a severe sprain and a fracture. For ankle

2008 Mentor

10651. Forearm Injuries and Fractures

metaphysis with lateral or anterolateral dislocation of the radial head (20%). [ ] Type IV - fracture of both the radius and ulna at their proximal third with anterior dislocation of the radial head (5%). [ ] Mechanism of injury : usually caused by a fall on to an outstretched, extended and pronated elbow, or by a direct blow. Presentation : acute, severe pain and swelling in the forearm and elbow. Damage may occur to the posterior interosseous nerve. Attribution: Jane Agnes (own work), via Wikimedia (...) arm whilst waiting for X-ray. Provide analgesia. Immediate fracture reduction is required if there is neurovascular compromise, severe displacement or skin tenting. Adult both-bone forearm fractures Mechanism of injury : usually a significant force injury. These most commonly occur in motor vehicle accidents, and also occur from a direct blow, a fall from a height or during sport. Presentation : pain and swelling at the site with obvious deformity. Assessment : may be nerve involvement

2008 Mentor

10652. Effect of patients' age on management of acute intracranial haematoma: prospective national study. Full Text available with Trip Pro

Effect of patients' age on management of acute intracranial haematoma: prospective national study. To determine whether the management of head injuries differs between patients aged > or =65 years and those <65.Prospective observational national study over four years.25 Scottish hospitals that admit trauma patients.527 trauma patients with extradural or acute subdural haematomas.Time to cranial computed tomography in the first hospital attended, rates of transfer to neurosurgical care, rates (...) %) for subdural haematoma (P=0.004)). There was no significant difference between age groups in the incidence of neurosurgical interventions in patients who were transferred. Logistic regression analysis showed that age had a significant independent effect on transfer and on survival. Older patients had higher rates of coexisting medical conditions than younger patients, but when severity of injury, initial physiological status at presentation, or previous health were controlled for in a log linear analysis

2002 BMJ

10653. Managing HIV Positive Individuals in Primary Care

Health England, January 2014 ; Gloves, extra gloves or special types of gloves for preventing percutaneous exposure injuries in healthcare personnel. Cochrane Database Syst Rev. 2014 Mar 73:CD009573. doi: 10.1002/14651858.CD009573.pub2. I have these little bumps on the head of my penis but I'm not sure what they are. Can anyone help? C4m3l Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 11 April 2015 Next Review 09 April 2020 (...) Managing HIV Positive Individuals in Primary Care Managing HIV-positive Individuals in Primary Care | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Managing HIV-positive Individuals in Primary Care Authored by , Reviewed by | Last edited 11 Apr 2015 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors

2008 Mentor

10654. Managing Epilepsy in Primary Care

with potential adverse effects. AEDs should not be given until the diagnosis of epilepsy has been confirmed. [ ] Management of provoked seizures [ ] Provoked seizures are defined as occurring within seven days of an acute condition such as encephalitis, head injury, cerebral infarction, craniotomy and cerebral haemorrhage. Seizures can be provoked by: Acute metabolic disturbances, treatment with certain drugs and drug withdrawal (eg, alcohol, benzodiazepines, barbiturates). Drug misuse (alcohol, heroin (...) by a specialist in the diagnosis and management of the epilepsies within two weeks of presentation. [ ] A wrong diagnosis of epilepsy can cause severe restrictions on a patient's lifestyle as well as unnecessary side-effects from long-term medication. Epileptic seizures and epilepsy syndromes should be classified according to the description of seizure, the seizure type, the epilepsy syndrome and the aetiology. The seizure type(s) and epilepsy syndrome, aetiology and comorbidity should be accurately

2008 Mentor

10655. Management of Choking

of consciousness, such as: Management [ , ] Adults In mild obstruction, encourage the patient to continue coughing; however, do nothing else except monitor for deterioration. In severe obstruction in a conscious patient: Stand to the side and slightly behind the victim, support the chest with one hand and lean the victim well forwards (so that the obstructing object comes out of the mouth rather than going further down the airway). Give up to five sharp back blows between the shoulder blades with the heel (...) Management of Choking Choking and Foreign Body Airway Obstruction (FBAO). Patient | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Choking and Foreign Body Airway Obstruction FBAO Authored by , Reviewed by | Last edited 19 Apr 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based

2008 Mentor

10656. PEG Feeding Tubes - Indications and Management Full Text available with Trip Pro

is planned. PEG tubes may also be indicated in other clinical situations such as malignant bowel obstruction [ ] , head injury, Crohn's disease, fistulae, other causes of short bowel syndrome, AIDS and HIV encephalopathy, and severe burns. Children [ ] In the past, it was considered that the lower limit of body weight to insert PEG tubes should be 10 kg but PEG has been reported to be inserted safely in infants with a weight as low as 2.3 kg. The use of PEG may be indicated for children (...) PEG Feeding Tubes - Indications and Management Percutaneous endoscopic gastrostomy (PEG) feeding tubes Indications and Management | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search PEG Feeding Tubes - Indications and Management Authored by , Reviewed by | Last edited 19 Dec 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use

2008 Mentor

10657. The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer

The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer Hodson D I, Browman G P, Thephamongkhol K, Oliver T, Zuraw L, Head and Neck Cancer Disease Site Group CRD summary This review assessed amifostine (...) ; Ontario Ministry of Health and Long-term Care. Bibliographic details Hodson D I, Browman G P, Thephamongkhol K, Oliver T, Zuraw L, Head and Neck Cancer Disease Site Group. The role of amifostine as a radioprotectant in the management of patients with squamous cell head and neck cancer. Cancer Care Ontario Practice Guidelines Initiative 2003. Available at: Accessed April, 2014 This paper is produced by Cancer Care Ontario Practice Guidelines Initiative. The series is published on the Internet

2003 DARE.

10658. Sargramostim in Decreasing Mucositis in Patients Receiving Radiation Therapy for Head and Neck Cancer

and 11 months. PROJECTED ACCRUAL: A total of 126 patients (63 per arm) will be accrued within 1.2-1.4 years. Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Allocation: Randomized Masking: Double Primary Purpose: Supportive Care Official Title: A Phase III Study to Test the Efficacy and Safety of GM-CSF to Reduce the Severity and Duration of Mucosal Injury and Pain (Mucositis) Associated With Curative Radiation Therapy in Head and Neck Cancer (...) Sargramostim in Decreasing Mucositis in Patients Receiving Radiation Therapy for Head and Neck Cancer Sargramostim in Decreasing Mucositis in Patients Receiving Radiation Therapy for Head and Neck Cancer - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please

2001 Clinical Trials

10659. Erlotinib in Treating Patients With Advanced Non-Small Cell Lung Cancer, Ovarian Cancer, or Squamous Cell Carcinoma of the Head and Neck

Erlotinib in Treating Patients With Advanced Non-Small Cell Lung Cancer, Ovarian Cancer, or Squamous Cell Carcinoma of the Head and Neck Erlotinib in Treating Patients With Advanced Non-Small Cell Lung Cancer, Ovarian Cancer, or Squamous Cell Carcinoma of the Head and Neck - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study (...) Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Erlotinib in Treating Patients With Advanced Non-Small Cell Lung Cancer, Ovarian Cancer, or Squamous Cell Carcinoma of the Head and Neck The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier

2003 Clinical Trials

10660. Measuring Head Impacts in Sports

Measuring Head Impacts in Sports Measuring Head Impacts in Sports - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Measuring Head Impacts in Sports The safety and scientific validity of this study (...) ) Study Details Study Description Go to Brief Summary: Head impacts in sports can lead to brain injury even when the participant is wearing a helmet. The forces that contribute to brain injury from sports-related head impacts are not well understood. This study will test a new device to measure the speed of head impacts among football players. Condition or disease Intervention/treatment Brain Injuries Brain Concussion Device: Head Impact Recording Technology (HIRT) Detailed Description: Each year, 50

2003 Clinical Trials

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