trauma presented by: joseph s. ferezy, d.c. introduction 1.25 million major injuries worldwide per...
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Trauma
Presented By:Joseph S. Ferezy, D.C.
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Introduction1.25 Million Major Injuries Worldwide Per YearIncludes
AccidentsAssaultsFallsSportsIndustrial
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Scalp InjuriesAbrasions and Contusions
Bleed ProfuselyUsually Stop Spontaneously With Good OutcomeCheck For FractureCephalohematoma (Neonates)
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Skull FractureLinear Fracture
Both Tables Of Skull (Multiple Bones = Comminuted)15% Extend To Brain (Depressed Skull Fracture)
Basilar FractureDifficult To See On Plain FilmsFluid From Ear/Nose
Raccoon (Panda) Sign Battles Sign
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Skull FractureOccipital Fracture
Immediate DeathAnterior Base Of Skull
Common SiteOlfactory Nerve CutSinus Films Show Air/Fluid Level
ComplicatedCSF Leak
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Brain“Post-Concussion” Syndrome“Coup Contracoup”ConcussionContusionLaceration
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Traumatic Intracranial HemorrhageEpidural Hematoma
Clinical 20% Mortality History of Head Injury With Loss of Consciousness 50% Have “Lucid Interval” Before Decrease in Level of
Consciousness As Intracranial Pressure Increases (Better Prognosis)
Rostral-caudal Deterioration
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Traumatic Intracranial Hemorrhage Acute Subdural Hematoma
Clinical 80% Mortality History of Severe Head Injury Rupture of a Berry Aneurysm A/V Malformation Rapid Decrease in Intracranial Pressure Bleeding Diathesis or Anticoagulant Therapy See Epidural Hematoma
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Traumatic Intracranial Hemorrhage • Subacute Subdural Hematoma
Clinical Patient Seems to Recover From Injury 1-10 Days Neurologic Deterioration
Chronic Subdural HematomaDefinition - Encapsulated Blood; At Least 10 Days to DevelopClinical
Usually in Elderly, Demented, or Alcoholics With Atrophied Brains Waxing and Waning of Symptoms C/O Headache, Memory Problems, and Decrease in Intellectual Capacity Contralateral Hemiparesis See Epidural Hematoma
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Traumatic Intracranial Hemorrhage• Subdural Hygroma
Definition - Accumulation of CSF in Subdural Space
Subarachnoid HemorrhagePrimary - Rupture of Vessel (A/v or Berry Aneurysm)Secondary - to Trauma
Traumatic Intracerebral HematomaDefinition - Blood in Substance of BrainSigns Depend Upon Site of Lesion
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Closed Head InjuryDefinition - Meninges Remain IntactClinical
Usually No Loss of ConsciousnessJuvenile Head Trauma Syndrome - Mild Head Injury Followed by Recovery, Few Hours Later C/o Headache, Becomes Irritable, Somnolent, and May Vomit
Possible Confusion, Blindness and Coma Terminates in Minutes to Hours Complete Recovery May Have Future Migraines After Trivial Head Trauma
Concussion-immediate, Transient Impairment of Consciousness, No Macroscopic Brain Damage
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Closed Head Injury Contusion-same Only With Neurologic Deficits - Changes in Personality, Loss of Memory, Confusion, Aphasia, and DementiasPossible “Post-traumatic” Syndrome-vascular Headache, Inattention, Poor Memory, Anxiety, Irritability, Lethargy, Unsteadiness of Gait - Usually Complete Recovery - Symptoms Exacerbated With Alcohol IngestionMay Be Coma
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Traumatic EncephalopathyRepeated Head Trauma“Punch Drunk” BoxerEvidence of Chronic TraumaParkinson-like Features
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Post-traumatic SeizuresCommon After Severe Head Trauma
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Cranial Nerve InjuryOptic Nerve
III, IV, V, VI, VII, VIII
CSF Rhinorrhea or OtorrheaClinical
C/O Clear Fluid From Nose, Ear or Down Posterior PharynxWorse With Head Flexion, or Increase Intrathecal Pressure
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Fat EmbolismEtiology and Pathology
Usually Follow Fracture of Long BonesOcclude Capillaries - Become Toxic and UFA - Hemorrhagic Interstitial PneumonitisClinical
Symptoms Occur Approx. 48 Hours Later Prodroma of Cough, Dyspnea, Chest Pain, Wheezing Agitation, Confusion, Disorientation, Delirium, Seizures, and Coma Focal Neurologic Deficits Death
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Air EmbolismRare - Usually After Injury, Cardiac or Thoracic Surgery, Arterial CatheterizationClinical - See Fat Embolism
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Near DrowningEtiology and PathologyHypoxia Due to Aspiration of Fluid
Fresh Water Causes Surfactant Concentration Decrease - Worse - Alveoli CollapseCold Water to Face Causes “Diving Reflex” - Blood Shunted to Brain
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Electrical Injury to CNSElectrocution or LighteningResult of AnoxiaClinical
SeizuresFlaccid Paralysis - Complete RecoveryPeripheral Neuropathy
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Radiation InjuryUsually Follows Treatment for CancerSecondary to Ischemia and InfarctionClinical Features
Signs of Infarction From Circle of Willis by Arteritis and ThrombosisProgressive Dementia, Spasticty, and RigidityCord Radiation May Cause Sensory Symptoms About Three Months After Radiation - Resolve Without SequellaeVascular Sequellae Months or Years After - Usually Infarction
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Decompression Damage (The Bends)
From Higher to Lower Atmospheric PressureNitrogen GasFocal Neurologic Signs
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Spinal Cord TraumaEtiology and Pathology
Fracture of VertebraDislocation – C1-2, C5-6, T11-12Penetrating Wounds
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Epidural Hemorrhage Usually Follows Trauma Radicular Pain Paraparesis
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Subdural HematomaSee Epidural - Less Common
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Other Traumatic InjuriesIndirect Injury - ExplosionIntramedullary InjuryIschemic DamageNerve RootCord Compression - Spinal ShockCord Transection - Spinal Shock - Gradual Spasticty
Hemisection of Cord (Brown-Sequard Syndrome) - Pain and Temperature Contralateral - Ipsilateral Proprioception Loss and Hemiparesis
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HematomyeliaDirectIndirect
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Conus MedullarisFirst Lumbar Area Fracture
No Motor DeficitSacral Dermatome Sensory Loss (Buttocks and Perineum)Urinary RetentionImpotence
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Cauda EquinaLarge Central Disc Lesion
See Above
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Herniated IVDDefinition - Protruded Nucleus Pulposus Into Spinal Canal - May Be Metaplastic Fibrous MaterialClinical
Common Usually in Young to Middle AgeL4-5, L5-S1, 10 Times As Common As C5-6 - Rare in Thoracics (Maybe)Anterior or PosteriorUsually Some History of TraumaPain, Paresis and Paresthesias, LMN Radicular SignsCervical and Thoracic Can Produce Cord Compression - Lumbars Cannot.
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Hyperextension-flexion Injury to Cervical Spine and Cord
ClinicalSevere Pain for Months Following InjuryMay Be Radicular PainOccipital - Bitemporal HA (Sub Occipital Neuralgia)Can Injure Vertebral ArteryFocal Injury and SignsCervical Hypolordosis and Subluxation
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Cervical SpondylosisDefinition - Degenerative Arthrosis - Cord, Root or Artery CompressionEtiology and Pathology - Usually Secondary to Disc Degeneration
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Cervical Spondylosis Diabetes Mellitus?CervicalgiaOccipital HAMay Be AsymptomaticRadicular Pain After TraumaLMN Disease SignsCord Compress - SpastictyRotation - Extension VBI