Management of Blunt Trauma Chest Injuries
Management of Blunt Trauma Chest Injuries
I’m Ed Smith, a Sacramento Chest Trauma Lawyer. Patients who seem clinically stable and have no apparent injury but have suffered a high energy blunt trauma injury from rapid deceleration, such as in an automobile accident, are at risk of having severe injury to the chest. A portable chest x-ray is part of the initial evaluation. If this is normal and there are no other injuries, a regular chest x-ray including lateral x-ray should be performed. A CT scan of the chest is done if there are any findings of suspicion on chest x-ray.
An EKG is performed on all patients who have sustained chest trauma to the front of the chest, patients who have a history of heart disease, and in the elderly. Patients who have no findings on any of the above evaluations and are otherwise stable, may be sent home. They should be told of the possibility of delayed issues and told to return to the emergency department immediately if they develop problems breathing, lightheadedness, or severe pain in the chest.
A cardiac contusion should be evaluated with an EKG in patients who have sustained a blunt trauma to the chest and have the following findings:
- Fracture of the sternum
- Pain or tenderness over the mid-chest area
- A history of heart disease
- Rollover, high speed collision, or a fatality in the accident
- Signs of ongoing heart disease
If there are cardiac arhythmias, the patient should be watched via cardiac monitoring and may need an echocardiogram. Continue reading
What is Blunt Cardiac Contusion?
I’m Ed Smith, a Sacramento Car Crash Lawyer. A blunt cardiac injury or BCI is an injury to the cardiac tissue from a blunt trauma to the chest. It usually results from trauma in a motor vehicle accident in which the chest strikes the steering wheel or dashboard of the car. It can range from being a clinically silent injury with brief arrhythmias or a severe rupture of the cardiac wall, which is almost uniformly fatal.
Things to consider when dealing with a blunt cardiac contusion include the possibility of a severe and sustained cardiac arrhythmias, wall motion abnormalities of the heart, cardiogenic shock, and the possibility of rupture of the heart valves or any of the atrial or ventricular walls within the heart.
Blunt Aortic Injury
I’m Ed Smith, a Sacramento Car Accident Lawyer. Most people who sustain a major injury to the aorta during a blunt aortic injury die instantly. Of those who survive to make it to the hospital, many die during the initial management of the condition and don’t make it to surgery. Hemorrhage from other nearby veins or rib fractures, vertebral fractures, or sternal fractures can mimic an aortic injury. Most aortic injuries are tears straight across the aorta with smooth edges. The injury can be as slight as a tear of the inner lining of the aorta to a complete transection of the aorta. Sometimes these injuries may be called cardiac contusions.
As a Sacramento Car Accident Lawyer, I’ve seen my fair share of these tragic injuries. The blunt aortic injury is the most lethal of all chest trauma injuries. The major risk factors include the following:
- Being in the front seat
- Being older than age 60
- Not wearing a seat belt restraint
- Front or near-side motor vehicle crashes
- Abrupt deceleration injury
- Crushed vehicle
- Intrusion into the passenger space
- Being hit by an SUV
High-velocity trauma is a major cause of death among those aged 18-44 years of age throughout the world. Many die from blunt trauma (80 percent), especially in those aged 34 and under. These types of injuries have cost the US $75 billion USD in lost income alone each year.
The Multiple Injury Patient
Breaking a bone is always painful and includes inherent recovery time, but trimalleolar ankle fractures present special challenges – in this post we will look at who is at risk for trimalleolar ankle fractures and examine the treatment protocol. An ankle can be fractured while participating in high impact sports, but they are just as commonly caused by simple falls. The type of treatment recommended and the estimated length of recovery are both dependent on the type and severity of the fracture. A trimalleolar fracture is severe and will disable a person for an extended length of time. A formal physical therapy regimen is crucial to achieve the best recovery possible from such an injury.
Some facts regarding trimalleolar fractures:
- Women over 60 years of age are the most common group to experience these injuries
With trauma and pregnancy, the trauma has two patients to manage—the mother and the unborn fetus. The various things done in dealing with a pregnant trauma patient depends on where she is in the pregnancy, the viability of the fetus and the nature of the injuries.
Overview of Trauma and Pregnancy
Trauma in pregnancy can be caused by accidents and violent acts. Trauma is involved in 5-20 percent of pregnancies. Trauma is the number one cause of death in pregnant women—above pregnancy complications. In one study, trauma caused maternal death in 46 percent of cases, compared to obstetrical issues causing maternal death in 31 percent of cases. A total of 57 percent of deaths were due to homicide, while 9 percent were due to suicide. The percent of maternal deaths were spread out as follows:
By the late 1980s, states in the U.S. began adopting a variety of bicycle helmet laws to improve safety and reduce serious injuries. Studies have found that helmets can reduce reduce the occurrence of head injuries by about half and the frequency of neck or facial injuries by about one third. These studies are not without controversy, however, as other studies and anecdotal data indicate there may be much less protection from helmets. Currently, more than 20 states have some form of a statewide bicycle helmet law and hundreds of cities have individually adopted similar requirements. Only about a dozen states have neither statewide nor local bicycle helmet laws.
Since 1999, standards for helmets in the United States have been mandated by the Consumer Product Safety Commission. The primary protection offered by this type of helmet is a reduction in impact acceleration to the head from an inner liner of polystyrene that absorbs energy as it crushes, similar to how a car’s structure is designed to absorb energy by crushing so as to protect its occupants. In order to offer this crush protection, however, it is crucial that bicycle helmets be in good condition (no prior impacts) and properly fitted to each individual rider’s head. Unfortunately, this often doesn’t happen — one study published in 2003 found that although nearly three-quarters of the studied children reported wearing helmets when bicycling, more than 90% of children had helmets with either condition and/or fit problems. When the fit of the helmet had been selected by the parent alone without any expert input, none were found by the study to fit properly. Expert assistance is key.
In California, anyone under age 18 using a bicycle, scooter, skateboard, or inline skates is required to wear a helmet. (And a few cities have additional requirements.) From time to time, more stringent bicycle helmet laws have been proposed, such as Senate Bill 192 put forward in 2015 that would have required helmets for all adult bicyclists in California — what would have been a first for a state in the U.S. That bill produced considerable backlash, and was subsequently changed from requiring helmets to merely calling for further study of helmet use.
Something about crane accidents capture the imagination and horror of many. When a tragic crane accident occurs, it is often front page news, perhaps because it results in dramatic images of property damage, sometimes way up in a city’s skyline. But the severe injuries and deaths that can occur in such a situation make an accident involving a crane something not to be ogled, but avoided at all costs. Construction workers account for a disproportionate percentage of work-related fatalities yearly and are substantially more likely to receive serious injuries when compared to employees in other industries.
After a series of crane accidents making the news, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) launched a program aimed at reducing significant injuries and deaths related to the operation of cranes in general industry, construction and maritime operations in the Pacific Northwest. And to improve compliance with its program, OSHA conducted compliance inspections, training, consultations on-site, and outreach programs. They also formed partnerships and alliances to help improve crane safety.
The guidelines that OSHA established in order to help prevent crane accident are as follows:
With so many large vehicles still on the roads in American, how smart is it to drive a “smart” car, especially considering the ability to walk away unharmed from an accident.
American automobiles are on a diet – getting smaller and more lightweight in order to comply with mileage regulations. This means that auto makers are replacing steel with light metals and plastics, which lowers gas mileage but also decreases the protection of the occupants. Some studies show that “smart” car drivers are up to 12 times more likely to suffer fatal injuries in a car accident. The likelihood of severe injury is even higher.
Mere physics dictate that size is a key component of safety, since mass times acceleration equals force of impact, and that force is what causes injuries and fatalities in vehicle occupants involved in a car accident. The vehicle’s size often dictates how close driver’s legs and torso are to the front of the vehicle – because of this, crash tests repeatedly show that occupants of smaller cars are at a greater risk for injuries. A look at this clip from Fifth Gear shows a great impact to a tiny car (test starts at 5:00):