Articles Posted in Trauma

Management of Blunt Trauma Chest Injuries

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.

Cardiac Injuries

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 ›

Traumatic Endophthalmitis

Traumatic Endophthalmitis

Traumatic Endophthalmitis

I’m Ed Smith, a Sacramento Eye Injury Attorney. Despite recent advances in the treatment of endophthalmitis, infection from penetrating eye trauma continues to present a clinical challenge.  It remains an important cause of vision failure following open globe injuries and may complicate seemingly benign injuries such as small, self-sealing corneal lacerations without associated intraocular damage.  About 62 percent of all cases of endophthalmitis occur after eye surgery, ten percent are associated with planned or inadvertent filtering blebs and the rest are due to metastatic spread from other infected areas.

Although the prognosis has been significantly improved by recent refinements in diagnoses, antibiotic therapy, and vitreous surgery, the overall prognosis of traumatic endophthalmitis remains poor compared to that seen in intraocular surgery.  The reasons for the poor prognosis include associated damage to vital eye structures, infection with extremely virulent organisms, and delay in diagnosis and treatment of the condition. Continue reading ›

What is Blunt Cardiac Contusion?

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.

Prehospital and Hospital Evaluation of Chest Trauma

Prehospital and Hospital Evaluation of Chest Trauma

I’m Ed Smith, a Sacramento Trucking Accident Lawyer. While still in the field, the most that emergency medical technicians can do is to follow routine Advanced Trauma Life Support, which focuses on airway, breathing, and circulation.  It is critical to take the patient to a high level trauma center as soon as possible, avoiding unnecessary interventions that may only delay definitive treatment.

Cervical spine immobilization should be done and high flow oxygen should be given by mask. The patient should be monitored via cardiac electrodes.  There should be no delay in order to place IV lines or to intubate the patient unless the patient cannot be stabilized with a bag/mask device.

If there is no indication of respiratory difficulty or major injury, no intervention is likely to be necessary.  The EMTs should, however, make note of the condition of the vehicle and steering wheel, whether or not the victim was ejected, significant intrusion into the passenger compartment, and whether or not there were fatalities among the other passengers.  If the patient is hypotensive at the scene, this may indicate significant injury; this information should be passed on to the attending physician prior to arrival to the emergency department. Continue reading ›

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Pediatric Trauma

Ed Smith is one of the top rated personal injury lawyers in Sacramento. Pediatric trauma is the leading cause of death among children and the leading cause of disability.  The principles of trauma care are the same in children as with adults but there are very big differences in the physiology of children that mean they are treated somewhat differently than adults.  Children have different patterns and causes of injury depending on age.  For this reason, there is a need for pediatric trauma centers apart from trauma centers dealing with adults.

Children’s injuries usually come from rapid acceleration and deceleration injuries, such as is seen in motor vehicle accidents.  Accidents around the home, falls, and bicycle injuries are also major causes of pediatric trauma.

Initial Assessment and Resuscitation of the Injured Child

Simultaneous assessment and resuscitation happen in children who are injured in the same way as it is done in adults.  Multiple organ injuries are more common in kids so it is better to assume that every organ is injured until proven otherwise. Continue reading ›

Burn Trauma

Burn Trauma

I’m, Ed Smith, a Sacramento Burn Injury Lawyer. Even though the number of burn injuries is going down in the US, about 1.25 million people get burned each year.  About 60,000-80,000 people require hospitalization for their burns and 5500 die from their injuries.   Most burns requiring hospitalization involve body areas greater than 10 percent or those that involve the face, hands, feet, or perineum.  Most burns are flame burns or scald burns.

Mortality Rate

The mortality rate at which 50 percent of the patients die is about 98 percent total burn surface area.  This has improved dramatically over the years.   This is true of people under the age of 14. The statistics are worse for elderly adults, where a 35 percent degree burn kills half of all patients.

Criteria for Burn Unit Admission

Not all people need to be admitted to a burn center.  Those that do meet these criteria:

  • Second and third degree burns greater than 10 percent of body surface area.
  • Full thickness burns
  • Any burn of the face, hands, feet, eyes, ears or perineum
  • Electrical injury
  • Inhalational injury
  • Chemical burns
  • Burns in patients with other significant health problems

Classifying Burns

Burns are classified into six different causes: flash burns, flame burns, liquid spill, liquid immersion, grease or steam burns.  They are also classified according to burn depth.  There are superficial burns (first degree burns), partial thickness burns (second degree) full thickness or deep partial thickness burns (third degree), or burns involving deep tissues or organs (fourth degree).

Skin Layers

The skin is the barrier to burns, and when it is breached, there is deeper involvement beneath the skin.  There is a deep layer, known as the “zone of stasis” involved in deeper wounds in which the blood flow is greatly diminished.  Giving medications that improve blood flow to the skin can decrease the depth of the burn. Continue reading ›

Blunt Aortic Injury

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

Continue reading ›

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South Sacramento Fiery Car Wreck

I’m Ed Smith, a South Sacramento Traumatic Injury Attorney.  Victims of car accidents that result in burn injuries can be serious and life altering.

On Wednesday, November 17, 2015, just before 11:00 p.m. a car collided with a truck causing a fiery wreck. The truck was pushed up against a fence pinning the driver inside. The video images taken by Fox 40 News are graphic.  The video depicts how sudden and violent car accidents may become.

Location of Crash

This accident occurred in South Sacramento on Del Norte Avenue and Fruitridge Road.

Toyota Caught Fire

The driver of the Toyota was able to get free from the vehicle before it became completely engulfed in flames.

Truck Mangled up against a fence

The driver of the truck was pinned by twisted metal.  Due to the heat of the fire, emergency crews were not immediately able to free him. After a short time, he was removed by emergency personnel from the truck.  He was transported to an area hospital in serious condition.

Continue reading ›

Trauma Systems, Triage and Transport

A trauma system is an organized approach to handling injured patients that involve’s principles of triage and transport, and works with local Emergency Medical Services to bring about the highest quality of care for the injured client. A trauma system must not be costly and must involve the best in care from the pre-hospital care on through rehabilitation of the client.

Trauma systems depend on the region the care is being given to the patient. Trauma care involves many disciplines of medicine, from the prehospital phase through to the rehabilitation phase. All phases of care are represented in trauma systems. The goal of trauma care is to enhance overall community health. You can do this by identifying who is at risk for trauma and by creating preventative solutions that can decrease the injuries and death from traumatic situations. A secondary goal is to provide the best care to have the best possible treatment from the prehospital phase through to rehab so that there can be lesser morbidity (injury) and mortality (death) from traumatic injuries.

Epidemiology of Trauma

According to the principles of medicine, trauma is a “disease” rather than an injury and, as such, is no different from malaria, heart disease, or cancer. It has degrees of severity and morbidity/mortality statistics just like other diseases. It is important to understand the epidemiology of trauma as it applies to different populations of people.

There is descriptive epidemiology, which looks at the distribution of the disease over time, place, and over different subgroups of people. There is also analytical epidemiology, which looks at the causation of the trauma/disease. The environment can be a physical one or a sociocultural one. How these factors interact determines the epidemiology of trauma. Knowing these things can help public policy and laws designed to protect people from injury secondary to trauma.