Articles Tagged with emergency room

SPECT (Single-photon emission tomography) imaging is emerging as a necessary tool in the evaluation and treatment of patients with TBI (traumatic brain injury) based on results of a recent study.  One of the reasons is the imaging provides greater ability to detect lesions than MRI and CT imaging, which remain valuable diagnostic tools to identify acute damage to the structures of the brain.

The difference with SPECT is that it can show dynamic information and show functional deficits…deficits that standard imaging such as MRI and CT do not reveal.  Given the difficulties of obtaining a definitive TBI diagnosis, especially in mild cases, SPECT can offer valuable information in conjunction with neuropsychological testing.

Personal injury victims, especially those who have been injured as a result of a rear-end collision, often suffer from painful injuries as a result of a whiplash type injury.  Whiplash is a common injury to the neck and upper back caused by a sudden back and forth motion of the head. This sudden violent snapping motion puts enormous strain on the neck and upper back muscles and ligaments. This type of injury is commonly referred to as hyperextension/hyperflexion injury neck sprain or strain, myofascial injury  or cervical strain or sprain.

whiplash
Symptoms related to a whiplash type injury caused by an auto accident may include the following:

Head_CT_scan.jpgIn some cases, patients sustaining trauma to the head and neck area will have both closed head injuries and maxillofacial trauma. Of the two, closed head injuries are more severe and need to be managed before the maxillofacial trauma is treated. Patients with closed head injuries can have intracerebral hematomas, subdural hematomas or epidural hematomas. Each of these blood clots can increase in size and can cause excess pressure on the brain. This can lead to semiconscious states or coma and, in severe cases, they can cause herniation of brain tissue through the foramen magnum at the base of the brain. Such a condition is almost uniformly fatal because the patient is unable to breathe on their own and have instability of pulse and blood pressure.

The recommendation of most physicians who suspect an intracranial injury when a maxillofacial injury is noted gives the patient a CT scan of the head and face. This CT scan will determine the presence of bleeding, swelling and blood clots in the brain and will demonstrate any skull fractures or facial fractures. When the brain is stabilized through surgery or other modality, then the maxillofacial fractures, contusions, and lacerations can be managed secondarily.

Craniofacial trauma in children involves any injury to the face, upper jaw bone, or skull. It can include skeletal injury, skin injuries and injuries to the neck, nose, eye socket, sinuses, teeth and other mouth parts. It is usually identified by a laceration, swelling or bruising of the facial tissue. Signs of fractures include bruising around the eyes, called Raccoon’s eyes or behind the ear, called a battle sign. One can see a widening of the space between the eyes or teeth that are not in alignment. There can be bleeding from the nose, ears or mouth.

There are about 3 million people treated for facial trauma in United States emergency rooms. Of the children involved, 5 percent have suffered facial fractures. In kids under the age of three, most of them suffered their injury due to a fall. In kids over the age of five, motor vehicle accidents are the top cause of craniofacial injuries. This means that seatbelts and proper child restraints can reduce the risk of facial trauma.

Colon-rectum.jpgA medical study was done from 1978-1982 that looked at 196 patients who suffered blunt trauma to the colon, small bowel or mesentery. They were treated at a major shock trauma center in Maryland. Greater than 80 percent of the patients were victims of motor vehicle trauma and many had injuries involving more than just the Gl tract.

Sixty of the patients had significant injuries, such as perforation or mesenteric injury with resulting dead bowel tissue. This group accounted for more than 7 percent of the people who had a celiotomy during the same time period. All injuries except for one were diagnosed through the use of peritoneal lavage. Only two people had duodenal injuries. The small bowel often had perforations along the entire course. Colon injuries made up a fourth of all blunt trauma to bowel, mostly occurring in the ascending colon and the sigmoid colon. Of this group, 16 people died. Six of the deaths were directly related to their bowel injury.

Among children, 60 percent of amputations are congenital in nature and 40 percent are acquired due to an injury. Most of these patients require some kind of prosthetic device more so than children who’ve sustained congenital amputations. These acquired amputee children attend specialized child amputee clinics. Acquired amputees are due to trauma most of the time but in a few cases, the limb loss was secondary to disease. The worst offenders are power tools and heavy machinery, followed by automobile accidents, explosions, gunshot wounds and railroad accidents. In the 1-4 age groups, the most common causes of amputation are lawnmowers and household accidents.

Of diseases causing amputation, the most common cause is malignancies, vascular malformations and neurogenic disorders. More than 90 percent of the time, acquired amputations involve just one extremity. In over 60 percent of the cases, the lower limb is the limb affected. Males have more amputations than females at a ratio of 3:2. This is because males tend to engage in activities that are more hazardous than females.

Approximately 300,000 injuries involving doors need treatment at an emergency room each year in the U.S. Most of the victims are children of preschool age and under, and most injuries from doors result in some kind of amputation. These door-related injuries are completely preventable and there are some inexpensive devices that could be put on doors to prevent these amputation injuries. There are door closing devices that prevent a door from slamming and prevent injuries from the open side of the door. Most serious injuries, however, result from the door’s the hinge side, where the closing pressure from the door can exceed 80,000 pounds per square inch.

Some companies have created hinge protectors that eliminate the possibility of hinge accidents. A casing made of plastic is placed around the sides of the door that blocks contact with the hinge face. There are door stoppers that can also help prevent unexpected door closures. You can also paint or tape near the hinge and door knob side of the door to remind kids to stay away from that part of the wall.

Water sports are becoming more popular around the world. People are spending more time racing boats, water skiing, scuba diving and skin diving. Injuries because of boat propellers are also becoming more frequent. One study looked at the ten year period from 1963-1973 and studied nine cases of injury by boat propeller. Some resulted in an amputation as a result of the propeller itself. Others needed surgical amputation due to mangled extremities.

Injuries on boats are not simply a national occurrence. The below examples are listed not for shock value but to illustrate the need to use caution when on or near boats. These were recent news items from 2012 and 2013 illustrating the mechanism of injury due to water sports and/or while on a watercraft.

Microsurgery is one of the latest types of surgery to develop. It involves doing surgery to blood vessels and nerves underneath a microscope. It is the type of surgery that makes doing replantation of amputated body parts possible. Vessels and nerves of around one millimeter in diameter have been reattached successfully. Microsurgery is used in trauma surgery as well as in plastic surgery, general surgery, ophthalmology, orthopedic surgery, neurosurgery, pediatric surgery, maxillofacial surgery, and otolaryngology.

Microsurgery was first used by otolaryngologists in about 1921. The first monocular surgical microscope was built and was eventually used in people who had fistulae. Binocular microscopes were then used starting in 1922. Other ear operations were done using a binocular microscope soon after.

Children have a higher likelihood of being injured or killed from trains than adults. They like to play on train tracks and have a lesser ability to detect the speed of a train coming towards them. Their bodies are more frail than adult bodies and the forces on the bodies from the train are great.

One study looked at the pattern of sustained injuries in kids who are injured in train tracks and train accidents. It was a retrospective review of those patients who showed up on two different trauma registries for the years 1984 through 1994. The patients attended a level I trauma center in a single metropolitan area. A total of 17 patients were treated for injuries at the level I trauma center. Those who were injured in a car that was struck by a train and those that were pronounced deceased at the scene were excluded from the study.