Trauma Archives - searchfortruth.info

The Management of Thoracic Injuries

February 21, 2019October 9, 2017 by admin

WITH THE roads daily becoming choked with fast cars, Casualty Departments throughout the country are increasingly familiar with major chest injuries. The crushing forces applied to the chest as the driver is thrown against the steering column, and the stresses imposed upon mediastinal structures by rapid deceleration in head-on collision often produce injuries so severe that death is instantaneous. In those fortunate enough to reach hospital, resuscitative measures must be applied immediately and often by doctors untrained in thoracic surgery. London (1963) found ninetythree chest injuries in a series of 551 casualties admitted to the Birmingham Accident Hospital, and of these, sixty-eight had other important lesions. The principles underlying the management of thoracic trauma are straightforward and their application involves only a few easily acquired techniques. Abrams (1961a) succinctly defined the causes of death from chest injury as 'the lethal triad, bleeding, drowning and suffocation',...

Sharp Edged and Pointed Instrument Injuries – Forensic Medicine

February 20, 2019September 28, 2017 by admin

Introduction

In this article we will primarily discuss those injuries produced by sharp-edged instruments, incised wounds, and pointed instruments with a sharp-edge or edges, stab wounds. This will be followed by a discussion of chop wounds and those instruments without a sharp edge, but have a blunt point such as found on screwdrivers and barbecue forks. Impaled injuries will be discussed. Mechanism and manner of death will then be reviewed. Throughout this article there will be a brief discussion of terms, such as ʻcardiac tamponade,ʼ and cellular structures such as neutrophils in order to enhance understanding. Lastly, there is considerable space devoted to a discussion of the chronological histological features for dating of incised or stab wounds, the purpose of which is to show there is sound scientific evidence for the histologic dating of these injuries.Incised Wounds-General Information..

Surgical Judgment in the Management of Stab Wounds of the Abdomen:

February 20, 2019September 13, 2017 by admin

SINCE 1830, the management of stab wounds of the abdomen has alternated between operative and non-operative, but the policy of routine exploration of these wounds has dominated since World War I. In that military setting, it was first shown that mortality could be lowered from 90%o to 53% by exploration of all penetrating wounds. This approach was reinforced by the experiences in World War IL and in Korea when the mortality was, respectively, 25% and 12%.29 These military precepts were enthusiastically applied to civilian wounds. At Charity Hospital in New Orleans, a rigid policy of mandatory laparotomy for all patients with wounds which might have entered the peritoneal cavity was instituted by Miles in 1891 and continued off and on9 11, 26 until 1967. Both university services at Charity Hospital adhered faithfully to the policy, the philosophy which was epitomized by Moss, Schmidt and Creech16 in their review o...f

Blood Loss in Trauma

February 14, 2019August 4, 2017 by admin

SPECIAL FEATURES OF TRAUMATIC BLEEDING

Multiple sources of bleeding

Blood loss in trauma commonly presents clinical features differing markedly from those seen in experimental bleeding and those arising in the course of disease. Severe traumatic oligaemia rarely arises from one area of bleeding as it does in, say, haematemesis or experimental work. In most cases multiple foci of haemorrhage in soft tissues or into body cavities exist, many of them not amenable to surgical haemostasis; this feature greatly alters the clinical picture and increases the difficulty of assessment of blood loss. Difficulties of diagnosis in trauma are frequently caused by the obscuration of signs of one injury by those of another (particularly in cranial or thoracic trauma) and by the development of complications, such as fat embolism or tension pneumothorax, in the course of resuscitation.

Progressive nature of bleeding

Bleeding into the tissues, other than that which can be staunched operatively, frequently continues for at least 24 hours after injury and the

Overview of Adult Traumatic Brain Injuries

February 11, 2019July 29, 2017 by admin

Introduction

Trauma is a leading cause of death in the adult population. Approximately one half of all adults who have died from a trauma injury sustained a head injury. Of those 50%, approximately half are admitted to the hospital with a diagnosis of a head injury. Head injuries are associated with approximately 50% of all motor vehicle crashes. Risk-taking behaviors can also lead to accidents that cause head injuries and include: alcohol intake, mind-altering drugs, improper use or non-use of safety equipment in motor vehicles, motorcycles (helmets), bicycles (helmets), and participation in contact sports. If a detailed history is unavailable and the patient is unconscious, then the loss of consciousness may have preceded and/or caused the injury.Anatomy , Physiology The components of the head and brain affected by head injuries include the scalp, skull, facial bones, brain tissue, meninges, blood brain barrier, intravascular component (blood in blood vessels), and cerebral spinal fluid (CSF). Scalp Injuries to the scalp are usuall...

The Management Of Stab Wounds To The Back.

January 21, 2019September 29, 2017 by admin

Abstract

The management of stab wounds to the back is controversial. There are certain clear indications for exploratory laparotomy, but most cases require a diagnostic workup and a period of observation. In this article, different diagnostic modalities are presented, including local wound exploration, diagnostic peritoneal lavage, abdominal computed tomography (CT) scan, triple-contrast abdominal CT scan, and intravenous pyelography (IVP). Recommendations for management are given, with emphasis on abdominal CT scan and observation.

Management of stab wounds of the back and flank.

Abstract

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries.

See Also: : Management Of Stab Wounds Of The Back And Flank.

Rib Fractures, Flail Chest, and Pulmonary Contusion

December 16, 2018August 29, 2017 by admin

Abstract

Blunt chest trauma accounts for a significant proportion of debilitating and life-threatening injuries. Rib fractures are notoriously painful and can lead to prolonged hospitalization, contribute to the development of pneumonia and respiratory failure, and delay outpatient recuperation significantly. Flail chest, along with chest wall deformity, the most severe of chest wall injuries, is associated with significant acute morbidity and mortality. Pulmonary contusion often accompanies blunt chest wall trauma and when diffuse will result in respiratory failure regardless of other injuries. Pulmonary lacerations, pneumatoceles, and even lobar infarction can occur. In this review, we describe the development of current principles of management of rib fractures, flail chest, and pulmonary contusion. Emerging or unclarified strategies include the importance of acute pain control of rib fractures to alleviate the development of chronic pain, the role of rib fracture operative reduction/internal fixation (ORIF) in severe chest wall trauma, and the use of surfactant and dual ...

Homicidal Penetrating Incised Wounds Of The Thorax. An Autopsy Study Of 52 Cases.

December 7, 2018September 13, 2017 by admin

Abstract

During March-June and August-September 1981, 245 medicolegal autopsies were conducted by the author at the Johannesburg and Diepkloof government mortuaries. In 52 cases (21.2%) penetrating incised wounds of the thorax were found to be the cause of death. These involved diverse and often multiple thoracic structures - ventricles, atria, interventricular septum, lungs, and, in particular, blood vessels. In most of these cases death was ascribed to either exsanguination and the attendant hypovolaemic shock or, in those wounds involving the pericardium and myocardium, cardiac tamponade. Several findings emerged from this study: (i) an abysmally low number of the victims (5.8%) reached a medical facility alive; (ii) no females were seen, and the 21-30 year age group predominated (46.2%); (iii) 80.8% had arrived at the casualty department during a weekend; (iv) 71.2% had received a single fatal penetrating incised wound; (v) nearly two-thirds of the wounds seen were inflicted over the...

Retroperitoneal Injuries: Pitfalls In Diagnosis And Management.

November 30, 2018September 27, 2017 by admin

Abstract

Retroperitoneal injury caused by penetrating trauma or associated with progressive shock following blunt trauma is usually recognized promptly and managed appropriately. Isolated retroperitoneal injury from blunt trauma, unless accompanied by major hemorrhage or gross hematuria, is often difficult to diagnose and needed treatment may be delayed. Although clinical examination remains the cornerstone of diagnosis, the high incidence of ethanol abuse and/or concurrent head injury in trauma patients has led to increased use of computed tomography in the diagnosis of abdominal trauma. To determine the effect, if any, of CT examination on the diagnosis and management of retroperitoneal trauma, we reviewed our patient experience. During the 16-month period ending in April 1986, 135 patients sustained 177 retroperitoneal injuries (116 by blunt and 19 by penetrating trauma). There were 26 deaths (19% mortality). There were 90 pelvic fractures and 31 lumbar spine fractures, as well as 21 genitourinary, 12 gastrointestinal, five pancreatic, and eight major vascular injuries....

Management Of Stab Wounds Of The Back And Flank

November 30, 2018September 27, 2017 by admin

Abstract

Abdominal stab wounds are managed on a selective basis with increasing frequency. Retroperitoneal injuries are more difficult to evaluate; hence wounds to the flank and back pose different considerations. A retrospective review of 108 patients with deep stab wounds of the flank and back was compared with a prospective study of 109 patients selectively managed with similar injuries. Physical examination was accurate in 86% of flank and 88% of back wounds. Local exploration was an effective procedure in differentiating superficial from deep wounds. Peritoneal lavage may be more accurate in flank wounds but is probably less reliable with retroperitoneal injuries. Adjunctive studies are helpful in selected patients. The incidence of negative celiotomies was reduced from 85.2% to 7.3% when the selective approach was adopted. There was no mortality or increased morbidity in the series. Although the risk of retroperitoneal injury is greater with flank and...

Homicidal And Suicidal Sharp Force Fatalities: Autopsy Parameters In Relation To The Manner Of Death.

November 30, 2018September 27, 2017 by admin

Abstract

A retrospective, comparative study was carried out on 118 sharp force fatalities, including 70 homicides and 48 suicides, and covering a 22-year period from 1986 to 2008. The objective was to identify relevant parameters that may be used to distinguish between these two manners of death. The following parameters were analysed: age, gender, number of wounds, type of wounds, anatomical sites of the wounds, presence of wounds affecting bones or cartilage, the longitudinal axis of stab wounds located at the anterior part of the trunk, Injury Severity Score (ISS) and associated traumatic injuries. Our statistical analyses revealed several relevant parameters that may help differentiate the two manners of death. Homicide victims were younger than those who had committed suicide. Homicide cases showed associated stab and cut wounds, whereas suicide cases predominantly showed isolated cut wounds. Wounds located at the head, limbs, hands, nape of the neck, or back were predictive of a homicide,...

Multiple Stab Wounds: A Short-term Respiratory Case Study.

November 30, 2018September 27, 2017 by admin

Abstract

Respiratory management is a role that is of paramount importance to intensive care nurses. Proactive nursing allows a nurse to have a positive effect on a patient's condition by actively improving the patient's status and setting priorities of care, avoiding deterioration wherever possible. In this account of the respiratory management of a patient who has sustained bilateral pneumothoraces following multiple stab wounds to the chest and back, the physiological assessment of the patient is described and a proactive respiratory plan of care is formed. Anatomy, physiology and pathophysiology in relation to pneumothoraces, metabolic acidosis and magnesium links with functional residual capacity are addressed. The potential risk of Adult Respiratory Distress Syndrome (ARDS) following direct and indirect lung injury is discussed. Recent research into ventilation modes and into areas of nursing practice relating to respiratory management are also considered....

The Management Of Penetrating Injuries Of The Back. A Prospective Study Of 230 Patients.

November 30, 2018September 27, 2017 by admin

Abstract

This is a prospective study of 230 patients with penetrating injuries of the back. The decision to operate or observe was taken exclusively on the abdominal physical findings. One hundred ninety-five patients (85%) did not require operation, 30 (13%) underwent a therapeutic laparotomy, four (1.7%) an unnecessary operation, and one patient (0.4%) had a completely negative laparotomy. The diagnosis and management was delayed in five (2.2%) patients with no serious consequences. Mortality rates were not recorded in this series. The initial physical examination was accurate in 95.2% of the patients. We suggest that penetrating injuries of the back should be assessed in the same way as anterior abdominal injuries. Physical abdominal examination is reliable in detecting significant intra-abdominal injuries. '''

How To Read A Stab Wound

November 30, 2018September 27, 2017 by admin

Most emergency departments do not see much penetrating trauma. But it is helpful to be able to learn as much as possible from the appearance of these piercing injuries when you do see them. This post will describe the basics of reading stab wounds.

Important: This information will allow some basic interpretation of wounds. It will not qualify you as a forensics expert by any means. I do not recommend that you document any of this information in the medical record unless you have specific forensic training. You should only write things like “a wound was noted in the midepigastrium that is 2 cm in length.” Your note can and will be used in a court of law, and if you are wrong there can be significant consequences for the plaintiff or the defendant. This information is for your edification only.

1. What is the length of the wound? This does not necessarily...

Penetrating Abdominal Trauma

November 29, 2018September 28, 2017 by admin

Practice Essentials Penetrating abdominal trauma typically involves the violation of the abdominal cavity by a gunshot wound (see the image below) or stab wound.

Signs and symptoms Signs and symptoms of penetrating uu trauma depends on various factors, including the type of penetrating weapon or object, the range from which the injury occurred, which organs may be injured, and the location and number of wounds.

Close-range injuries transfer more kinetic energy than those sustained at a distance, although range is often difficult to ascertain when assessing gunshot wounds. A gunshot wound is caused by a missile propelled by combustion of powder. These wounds involve high-energy transfer and, consequently, can involve an unpredictable pattern of injuries. Secondary missiles, such as bullet and bone ragments, can inflict additional damage. Stab wounds are caused by penetration of the abdominal wall by a sharp object. This type of wound generally has a more predictable ..

Forensic Autopsy of Blunt Force Trauma

November 29, 2018September 29, 2017 by admin

Overview

Deaths resulting from blunt force trauma are some of the most common cases encountered by the practicing forensic pathologist. Whereas other forms of traumatic death (eg, gunshot wounds, sharp force injuries) occur under a relatively limited number of circumstances, deaths resulting from blunt force trauma occur in a variety of scenarios. For instance, almost all transportation fatalities — including those involving motor vehicle collisions, pedestrians being struck by vehicles, airplane crashes, and boating incidents — result from blunt force trauma. Other deaths resulting from blunt force trauma involve jumping or falling from heights, blast injuries, and being struck by a firm object, such as a fist, crowbar, bat, or ball. Bite wounds and chop injuries may be considered variants of blunt force trauma, sharp force trauma, or a class of injuries untothemselves.

Blunt force trauma is routinely involved in cases classified as accidents, as well as in...