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Stasis:
A stoppage or slowdown in the flow of blood or other body fluid, such as lymph.
cystitis
– infection of the bladder.
Concussion symptoms and modalities
CT, MRI, Loss of consciousness, Loss of memory,
Cerebral contusion normally occuer at the
frontal part of brain
Hematoma symptoms and modalities
-MRI (shows edema and contusions). Hemorrhage.
Carotid artery symptoms and modalities
(takes blood to the front part of the brain) – uses Angiography studies (Laceration of artery,Dissection/occlusion).
Contusion symptoms and modalities
(cerebral) – uses CT, MRI
(Loss of consciousnes,Traumatic event forgotten).
Mandible is
strongest bone in the face
modified water uses how many body rotation
55
water view uses body rotation of
37
Zygomatic arch (SMV) uses which view
“jug handles” view
Hyperextension injuries of the head and neck or direct trauma to the neck may injure the
carotid arteries. Bleeding must be controlled to prevent shock, which may worsen the head injury. Once the person arrives in the ER dept, cervical spine radiographs or a CT scan of the cervical spine must be obtained. CT of the head may also be indicated, especially if the person is comatose. Those who do not use any protective devices while driving (i.e seatbelts and/or airbags) sustain the most injuries. Those who depends on airbags only sustain the second largest number of injuries to the head and face, followed by those who use only a seatbelt. Those using only a lap-type seatbelt have a high incidence of lumbar spine injuries.Individuals that wears only a shoulder belt without a lap belt sustain more cervical spine injuries.
The causes of vertebral column injuries include
direct trauma and Hyperextension-flexion injuries (whiplash injuries).Radiograph indications of spinal column injuries include the interruption of smooth, continuous lines formed by the vertebrae stacked on one another.
Anterospondylolisthesis
(commonly known as spondylolisthesis): the anterior slipping of the vertebral body. Symptoms identical to those of a herniated disk. ‘Commonly occurs at the L5-S1 junction and is best detected on a lateral projection.
Retrospondylolisthesis:
the posterior slipping of the vertebral body.
Compression fractures are the most frequent type of injury involving
a vertebral body. Usually, the damage is limited to the upper portion of the vertebral body, particularly to the anterior margin. Such fractures generally occur in the thoracic and lumbar vertebrae, w/ the most common site being T1-T12 in the thoracic spine.and T12-L1 at the thoracolumbar junction. Often associated with osteoporosis and range from mild to severe. Cervical spine injuries may involve the odontoid process, usually at the junction of the odontoid and the body of the second cervical vertebra
A hangman’s fracture, sometimes referred to as
traumatic spondylosis, results from acute hyperextension of the head
Jefferson fracture
was first described as a “burst fracture” of the first cervical vertebra (atlas).. It generally occurs as a result of a severe axial force that causes compression, as in diving accident. The vertebral arch literally bursts. Radiographic ally, particular attention needs to be paid to the transverse longitudinal ligament by reviewing the lateral masses on the open-mouth odontoid projection. MRI is the preferred imaging modality to best examine the transverse longitudinal ligament. Fx of C1. C1 ring fx in four (4) places. Happens when someone falls on their head (e.x dive into a pool)
Fractures and dislocations of the spine are classified as
stable or unstable.
The spine may be visualized as
two columns, with the anterior column composed of vertebral bodies and intervertebral disks and the posterior column composed of the posterior elements (e.g., spinous processes, lamina).
the anterior column or the posterior column of the spine is fractured or dislocated, the injury is classified
as stable.
if both side of columns are involved in the injury, it is classified as
unstable.
Compression of the spinal cord by contusion or hemorrhage leads to
rapid swelling of the spinal cord. This causes a rise in intradural pressure and causes temporary neurologic dysfunction. This temporary loss of neurologic function usually resolves in several days However, lacerations of the spinal cord or transaction of the cord results in permanent damage because the severed nerves do not regenerate. Lacerations of the spinal cord above the fifth cervical is almost always fatal, and lacerations below this region result in permanent paralysis. .
Persons with lacerations or transection of the cord develop
immediate flaccid paralysis with loss of all sensation and reflex activity, which gradually changes to spastic paraplegia within days.
Spinal Trauma Major Effects
Fractures -
Dislocations -
Paralysis
Pain
shock
Most common cervical fractures occur at
C2.
Most of the luxation (dislocation) or subluxation (incomplete dislocation) occurs at
C6-C7. If a person has a problem at C7-T1, there are going to have dexterity problems.
Paraplegia:
paralysis in the lower half of the body (injury occurred in thoracic-lumbar area or sacral area)
Fecal incontinence
develop severe constipation and may also develop hemorrhoids in paralysis Atrophy of the muscle, weakness of the muscles, and have a problem with coordination and balance.
Intrinsic factor
(influence from the inside): age
Extrinsic factor
(influence from outside): Loss of sensitivity and the fact that they have limited mobility.
Quadriplegic/ Tetraplegic:
paralysis in the trunk, arms, pelvic organs, and the legs (injury occur around C1-C4)
Hemiplegia-
paralysis in one half of the body (usually when a person has a stroke or cervical injury)
Neuropathic pain:
pain occurs when the damaged nerve fibers sent out incorrect signals to the brain. The pain is the worst at night. This pain will affect the overall quality of life for these patients.
Shock during spinal injury
It develops after injury to the spinal cord bc at this point the reflexes and all of the functions of the spinal cord is going to stop at the level of the injury and below the level of the injury. For a while the person may experience complete paralysis and the loss of all reflexes and sensation. Spinal shock occurs 30mins- 1hr following the traumatic experience. Can lasts up to 6 weeks. The immune system takes over and will cause inflammation. If this happens, those cells from the immune system can reach the blood-brain barrier and cause self-destruction of the nerve cells leading to scarring of the nerve cells. Remember scars have no function. Result in a limited conduction or will stop the conduction of any remaining nerve cells. That’s if the person doesn’t recover within a certain length of time.
The strongest cervical vertebra is the
axis because it has the odontoid (dens).
The spinal injury tends to occur in the regions of the spine that has the
greatest mobility.
Common Cervical Fractures
Clay-Shoveler’s:
Hangman’s
Jefferson:
Compression:
Clay-Shoveler’s:
Avulsion fx of the spinous process of C6, C7, and T1. Sometimes T2. Avulsion fx=pulling away” fx. Least unstable fracture of the spine bc it does not involve the spinal cord.
A hangman’s fracture
:Fx through the pedicle of C2 w/ or w/o subluxation (dislocation) on C3. This occurs when someone gets hung. Caused by an acute hyperextension of the head.
Compression of spine:
Generally, T11-T12 OR T12-L2. Most likely from a fall or an MVA. Affects the vertebral body. The vertebral body will collapse like a crushed can. The best imaging modality is CT. The result of direct trauma or flexion injuries. Most fractures of the TL spine are caused by compressive forces. When the upper part of the body is thrust backwards, the force is going to disrupt the vertebral anatomy from anterior to posterior.
Contra Coup
(fx on side of skull) Hit on one side of skull and injury happens on the other.
Seatbelt fracture
a.k.a Chance fracture. If the seatbelt is used incorrectly, the person may end up with a Chance’s fracture (L2). Chance’s fracture (most common injury found as a result of a seatbelt) extends through the spinous process and to the pedicle to the vertebral body.
Thoracic Spine
Composed of 12 thoracic vertebrae separated by intervertebral disks. Each vertebra is attached to 2 ribs. The thoracic vertebrae and the ribs form a thoracic cage that protects the thoracic organs (the heart, lungs, and large vessels). Thoracic spine provides attachment points for the muscles in the neck, the back, the chest, and the shoulders. Supports the upper part of the arms, hands, shoulder, clavicle, and the scapula. The major modality for the T-spine is CT.
Most of the injuries in the thoracolumbar region is caused by
blunt force trauma.
MVA is the primary cause of the
thoracolumbar injuries.
Pressure from a fractured or dislodged vertebra can crush and destroy the
sensitive axons (that carry the signals) in the spinal cord.
Spinal cord starts at the medulla of the brain and ends at
L1-L2.
If there is complete transection (meaning complete severing/two pieces) or crushing of the cord, that is
IRREVERSIBLE. That is a loss of function at the point where it happens AND below the level of injury.
laceration or transection above C5 (C1-C4) it is almost
always fatal.
When a patient experiences a laceration or transection in the spine, you’ll notice there is a flaccid paralysis
(paralysis in which muscle tone is lacking in the affected muscles and in which tendon reflexes are decreased or absent) bc there is a loss of sensation. These patients also become spastic, the drawing and the pulling of the spinal cord itself. Flaccid paralysis will eventually change into spastic paralysis.
Spastic paralysis involves
tight and hard muscles. It can cause your muscles to twitch uncontrollably, or spasm
Spasticity:
a condition in which muscles stiffen or contract.
Bruising of the spinal cord is
reversible. When there is mild edema or minor bleeding, it is going to temporarily impair the conduction of nerve impulses. Remember when there is a injury to something, you are going to get inflammation!! If there is any compression of the cord itself, it is going to affect the blood flow. Bleeding and inflammation develop locally.
The crushing of the vertebra causes
pressure and then as a result of the trauma itself, there is going to be inflammation, which causes additional pressure on the spinal cord leading to disruption of blood flow. When there is injury in the cervical area, inflammation may extend it upward to the level of C3-C5 and it may interfere with phrenic nerve. Phrenic nerve (controls the diaphragm) provides motor innervation to the diaphragm. It will affect respiration! When there is a minor injury, there may still be a blockage of nerve signal, but the person will recover.
Complete spinal cord injury:
a total absence of sensory and motor function below the site of injury.
Incomplete spinal cord injury:
there is some preservation of sensory and motor function.
If injuries occur above C5, it can result in immediate life-threatening conditions bc in the area it is where cardiovascular complications will occur as a result of blockage of the nervous system. Remember there is also possible respiratory failure. The person may also experience a problem with the GI tract. People who have injury in that area (above C5) do not have bladder control. That is because muscles in the urinary tract are affected by spinal cord injury. This is referred to
neurogenic bladder.
neurogenic bladder
generalized term given to a number of conditions in people who lack bladder control due to a brain, spinal cord, or nerve problem. May lead to skin decubitus (ulcers) which can occur wherever there is a bony prominence such as the elbow.
Damage to C1-C4, causes
paralysis to all four (4) limbs (quadriplegic).
MRI is best when it comes to
neurological concerns (spinal cord) and skull trauma
Nerve tissue does not
repair itself.
Laceration or transaction above C5 is usually
fatal.
Trauma to C-spine happens two ways:
Direct trauma (MVA or a fall)
Hyperextension
CT is the best modality for
skull trauma.
Fractures visible after skull trauma are generally classified as
linear, depressed, or basilar.
Basilar skull fractures x-ray
very difficult to demonstrate radiographically. The presence of air-fluid levels in the sphenoid sinus or clouding of the mastoid air cells is often the only radiographic finding suggesting a fracture. It is important to include cross-table lateral skull radiography with the trauma skull radiographic series. CT and MRI are often used to better identify basilar area fractures and associated soft tissue damage within the skull.
In addition to brain injury from a penetration wound (ex. fracture), brain injury may also occur from acceleration and rapid deceleration of the head, which is termed a
closed head injury or traumatic brain injury (TBI).
The superficial cerebrum in the frontal, temporal, and occipital regions is
most often affected in brain trauma
After a blow to the head, an individual may experience temporary loss of consciousness and reflexes. This widespread paralysis of brain function is known as a
concussion and is characterized by headache, vertigo, and vomiting.
A brain contusion may also result from a direct blow to the head.
This bruising of brain parenchyma is more serious than a concussion.
A contusion formed on the side of the head where the trauma occurs is called a
coup lesion, and one formed on the opposite side of the skull in reference to the site of the trauma is a contrecoup lesion.
Contusions are characterized by
neuron damage, edema, and punctuate (pinpoint punctures or depressions) hemorrhaging.
Subdural or epidural hematomas may occur in conjunction with a contusion and result in
increased intracranial pressure that may be life-threatening.
CT plays a major role in the diagnosis of
hematomas resulting from contusions.
Skull Trauma Priorities:
Maintenance of airway
Patient’s LOC (level of consciousness)
Change in patient’s: Respiration, Color, General Condition
Shock
Skull Trauma Major Effects
Fracture (Fx
Edema
Hemorrhage (rupture of blood vessel)
Hematoma (accumulation of blood w/in tissues)
Infection through fracture side
Seizures (result of concussion)
Shock
Direct injury to brain tissue -The skull is meant to protect the brain, but it could also cause damage to the brain (ex. Bone fragments penetrating the brain or compression on the brain)
Fracture signs in skull
can be indicated by bleeding from ears or nose or CSF from nose. Most common place for skull fx is temporal area/bone. Either closed or open fracture. W/open fracture there is a high risk of infection.
Basal fracture:
occurs at the base of the skull. Very difficult to demonstrate radiographically. Leakage of CSF from nose. Provides an opportunity for microbes to enter the brain. Forehead hits the car windshield which can cause basilar fracture. Contra Coup (fx on side of skull)- Hit on one side of skull and injury happens on the other. The presence of air-fluid levels in the sphenoid sinus or clouding of the mastoid air cells is often the only radiographic finding suggesting a fracture. You will use a horizontal beam to demonstrate the air-fluid levels. In most cases, the location of the fracture is more important than the extent of the fracture. If the fracture crosses an artery, there will be an arterial bleed. A fracture that enters the mastoid air cells or a sinus communicates with a potentially infected space and may lead to infection, possibly resulting in encephalitis. The area that is most commonly fractured is the temporal bone. There could be a crushing of the nerves tissue or compression/rupture of blood vessels.
Depressed fracture:
appears as a curvilinear density because the fracture edges overlap. These fractures are caused by high-velocity impact by small objects. Injury to the cerebral cortex may result, causing bleeding into the subarachnoid space. Best demonstrated when the x-ray beam is directed tangentially to the fracture. a lot of the bone in the skull is going to be displaced. In this fracture, part of the skull is actually sunken in from the trauma. Appears as a curvilinear density bc the fracture edges overlap. Caused by high-velocity impact by small objects. Injury to the cerebral cortex may result, causing bleeding into the subarachnoid space. Blood supply is often impaired bc of the depressed brain tissue
Compound fracture
bone broken in multiple pieces ex : brain tissue is exposed to the environment, Bone fragments may penetrate the tissue. Heighten risk of infection because the fracture is open.
Communicated
several fracture lines are present.
Linear fracture:
simple crack in the bone Appear as straight, sharply defined nonbranching lines and are intensely radiolucent. appear as straight, sharply defined, nonbranching lines and are intensely radiolucent. Up to 80% of all skull fractures are linear
Signs/symptoms of skull trauma:
Conscious/unconscious, Decreasing level of consciousness, Disoriented, Restlessness, Pupils may not react to light (dilated) , Bleeding from ears, nose, or mouth, Fluid discharge from ear or CSF from nose, Air-fluid level in sphenoid sinus, There is most likely a fx in the occipital area. Decrease pulse rate, respiratory rate. Increase in BP, Increase in temperature. Coma, Concussion Contusion Hematoma -Hemorrhage.
Types of Hematomas:
Epidural- arterial bleeding (CT)
Rapid loss of consciousness
Dilated pupils
Compression of brain
Dizziness, nausea, vomiting
Subdural-venous bleeding (MRI)
Headache-agitation
Confusion- drowsiness
Loss of consciousness
Brain compression
subarachnoid
intracerebral.
Subdural (venous) is slower
bleeding than epidural (arterial). In other words, venous is slower than arterial).
Epidural uses
CT bc better for active bleeding and an arterial bleed shows up right away
Subdural USES
MRI bc bc it’s a slower bleed
Skull Trauma Radiographic Examination
CT/MR
Arteriography
Conventional-AP (2nd)/Cross-Table Lateral (1st)
Immobility (spinal trauma):
When a body is supine for long term, there is going to be a loss of force of gravity. This loss of force of gravity is going to affect a lot of natural functions in the body especially in the intestines and the urinary tract. Decreased circulation of blood, less metabolism, renal function will be affected, atrophy of muscles bc of lack of muscular activity, less respiratory function, etc. Bone is living tissue; the inactivity of the bone will cause deterioration and the muscles will become flaccid. The skin is going to be break down and eventually lead to decubitus ulcers. The skin breaks down easily when the circulation is impaired. Cell regeneration is going to be reduced.
Immobility (spinal trauma): Cardiovascular effect
:a patient is in a horizontal position for a long period of time, that blood that is supposed to be returning to the heart from the lower part (venous blood) is going to pool when it gets to the trunk of the body. It is going to pool in the lungs. Causing an increased workload on the heart bc it needs to make up the blood that the body is not getting. Formation of a thrombus: blood clot formation that occurs in the veins; particularly in the legs. Part of that thrombus may break away and become an embolism. It will travel to the IVC to the heart. If it’s large enough, it can block the pulmonary artery.
Immobility (spinal trauma):Urinary effect
Stasis (urinary retention): the normal urine flow from the bladder is impeded, causing the urine to accumulate or back up.
Causes an infection (bladder infection) and stones to develop.
Leads to residual urine in the calyxes in the kidneys.
Immobility (spinal trauma): Digestive effect
Constipation bc there is slow fecal matter moving through the system.
Reduced food consumption leads to reduced peristalsis in the intestines (due to lack of movement) and more water absorption (harder poops).
Obesity bc of lower caloric intake.
Immobility (spinal trauma): respiratory effect
Less demand for oxygen and respiratory function
Deep breathing and coughing becomes very difficult.
Exchange of CO2 and O2 is reduced.
Secretions build up in the airway.
Inflammation comes around again!!
Increased mucus secretions leads to infection such as pneumonia or atelectasis.
Pneumonia and atelectasis can be the result of aspiration of food and/or water intake.
The most common facial fracture is
a nasal fracture bc it is the most prominent feature.
Facial Injury Effects:
Bleeding: (most dangerous complication bc it can obstruct the airway) Ex. Maxillary bone fracture or nasal bone fracture, If possible, turn the patient to the side. If not, time to call for suctioning. You do not want bleeding into the air passage.
Disfigurement in some local areas in the face.
Facial injury radiographs:
Plain radiographs (2D)/CT (3D). If there is severe trauma, or disruption of facial fragments: CT. Erect (PA) position-when possible CT can demonstrate more facial fractures than conventional radiographs. CT of the spine and head if a CT is being done. Make sure the facial bones are as close to the IR as possible.
In conventional radiography, we are looking at four spaces: Oral Nasal Orbit(s) Paranasal sinus (dark areas on a radiograph); Everything is super imposed on a lateral. Gunshot wounds ppl tend to have injuries in the orbit or to the cranial content. If there is a bullet entering the orbit, it may enter from one side to the contralateral side. May have mandible fractures. Causes a significant amount of bleeding and swelling. This will affect the pt’s airway. May have bone inter-fragments in the facial area.
Orbit- Modified water’s position-
Look at all 14 facial bones. Done first! in facial trauma
Blow out fracture:
when someone gets punched in the eye and lower rim of the orbit gets fractured. See air-fluid level in the maxillary sinus. You need to see the entire rim of the orbit.
Tripod Fracture
fracture is second most common fractur, Zygomatic arch is affected. Orbital floor or rim with separation of the zygomaticomaxillary complex. Air-fluid level on affected side. Can occur after discharging a gun after the face (suicide).