Laryngeal injury 2019
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A 13-year-old boy was injured after crashing a quad bike into a rope stretched across the track. While he was able to get up and walk away with only a sore neck, the doctor is concerned about potential injuries to his airway, cervical spine, or arteries in his neck. A CT scan and CT angiography are recommended to check for injuries to his larynx or fractures as well as tears or dissections of his carotid or vertebral arteries since his mechanism of injury carries risks of damage to these structures.
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- The incidence of neck trauma is about 1 in 30,000 ER visits. Initial management is crucial in determining outcome.
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- Evaluation involves securing the airway, examining for signs of injury, and radiographic imaging like CT scans to determine fracture extent and rule out injuries. Treatment depends on injury severity and may include laryngeal exploration and repair.
E.N.T.Neck trauma.(dr.usif chalabe)
This document discusses neck trauma, including the anatomy of the larynx, mechanisms of injury from blunt and penetrating trauma, initial evaluation and management, signs and symptoms, diagnostic imaging, classification of laryngotracheal injuries, indications for repair, and treatment goals. Flexible fiberoptic laryngoscopy is used to evaluate injuries, while CT scanning is useful for intermediate cases. Injuries are classified in five groups based on extent of damage. Tracheotomy, panendoscopy, and exploration may be indicated. Framework repair and endolaryngeal stenting can restore function. Outcomes include voice and swallowing function.
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This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and management. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, initial treatment focuses on immobilization using rigid collars, braces, halo traction, or halo vests.
3. Common injuries include fractures of C1-C2 and the odontoid process. Type II odontoid fractures are prone to displacement and non-union, so may need open reduction and fusion
cervicalspineinjuriesanditsmanagement-161119063840.pdf
This document discusses cervical spine injuries, their classification, mechanisms of injury, diagnosis, and treatment approaches. Some key points:
1. Cervical injuries can be caused by traction, direct impact, or indirect forces like flexion, compression, or rotation. Imaging helps classify injuries and assess stability.
2. Unstable injuries with neurological deficits or multiple injuries may require urgent surgical stabilization. Otherwise, treatment focuses on immobilization, reduction if needed, and rehabilitation.
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A 65-year old man crashed his bike into a group of cyclists and fell to the ground complaining of right hip pain. An x-ray showed he had a comminuted fracture of the right acetabulum with medial displacement of fragments. A CT scan was recommended to further characterize the injury and inform surgical planning. His treatment options included closed reduction, open reduction, or an acute acetabular prosthesis given the displacement.
Hypothermia ecg 2019
A 79-year-old man was brought to the emergency department after being found collapsed at home. He has a history of diabetes, hypertension, a stroke with residual weakness, and depression. His ECG shows slow atrial fibrillation and Osborne waves, consistent with a body temperature of 29.5°C, indicating moderate to severe hypothermia. Hypothermia is often caused by an underlying condition that leaves the patient unable to rewarm themselves, such as trauma, neurological issues, drugs, endocrine problems, or infection. Treatment focuses on rewarming with a forced air blanket and providing glucose to generate heat.
Battle's sign child 2019
The image shows bruising over the mastoid process, indicating a fracture of the base of the skull from the fall. Important symptoms and signs to identify those at higher risk of brain injury include dangerous mechanisms, decreased consciousness, repeated vomiting, and signs of skull fractures. This child needs a low-dose head CT scan after transfer to a pediatric trauma center given the loss of consciousness and signs of a skull fracture. Ongoing management will involve evaluating for risks of significant brain injury or need for neurosurgery.
Ankle dislocation 2019
A 37-year old man injured his right ankle after stepping in a pothole while jogging. His ankle appears deformed with the foot displaced laterally and posteriorly. The skin over the lower tibia also appears stretched and pale. This clinical presentation is most consistent with a fracture dislocation at the ankle joint. The priorities are to provide analgesia, reduce the injury in the emergency department to preserve skin integrity, and obtain an x-ray for orthopedic guidance before definitive repair. Initial analgesia could include nitrous oxide and narcotics, with additional sedation like propofol or ketamine if needed despite his fasting status.
Takotsubo cardiomyopathy 2019
A 68-year-old woman presented to the emergency department with chest pain and shortness of breath. Tests showed elevated troponin and ECG changes suggestive of a heart attack. A ventriculogram revealed ballooning of the left ventricular apex, consistent with Takotsubo cardiomyopathy. Takotsubo is a stress-induced heart condition where the heart enlarges at the apex. It is thought to be caused by high catecholamine levels due to life stress. While initial symptoms mimic a heart attack, prognosis is generally good with typical recovery and low mortality around 1-3%.
Posterior shoulder dislocation 2019
The x-ray shows a posterior dislocation of the footballer's right shoulder. Key signs on the x-ray include a symmetrical "light bulb" shaped humeral head and widening of the gleno-humeral joint space. There is also likely a fracture fragment at the inferior rim of the glenoid. The injury should be managed by reducing the dislocation under procedural sedation using traction, abduction, and external rotation, known as the Milch method.
Hyperacute ami ecg 2019
The ECG shows changes suggestive of acute myocardial ischemia, including tall, peaked T waves in leads V2-V4 and possible ST elevation in leads V1 and III. The most important interventions are to give aspirin, heparin, and regular ECGs looking for ST elevation. The man likely needs urgent coronary angiography if ST elevation appears, or angiography soon otherwise, to treat his acute coronary syndrome.
Jefferson fracture xr and ct 2019
A 32-year-old man presented with severe neck pain after being dumped in heavy surf. An x-ray showed a burst fracture of the atlas (C1 vertebra), known as a Jefferson fracture, with fracture lines running vertically through the anterior and posterior arches. Jefferson fractures are caused by an axial load from above, such as falling on the head from height. Although many patients have no neurological deficits, this patient will require immobilization through prolonged use of a cervical collar as treatment, as confirmed by a subsequent CT scan.
Renal trauma ct 2019
A 27-year-old construction worker fell 3 meters and is complaining of abdominal and back pain. A urine test showed blood and his vitals suggest compensated shock. A CT scan revealed a grade 5 injury to the left kidney with shattered architecture, hematoma, and contrast extravasation, indicating active bleeding. The patient has a high chance of requiring a nephrectomy and needs urgent surgical referral. He requires controlled hypotensive resuscitation with sufficient fluids to maintain perfusion but not return to normal blood pressure, as over-resuscitation could worsen bleeding.
Raccoon eyes 2019
A 38-year-old man presents to the emergency department with a headache and nausea after being involved in a bar room brawl while intoxicated the previous night. On examination, he has bilateral bruising around his eyes known as "raccoon eyes" or "panda eyes", which is strongly suggestive of a base of skull fracture given his history of trauma. He will need a head CT scan to further characterize any skull fracture and assess for other significant injuries such as intracranial hemorrhage. He may require neurosurgical consultation and hospitalization for symptom management and monitoring.
Dengue fever 2019
A 22-year old man recently returned from Timor with a fever, headache, body aches and pains, and now a rash. Given his symptoms and travel history, the most likely diagnosis is dengue fever. Blood tests should be performed to check for malaria, as well as a full blood count, electrolytes, liver and kidney function. A diagnosis of dengue can be confirmed by detecting antibodies in follow-up blood samples. With rest and over-the-counter pain medication, most dengue cases can be managed without hospitalization.
Dengue fever 2019
A 22-year old man recently returned from Timor with a fever, headache, body aches and pains, and now a rash. Given his symptoms and travel history, the most likely diagnosis is dengue fever. Blood tests should be performed to check for malaria, as well as a full blood exam, electrolytes, liver and kidney function. While dengue can often be managed as an outpatient, this patient should stay for observation and treatment of symptoms like fever and pain with paracetamol and fluids.
Bifasicular block ecg 2019
A 77-year-old woman presented to the emergency department after losing consciousness at church for about 30 seconds. Her ECG showed signs of a bifascicular block indicating issues with the right and left bundles of the heart's conduction system. Due to her unprovoked loss of consciousness and abnormal ECG, she is at risk of having another episode of complete heart block and should be admitted for monitoring. She may ultimately require a permanent pacemaker given the conduction abnormalities shown on her ECG in the absence of a reversible cause.
Benign bone cyst 7yo xray 2019
A 7-year-old boy complained of thigh pain after jumping from play equipment. An x-ray showed a lucency in his proximal right femur that appears to be a benign bone cyst. As he presented after injury, further investigation with MRI is recommended to check for possible micro-fractures. Treatment options include observation with activity limitation or potential surgery, as cysts sometimes resolve on their own but fracture could require healing.
Pupura fulminans 2019
A 6 month old child presented with fever, poor feeding, and drowsiness. Upon removing the child's sock, their foot appeared severely damaged, which is indicative of severe meningococcal sepsis or purpura fulminans. Treatment in the emergency department should include prompt intravenous access, urgent antibiotics like ceftriaxone, fluid boluses, and expedited transfer to the pediatric ICU. While survival is possible with intensive care, long-term complications such as renal failure and loss of limbs are common with this high-risk condition.
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- 1. A 13 year old boy riding a quad bike ran into a rope that had been stretched across the track he was riding on. He was able to get up and walk away from the crash. Other than a sore neck he is complaining of no other injuries. He is conscious & alert with all vital signs in the normal range. •What structures are you concerned may have been injured in this crash ? •What specific examination features should be sought ? •What investigations are indicated ?
- 3. Given the mechanism of injury the 3 big areas of concern in this lad are: airway, cervical spine, and arterial (carotid & vertebral) injury. Of these cervical spine injury is probably the least likely, as given the mechanism it would likely either be fatal or present with gross neurological deficit. The airway can be involved through trauma to the soft tissues, fractures of the laryngeal cartilages or recurrent laryngeal nerve damage. Airway injury may be suspected/detected clinically by the presence of stridor or drooling in severe cases, or by dysphonia/haemoptysis in the less severe. Take any change in the patients voice seriously. Specifically look for crepitus due to subcutaneous emphysema in the neck or supraclavicular fossae, as it indicates significant airway damage/perforation. The best form of examination for laryngeal injury is direct or fibre-optic laryngoscopy which will need the involvement of an ENT specialist. Plain xrays, whilst moderately sensitive for cervical spine injury, are not adequate to image laryngeal/airway trauma. If the patient is able to lie flat, and there are no acute concerns for the airway, then the investigation of choice is CT & CT angiography. This will accurately identify carotid/vertebral artery tears/dissection and is good at finding laryngeal skeleton injuries. Airway concerns mandate direct laryngoscopy