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External signs of internal injuries tfinal

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External signs of internal injuries tfinal

  1. 1. External Signs Of Internal Problems “ A Visual Diagnosis” Troy Pennington, DO, MS, FAAEM EMS Director- ARMC Mercy Air California, SBCFD & Barstow FD
  2. 6. Hyphema <ul><li>Blood or clots in the anterior chamber. Hyphema may be traumatic or spontaneous. Traumatic hyphema results from a ruptured iris root vessel. Spontaneous hyphemas are frequently associated with sickle cell disease. </li></ul><ul><li>Treatment </li></ul><ul><li>Elevate Patient ’s Head </li></ul><ul><li>Dilate the eye to avoid “Pupilary Play” </li></ul><ul><li>Control of intraocular pressure- topical B-Blockers, IV mannitol, topical alpha adrenergic agonists and oral, topical or IV carbonic anhydrase inhibitors (CAIs) such as Diamox. </li></ul><ul><li>Rebleeding can occur 3 to 5 days later in up to 30%, causing severe increase in intraocular pressure necessitating surgical anterior chamber “washouts” </li></ul>
  3. 7. Top TEN Visual Clues Your DRUNK! # 1
  4. 10. Blow Out Fracture
  5. 11. Blow Out Fracture X-Rays Features on Exam
  6. 12. Blow Out Fracture Management & Disposition
  7. 13. References
  8. 14. Top TEN Visual Clues Your DRUNK! # 2
  9. 15. #1 #2
  10. 17. #1 Tarsal Plate Sparing
  11. 22. Skull Fractures
  12. 23. Top TEN Visual Clues Your DRUNK! # 3
  13. 24. What Zone of The Neck is this?
  14. 25. What Zones of The Neck are affected?
  15. 26. Zones of The Neck
  16. 27. Zones of The Neck
  17. 28. Zones of The Neck
  18. 29. Zones of The Neck
  19. 30. Zones of The Neck
  20. 31. Zones of The Neck
  21. 32. Zones of The Neck
  22. 36. What ’s Your Diagnosis?
  23. 38. Angioedema
  24. 39. Epidemiology & References
  25. 40. Top TEN Visual Clues Your DRUNK! # 4
  26. 44. CXR Of The Same Child
  27. 46. What do All Those Patients Have in Common? Subcutaneous Emphysema
  28. 54. Top TEN Visual Clues Your DRUNK! # 5
  29. 57. Seat Belt Sign
  30. 58. Seat Belt Injuries
  31. 59. Seat Belt Injuries
  32. 60. Top TEN Visual Clues Your DRUNK! # 6
  33. 61. #1 #2 Which Shoulder is Dislocated?
  34. 63. Shoulder Dislocation
  35. 64. Shoulder Dislocation
  36. 65. Shoulder Dislocation
  37. 67. Mel Gibson ’s tips on Shoulder Reduction 
  38. 71. AC Separation
  39. 72. Top TEN Visual Clues Your DRUNK! # 7
  40. 73. #1 #2 Which Represents An Acute Injury
  41. 74. #1 Traumatic Posterior Elbow Dislocation
  42. 79. Elbow Dislocation
  43. 80. Elbow Dislocation
  44. 81. Elbow Dislocation Management
  45. 82. Elbow Dislocation Management
  46. 83. Elbow Dislocation Management Complex Dislocations
  47. 86. Electrical Injuries
  48. 87. Electrical Injuries
  49. 88. Electrical Injuries
  50. 91. Closed Fist Injury “Fight Bite”
  51. 92. Closed Fist Injury “Fight Bite”
  52. 98. High Pressure Injection Injuries
  53. 99. High Pressure Injection Injuries
  54. 100. High Pressure Injection Injuries
  55. 103. A patient with a history of alcohol abuse presented to the Emergency Department complaining of acute upper abdominal pain. Examination revealed the findings in the images below. The physician repeatedly questioned the patient about recent trauma, but the patient adamantly denied this. The physician simply assumed that the patient sustained trauma while intoxicated and did not recall the event. 
  56. 106. What ’s Your Diagnosis? Cullen's Sign 

 The patient exhibits Cullen's sign - ecchymosis in the periumbilical region. In acute pancreatitis, Cullen's or Turner's sign (ecchymotic discoloration of the flank) occurs in approximately 3% of patients and is associated with a mortality of 37% (2). Although most commonly considered a sign of hemorrhagic pancreatitis, neither of these signs is specific to this condition.

In fact, Cullen's sign has been described in a variety of conditions including retroperitoneal bleed after coronary angiography, splenic rupture, hip dislocation, perforated duodenal ulcer and ruptured abdominal aortic aneurysm (1-4).

Cullen's sign arises from the spread of retroperitoneal blood into the falciform ligament and subsequently to subcutaneous umbilical tissues through the connective tissue covering of the round ligament (5). It is named after Dr. T S Cullen who described the sign in 1919 in a patient with a ruptured ectopic pregnancy. 
 References:
(1) Spence M, Webb S. Images in cardiology: Cullen's sign after coronary angiography Heart 2000;83: 640. 
(2) Mookadam F, Cikes M. Images in clinical medicine: Cullen's and Turner's signs N Engl J Med 2005;353: 1386. 
(3) Chung MA, et al. Cullen's sign: it doesn't always mean hemorrhagic pancreatitis Am J Gastroenterol 1992;87: 1026-8. 
(4) Sayers RD, Porter KM. Cullen's sign: a new association with central dislocation of the hip joint Injury 1988;19: 280-1. 
(5) Sugimoto M, et al. MPR-hCT imaging of the pancreatic fluid pathway to Grey-Turner's and Cullen's sign in acute pancreatitis Hepatogastroenterology 2005;52:1613-1616.
  57. 107. What ’s Your Dx?
  58. 108. Grey Turner ’s Sign
  59. 109. #1 #2 Which is Dislocated
  60. 110. Hip Fracture
  61. 114. A Common Mechanism
  62. 115. Posterior Hip Dislocation
  63. 118. What ’s Your Diagnosis?
  64. 119. Knee Dislocation
  65. 124. Patellar Dislocation
  66. 125. Knee Anatomy
  67. 126. Patellar Dislocations
  68. 127. Patellar Dislocation
  69. 128. Patellar Dislocation
  70. 129. Top TEN Visual Clues Your DRUNK! # 9
  71. 130. #1 #2 Which Represents Abuse?
  72. 131. Both Are 
  73. 132. BURNS <ul><li>BRANDING/CONTACT BURNS </li></ul><ul><li>CIGARETTE BURNS </li></ul><ul><li>IMMERSION BURNS </li></ul><ul><li>MICROWAVE OVEN BURNS </li></ul>
  74. 133. #1 #2 Which Represents Abuse?
  75. 134. #1
  76. 135. #1 #2 Which Represents Abuse?
  77. 136. Neither
  78. 137. BRUISING <ul><li>MOST COMMON TYPE OF INJURY IN CHILDREN. </li></ul><ul><li>AGING OF BRUISES AN INEXACT SCIENCE. </li></ul>
  79. 138. CHILD ABUSE MIMICS <ul><li>BLEEDING DISORDERS: </li></ul><ul><li>ITP </li></ul><ul><li>VON WILDEBRANDS </li></ul><ul><li>FACTOR DEFICIENCY </li></ul><ul><li>ASA TOXICITY </li></ul><ul><li>VASCULITIS </li></ul><ul><li>MONGOLIAN SPOTS </li></ul>
  80. 139. PATTERNS <ul><li>HANDPRINTS OR FINGER MARKS ON FACE, TRUNK, UPPER ARMS, BUTTOCKS </li></ul><ul><li>BELT MARKS </li></ul><ul><li>LOOP MARKS FROM ROPE OR WIRE </li></ul><ul><li>LIGATURE MARKS </li></ul>
  81. 140. Top TEN Visual Clues Your DRUNK! # 10

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