Regional Injuries Flashcards
Most common type of penetrating chest wound
- left sided anterior chest wall
- directed downward, medially and backwards
Possible effects of penetrating injury to lung and pleura
- haemothorax
- pneumothorax
- anoxic anoxia (blood in bronchi and trachea)
Mechanism of injury in penetrating lung and pleura injury
Leverage of instrument on fulcrum of a rib during withdrawal may extend wound greatly
Complications of penetrating lung and pleural injury
- infection with empyema or bronchopneumonia
- healing with pleural adhesions
Possible effects of penetrating injury to heart
- haemopericardium
- haemothorax
- external haemorrhage
Causes of death in penetrating injury to heart
- shock
- haemorrhage
- tamponade
Complications of penetrating heart injury
- infection
- healing with adhesions and constrictive pericarditis
Large vessels at risk in penetrating injury to chest
- superior VC
- pulmonary artery
- aorta
Potential result of penetrating injury to oesophagus
Fatal mediastinitis
Possible mechanisms of non-penetrating injury to the chest
- rib fractures
- stove-in chest
- sternum fractures
How do lung lacerations occur in non-penetrating injury to chest?
- fractured rib-ends
- falls or sudden accel/decel
Results/complciations of lung lacerations
- haemothorax
- pneumothorax
- blood in tracheobronchial tree with asphyxia
- interstitial emphysema
- pulmonary infections
How do lung contusions happen?
- direct violence
- contre-coup injury (posterior surface)
- pinching in phrenico-costal sinus
Types of lung injury in non-penetrating injury
- laceration
- contusion
- tearing off of hilus and bronchi
Types of heart injury in non-penetrating injury
- lacerations
- rupture
- contusion
How does rupture of the heart occur?
- sudden compression of chest wall
- rapid increase of intra-cardiac pressure (falls/ vehicle over abdomen)
How do contusions of the heart occur?
- blow on chest
- falls on projecting objects
- compression in traffic accidents
Types of large vessel injury (non-penetrating)
- traumatic asphyxia
- rupture of aorta
Complications of chest injuries
- pneumothorax
- haemothorax
- chylothorax
- interstitial emphysema
- cardiac tamponade
How much blood in cardiac tamponade usually causes death?
400-500ml
Consequences of healing of immediately non-fatal injuries of the heart
- occlusion of coronary arteries with infarction
- myocardial fibrosis with cardiac aneurysm
- disturbances of conduction system
- pericarditis (constrictive)
Non-penetrating injuries to abdominal wall
- skin abrasions
- bruises
- haematoma in muscles
- muscle rupture
How do non-penetrating injuries to stomach and intestine occur?
- compression
- traction forces
- disruption/bursting
Types of non-penetrating injuries to the liver
- transcapsular lacerations
- subcapsular lacerations
- central lacerations
Types of non-penetrating injuries to the spleen
- compression (transcapsular/subcapsular)
- traction ( haemorrhage)
Complications of non-penetrating injury to pancreas
- profuse haemorrhage
- traumatic pancreatitis
Complications of abdominal injuries
- shock
- internal haemorrhage
- peritonitis
- paralytic ileus
Complications of penetrating injury to kidneys and adrenal glands
- haemorrhage
- sepsis
- damage to adrenal glands
How to non-penetrating injuries to the kidneys occur?
- direct blow to loin
- crushing against lower ribs by forces transmitted through liver
- fall from height
Pathology seen in non-penetrating injuries to kidneys
- contusions (transcapsular)
- lacerations (subcapsular, transrenal)
- tears of renal artery
- rupture of adrenal gland
Complications of penetrating injury to the bladder
- haemorrhage
- extravasation of urine with pelvic cellulitis
Causes of non-penetrating injury to bladder
- direct blow to distended bladder
- fractured pelvis
General effects of injuries to limbs
- haemorrhage and shock
- wound infection
- pulmonary embolism
- lower nephron necrosis
- fat embolism
Sources of embolic fat
- bone marrow
- plasma fat
- depot fat
Treatment of fat embolism
- oxygen
- hydrocortisone
- dextran 40
