Traumatic Flashcards
What are the three stages of injury after caustic ingestion?
- Necrosis, bacterial invasion, sloughing of the mucosa.
- Granulation tissue and reepithelialization (days-several weeks).
- 3•Scar formation and contraction.
What is the mortality rate of patients who develop meningitis with a traumatic CSF leak?
10%.
What percent of patients with CSF leak secondary to nonsurgical trauma will develop meningitis?
10-25%.
What percent of basilar skull fractures result in CSF leak?
10-30%.
What percent of patients with esophageal stricture will develop esophageal cancer?
1-4%.
In what age groups is caustic ingestion most common?
18-24 months, 20-30 years.
What is the incidence of facial nerve paralysis in patients with longitudinal temporal bone fractures?
20-25%.
How long should immobilization typically be maintained in children?
2-3 weeks.
What does medical management of laryngeal injuries consist of!
24 hours or more of airway observation, voice rest, elevation of the head, humidified air, H2 blockers, steroids; antibiotics if lacerations are present.
What percent of CSF leaks are from nontraumatic causes?
3-4%.
What is the incidence of facial nerve injury after transverse fracture of the temporal bone?
40-50%.
What percent of mandible fractures are associated with other injuries?
40-60%.
What percent of children with esophageal burns will develop esophageal stricture?
7-15%.
What percent of patients without oropharyngeal burn will have evidence of esophageal injury?
8-20%.
What percent of CSF leaks are cranionasal?
8o%.
How does the injury differ after ingestion of acidic substances versus ingestion of basic substances?
Acidic substances cause coagulation necrosis; the eschar limits the depth of injury. Basic substances cause liquefaction necrosis and are likely to cause deeper injury.
What is the best way to treat mandible fractures in infants < 2 years of age?
Acrylic splints x 2-3 weeks.
Where are the laceration and bony disruption in the external auditory canal most often found after longitudinal temporal bone fracture?
Along the tympanosquamous suture line (posterior and superior).
What is the most likely mechanism of injury for bilateral condylar fractures?
Anterior blow to the chin.
Where does the fracture line typically course in relation to the otic capsule?
Anterior to the otic capsule.
What percent of skull fractures involve the temporal bone?
Approximately 20%.
What is the strongest predictor of negative outcome in trauma patients?
Arterial hypotension
What is the most common diagnosis inappropriately given to a child with an airway foreign body?
Asthma.
When should middle ear exploration and ossicular reconstruction be performed after temporal bone fracture?
At least 3 months after injury.
What are the relative indications for open reduction of a condylar fracture?
Bilateral condylar fractures in an edentulous patient when MMF is impossible, condylar fractures when MMF is not recommended for medical reasons, and bilateral condylar fractures associated with midface fractures.
What is the most common etiology of dizziness after longitudinal temporal bone fracture?
BPPV.
What is the most common esophageal foreign body in children
Coins.
What is a type II NOE fracture?
Comminuted, but identifiable, central fragment.
What is a type C ZMC fracture?
Complex fracture with comminution of the zygomatic bone.
Which parts of the mandible are most commonly fractured?
Condyle (36%), body (21%), and angle (20%).
Which part of the mandible is most commonly fractured in children?
Condyle.
Which teeth can be used in children between the ages of 5 and 8 for immobilization?
Deciduous molars.
What are the most common injuries associated with facial trauma in children?
Dental injuries.
What are the absolute indications for open reduction of a condylar fracture?
Displacement of the fracture fragments into the middle cranial fossa; Inadequate reduction; extracapsular displacement of the condyle and foreign-body in the joint.
After caustic ingestion, what sign is most likely to signal the development of a complication?
Drooling.
What are the most common etiologies of nerve dysfunction after longitudinal temporal bone fracture?
Edema and intraneural hemorrhage.
Which types of laryngeal injuries are best managed medically?
Edema; small hematoma with intact mucosa; small glottic or supraglottic lacerations not involving the free margin of the vocal cords or the anterior commissure and without cartilage exposure; single nondisplaced thyroid cartilage fractures.
What is the medical management of CSF leak?
Elevation of the head of bed, antitussives, laxatives, antihypertensives, analgesics, bed rest, lumbar drain.
What is the management of patients with evidence of grade 2 or 3 injury (transmucosal or transmural) on endoscopic exam?
Esophageal rest (NPO), reflux precautions, +I- steroids, +I- antibiotics, +I lathyrogens, +I- subcutaneous heparin, +I- nasogastric tube, +I- prophylactic bougienage.
True/False: Airway foreign bodies are more common than esophageal foreign bodies.
False.