Podcast #397: Pharyngeal Trauma

Author: Aaron Lessen, MD

Educational Pearls:

  • Injuries from penetrating pharyngeal trauma  are often subtle on examination in children
  • Potentially serious complications including carotid artery injury, mediastinitis from spreading infection, or airway compromise from hematoma formation
  • Imaging choice is typically CTA to assess for vascular injuries
  • These injuries may require antibiotics

References:

 

Zonfrillo MR, Roy AD, Walsh SA. Management of pediatric penetrating oropharyngeal trauma. Pediatr Emerg Care. 2008 Mar;24(3):172-5. doi: 10.1097/PEC.0b013e3181669072. PubMed PMID: 18347498.

Sasaki T, Toriumi S, Asakage T, Kaga K, Yamaguchi D, Yahagi N. The toothbrush: a rare but potentially life-threatening cause of penetrating oropharyngeal trauma in children. Pediatrics. 2006 Oct;118(4):e1284-6. PubMed PMID: 17015515.

Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

Podcast # 335: Blunt Head Trauma

Author: Peter Bakes, M.D.

Educational Pearls:

  • Epidural hematomas have a characteristic convex appearance on CT while a subdural hematoma will have a concave appearance.
  • Indications for operative intervention for subdural hematoma may include: >5 mm midline shift, over 10 mm in thickness, comatose with ICP >20, or patient neurologic deterioration.

 

References

Bullock, M. R. et. al. . Surgical management of acute subdural hematomas. 2006. Neurosurgery, 58(SUPPL. 3). DOI: 10.1227/01.NEU.0000210364.29290.C9.

Huang KT, Bi WL, Abd-El-Barr M, Yan SC, Tafel IJ, Dunn IF, Gormley WB. The Neurocritical and Neurosurgical Care of Subdural Hematomas. Neurocrit Care. 2016. 24(2):294-307. doi: 10.1007/s12028-015-0194-x.

Podcast #333: TBI Prognosticators

Author: Michael Hunt, MD

Educational Pearls:

  • Studies have shown that patients with decreasing GCS scores have worse outcomes, however GCS of 4 has worse outcome than GCS 3.
  • Alternative scoring system is the GCS-P score which is GCS score – number of non-reactive pupils.
  • GCS3 50% mortality 70% poor outcome at 6 months; GCS-P of 1 had mortality 74% and poor outcome at about 90% at 6 months.
  • GCS-P score is a better prognostic indicator than GCS score.

 

References:

Han J, et al (2014). External validation of the CRASH and IMPACT prognostic models in severe traumatic brain injury. Journal of Neurotrauma. 31(13):1146-52.

Maas AI, et al. (2007). Prognosis and clinical trial design in traumatic brain injury: the IMPACT study. Journal of Neurotrauma.  24(2):232-8.

The CRASH trial management group, & the CRASH trial collaborators. (2001). The CRASH trial protocol (Corticosteroid randomisation after significant head injury) [ISRCTN74459797]. BMC Emergency Medicine, 1, 1. http://doi.org/10.1186/1471-227X-1-1.

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Podcast #317: Elbow Dislocation

Author: John Winkler, M.D.

Educational Pearls:

-Lower mechanisms of injury have a lower chance of an associated fracture or major ligament injury.

-One major concern is having a fracture fragment in the joint (can lead to chronic arthritic pain).

 -Evaluation should involve checking the neurovascular status of the arm and reduce the fracture as soon as possible. Immobilize arm in a sling and consult orthopedics if there is intra-articular involvement.

References:

https://orthoinfo.aaos.org/en/diseases–conditions/elbow-dislocation/

Mehta, JA; Bain, GI. (2004). Elbow dislocations in adults and children. ?Clinics in Sports Medicine.? 23(4):609-27.

Podcast #294: Rhabdomyolysis

Author: Michael Hunt, M.D.

Educational Pearls

  • Rhabdomyolysis is caused by the destruction of skeletal muscle that leads to the release of myoglobin, which causes renal failure. It presents with pain and weakness in the affected muscle, as well as dark urine.
  • Diagnosis is made with creatinine kinase levels
  • It can happen to extreme athletes after competition, but the most common presentation is in people who fall and are immobilized for long periods of time.
  • Other causes include burns, crush injuries, viral infections (influenza), bacterial infections (Legionella), and medications (statins in adults, propofol in kids)
  • Treatment is aggressive fluids

References: Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis ? an overview for clinicians. Critical Care. 2005;9(2):158-169. doi:10.1186/cc2978.

Podcast #281: Intracranial Hemorrhage Treatment

Podcast #281: Intracranial Hemorrhage Treatment

Author: Don Stader, M.D.

Educational Pearls

  • Types of traumatic bleeds include subdural, epidural, and subarachnoid.
  • Treatment for a traumatic bleed includes maintenance of systolic BP above 120 and seizure prophylaxis with phenytoin.
  • In atraumatic bleeds, treatment should focus on lowering  blood pressure to reduce bleeding.

References: https://www.aliem.com/2017/09/intracranial-hemorrhage-management/

Podcast #278: Subdural Hematomas

Author: Jared Scott, M.D.

Educational Pearls

  • Subdural hematomas can happen in the elderly because of brain atrophy, and can manifest with neurological deficit.
  • Subdural hematomas are caused by rupture of the bridging veins of the brain. This can be caused by trauma, brain atrophy, or possibly by anticoagulant use. They are crescent-shaped on head CT.  
  • Epidural hematomas, in contrast, are caused by rupture of meningeal arteries secondary to trauma. They are usually lens-shaped on head CT.
  • Subdurals are difficult to pick up on head CT because they may be isodense to brain tissue.

References: Management of Recurrent Subdural Hematomas Desai, Virendra R. et al. Neurosurgery Clinics , Volume 28 , Issue 2 , 279 – 286

Podcast #271: Nexus Chest CT Scan Guidelines

Author: Chris Holmes, M.D.

Educational Pearls

  • The nexus chest CT scan rule is based on an 11,000 subject, multicenter study that looked for signs following a trauma that predicted significant findings on subsequent chest CT.
  • Findings that were associated with abnormal chest CT included: abnormal CXR, distracting injury, chest wall, sternal, thoracic spine or scapular tenderness. Furthermore, a mechanism of injury that includes rapid deceleration was also associated.
  • If a patient has none of the above findings, then there is only a small chance that there will be an abnormal chest CT.

References: https://www.mdcalc.com/nexus-chest-ct-decision-instrument-ct-imaging

Podcast #267: Causes of Very High Lactate

Author: Dylan Luyten, M.D.

Educational Pearls

  • Lactate is a byproduct of anaerobic metabolism, a sign of dying tissue. Dangerous causes of high lactates will not normalize with repeat labs.
  • Crush injuries, seizures, bowel necrosis,  end-stage liver disease, and metformin toxicity are common causes of highly elevated lactate.

References: https://lifeinthefastlane.com/ccc/lactic-acidosis/