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Other Asphyxial Deaths
Published in Sudhir K. Gupta, Forensic Pathology of Asphyxial Deaths, 2022
A 25-year-old man was working under heavy machinery, a portion of which suddenly collapsed over him (Figure 6.54). Rescue attempts were made by his co-workers, but by the time they rushed him to the hospital, he died. Postmortem examination was carried out at AIIMS, New Delhi, and it revealed intense congestion and petechiae over the face, including the bilateral conjunctivae, the neck and the front of upper chest and shoulders (Figure 6.55). The lower line of demarcation was not very clearly identifiable over the trunk, but it reached up to the level of fourth rib. Rib fractures and underlying lung injuries were also present. This was a case of a combination of blunt trauma to chest resulting in hemorrhage along with the compression of chest causing traumatic asphyxia.
Injuries in Children
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Rib fractures are rare in the children, and their presence will be associated with severe underlying chest injury. If they occur in children under 12 months of age, the possibility of NAI needs to be considered as well as osteogenesis imperfecta or rickets. A first rib or posterior rib fracture is highly suspicious of child abuse. If a rib fracture is detected, the emergency physician should be alerted to the possibility of associated injuries such as pneumothorax, haemothorax or major vascular injury. Multiple rib fractures are a marker of severe injury and are associated with high mortality rates. The management of rib fractures is supportive. The goal is to provide oxygenation and pain relief in order to prevent atelectasis and secondary pneumonia.
Thoracic trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Rib fractures are initially suspected on physical examination, but are most commonly diagnosed on chest X-ray (CXR). In children under 3 years of age, rib fractures should raise suspicion of non-accidental injury and appropriate further investigation and management should be instituted. Fractures of the first and second ribs have traditionally been associated with significant thoracic trauma and should also raise suspicion of injury to mediastinal organs, for instance cardiac contusion or major vascular injury.
Predictive factors of nebulized morphine failure in North-African patients with chest trauma: a prospective pilot study
Published in Expert Review of Respiratory Medicine, 2022
Hela Attia, Helmi Ben Saad, Karim Masmoudi, Imen Bannour, Mouna Ouaz, Kais Gardabbou, Ali Majdoub
A VAS score > 7 was a predictor of the nebulized MOR failure. This can be explained by the notion of the mechanism of violence leading to higher VAS in the MOR (-) group. In the latter group, the mean VAS score was 8 with 45% of the patients having VAS at 10. Multiple rib fractures and flail chest are generally associated with high-energy trauma, such as road traffic accidents [28]. Moreover, an increased number of rib fractures is associated with an increase in morbidity [29,30], and correlations between the number of ribs fractured, and injury severity score [29], and mortality [30] were reported. The treatment and follow-up of multiple rib fractures are critical due to their high incidence and their related serious complications [28]. According to the literature, the choice of the analgesic protocol depends on the degree and the intensity of pain [31]. Indeed, a more advanced evaluation of pain intensity should be performed at rest, and during cough and movement.
Development and implementation of a time- and computationally-efficient methodology for reconstructing real-world crashes using finite element modeling to improve crash injury research investigations
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Casey Costa, James P. Gaewsky, Joel D. Stitzel, F. Scott Gayzik, Fang-Chi Hsu, R. Shayn Martin, Anna N. Miller, Ashley A. Weaver
Injury timing accuracy is critical for CIREN case reconstructions. All reconstructions displayed sharp and significant elevations in chest compression during belt loading, followed by sustained or increased chest compression during airbag and steering assembly loading, indicating that the belt was the primary component causing chest deflection. This is expected because shoulder belts are designed to absorb the majority of the occupant energy in a frontal crash and airbags are intentionally designed to absorb the remaining energy surplus (Petitjean et al. 2003). Though the shoulder belt appears to be the primary component causing chest compression, this is not always true for rib fracture. In cases 19 M-RSL, 56 F-R, and 61 F-RSH, rib plastic strain did not develop until the M50-OS model loaded the steering wheel airbag and assembly, indicating that these components may have played a crucial role in generating fracture. The Case 56 F-R BioTab aligns with this finding, but the 19 M-RSL and 61 F-RSH BioTabs, which attribute the shoulder belt as the primary causative component of injury, do not. Therefore, this indicates that it may have been more appropriate to assign equal confidence (and therefore equal contribution) to both the shoulder belt and the airbag for these cases.
Abusive head trauma in India: imaging raises the curtain
Published in International Journal of Injury Control and Safety Promotion, 2022
Hima Pendharkar, Shumyla Jabeen, Nupur Pruthi, K. V. L. N Narasinga Rao, Dhaval Shukla, Nitish Kamble, Kavita V. Jangam, John Vijay Sagar Kommu, Thennarasu Kandavel, Senthil Amudhan
Spinal ligamentous injuries are also known to occur in AHT (Kadom et al., 2014; A. Kemp et al., 2014 ). Additionally, spinal SDH has also been noted in cases of AHT (Choudhary et al., 2012; 2014). In our study, spinal MRI was available in only one child (though not a dedicated study), and CT spine in two of them. As a part of the workup for AHT, ACR recommends a skeletal survey for children suspected of AHT. It is to look for associated injuries such as rib fractures and metaphyseal fractures. Though chest X-rays were available in 29/48 (60.5%) of our patients, a skeletal survey was available in only 7/48 (14.5%) cases. Rib fractures were noted in two cases. As is known, the rib fractures affect the lower thoracic ribs and the most common site of fractures is near the costovertebral junction and along the lateral margin (Shekdar, 2016). Rib fractures have very high specificity for abusive trauma and are often the key to diagnosing AHT. One of our case had a tibial shaft fracture and another child had a radial fracture.