Spinal injuries
Helen Whitwell, Christopher Milroy, Daniel du Plessis in Forensic Neuropathology, 2021
The symptoms from which a spinal injury victim may complain are, for the most part, restricted to local pain, plus awareness of any loss of motor or sensory function. Signs of underlying skeletal damage may include local bruising, swelling, tenderness or deformity but the capacity to search for such signs may be limited, particularly in the victim of polytrauma. Neurological examination is needed as soon as practically possible. In addition to recording power (Table 16.1), together with sensation and reflexes in the limbs, assessment should include the lower cranial nerves and function in the lower sacral dermatomes, including sacral reflexes.1 Findings should be documented, to provide a baseline from which to measure any subsequent deterioration or improvement. The absence of all motor, sensory and reflex function below the level of injury, soon after injury, may be due to spinal shock. This will resolve within 48 hours and, unless the conus has been damaged, sacral reflexes will then return. If, at this point, there is no voluntary motor or sensory function, the lesion is deemed to be complete. If, on the other hand, even a small amount of voluntary lower limb movement is seen, the individual will very likely recover sufficiently to walk again, given proper treatment. If there is sacral sparing evident at the outset, then the chances of functional recovery are also good.
Basic Principles of Trauma Care
Armstrong Milton B. in Lower extremity Trauma, 2006
Devastating limb injuries may distract the treating team from more life-threatening lesions. In this chapter, we have emphasized the critical importance of adhering to the general algorithm of establishing a definitive airway and maintaining adequate respiratory function and circulation. The recognition that traumatic brain injury accounts for 50% of trauma-related deaths is essential. Secondary hypoxia and, more importantly, hypotensive insults must be avoided. The various diagnostic modalities that help in identifying injuries to the head, chest, abdomen, and pelvis must be utilized in a rapid and efficient manner while observing the patient’s response to resuscitation. Finally, those patients that become hemodynamically unstable or fail to respond to resuscitation belong either in the operating room (intracavitary bleeding) or in the angiography suite (bleeding from a pelvic fracture). In cases of polytrauma with severe lower extremity injuries, the proper treatment strategy must be based upon continuous discussion between the trauma and orthopedic surgeon. This team approach will provide the multiple trauma patient with the best chance for survival.
The neurointensive care and neuromonitoring unit
Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni in Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
The Neuro-ICU provides care to some of the most critically ill patients in a given hospital. These patients require close nursing care and frequent monitoring of their vitals, neurologic exam, and ICP when applicable. Patients may be sedated or comatose, and thus small changes in the exam may be the first sign of an acute decompensation. The CT scan provides fast and reliable imaging of the central nervous system; many Neuro-ICUs have portable scanners that allow for acute imaging in the ICU for patients who are unstable for transport. Patients with polytrauma are often managed by multidisciplinary teams and require constant communication for optimal management. Delirium is a common complication of prolonged ICU stay, and it is important to promote good sleep hygiene, provide frequent orientation, and ensure that patients are allowed to wear glasses and hearing aids when possible.
Burden among caregivers of service members and veterans following traumatic brain injury
Published in Brain Injury, 2018
Tracey A. Brickell, Louis M. French, Sara M. Lippa, Rael T. Lange
Improvised explosive devices (IEDs) have been the weapons of choice for the enemy during the conflicts in Iraq and Afghanistan and the leading cause of death and injury among service members. With advances in protective body armour and helmet design, battlefield medical procedures, and rapid medical evacuation, more service members are surviving injuries than in past conflicts and returning home with numerous concurrent impairments or polytrauma. Polytrauma can consist of multiple physical injuries (e.g. traumatic brain injury (TBI), amputations, burns, fractures, spinal cord injuries, and sensory impairment) and/or mental health comorbidity (e.g. post-traumatic stress disorder (PTSD), depression, and anxiety). Polytrauma can complicate reintegration to civilian and family life and often requires complex treatment and clinical rehabilitation services by a team of multidisciplinary health-care professionals over an extended period of time (1–3).
Utilization of Outpatient Social Work Services Among Veterans with Combat-Related Polytrauma: A Review and Case Analysis
Published in Military Behavioral Health, 2019
David L. Albright, Bruce A. Thyer, Raymond J. Waller
A blast injury is a trauma that results from an explosion. Sources include improvised explosive devices, land mines, roadside bombs, and rocket and mortar shells (DePalma, Burris, Champion, & Hodgson, 2005). Blast sequelae can result in complex, polytrauma injuries. The Veterans Administration (VA) defines polytrauma (PT) as “two or more injuries to physical regions or organ systems, one of which may be life threatening, resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability” (US Department of Veterans Affairs, 2018, polytrauma). Polytrauma injuries can include bone fractures, burns, loss of limbs, posttraumatic stress disorder (PTSD), spinal cord injury, and traumatic brain injury (TBI; Friedemann-Sanchez, Sayer, & Pickett, 2008).
Early changes in cerebral autoregulation among youth hospitalized after sports-related traumatic brain injury
Published in Brain Injury, 2018
Monica S Vavilala, Carly K Farr, Arraya Watanitanon, BS Crystalyn Clark-Bell, Theerada Chandee, Anne Moore, William Armstead
After University of Washington Human Subjects Approval (IRB # 35291), we enrolled youth aged 0–18 years who were admitted to a level one trauma centre with a diagnosis of TBI with an International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for TBI (ICD 800.1–800.4, 800.6–800.9, 850.0–854.9, 801.1–801.4, 801.6–801.9, 803.1–803.4, 803.6–803.9, 804.1–804.4 and 804.6–804.9). This is an ongoing study of cerebral autoregulation among 75 youth hospitalized with all cause TBI which is expected to continue enrolment through the end of calendar year 2017. In this report, we present findings from patients whose mechanism of injury was recorded as sports-related. Patients with polytrauma were included. Eligible patients could be recruited from the Harborview Medical Centre paediatric intensive care unit (ICU) or hospital ward (Seattle, WA). Informed consent for participation was obtained from parent or guardian, and age-appropriate assent was obtained from each patient.
Related Knowledge Centers
- Cervical Vertebrae
- Chest Radiograph
- Vertebra
- Hemothorax
- Pelvis
- Injury
- Injury Severity Score
- Traffic Collision
- Medical Imaging
- CT Scan