Regional Injuries

Question 1

Most common type of penetrating chest wound

Answer 1

• left sided anterior chest wall

- directed downward, medially and backwards

Question 2

Possible effects of penetrating injury to lung and pleura

Answer 2

• haemothorax
• pneumothorax
• anoxic anoxia (blood in bronchi and trachea)

Question 3

Mechanism of injury in penetrating lung and pleura injury

Answer 3

Leverage of instrument on fulcrum of a rib during withdrawal may extend wound greatly

Question 4

Complications of penetrating lung and pleural injury

Answer 4

• infection with empyema or bronchopneumonia

- healing with pleural adhesions

Question 5

Possible effects of penetrating injury to heart

Answer 5

• haemopericardium
• haemothorax
• external haemorrhage

Question 6

Causes of death in penetrating injury to heart

Answer 6

• shock
• haemorrhage
• tamponade

Question 7

Complications of penetrating heart injury

Answer 7

• infection

- healing with adhesions and constrictive pericarditis

Question 8

Large vessels at risk in penetrating injury to chest

Answer 8

• superior VC
• pulmonary artery
• aorta

Question 9

Potential result of penetrating injury to oesophagus

Answer 9

Fatal mediastinitis

Question 10

Possible mechanisms of non-penetrating injury to the chest

Answer 10

• rib fractures
• stove-in chest
• sternum fractures

Question 11

How do lung lacerations occur in non-penetrating injury to chest?

Answer 11

• fractured rib-ends

- falls or sudden accel/decel

Question 12

Results/complciations of lung lacerations

Answer 12

• haemothorax
• pneumothorax
• blood in tracheobronchial tree with asphyxia
• interstitial emphysema
• pulmonary infections

Question 13

How do lung contusions happen?

Answer 13

• direct violence
• contre-coup injury (posterior surface)
• pinching in phrenico-costal sinus

Question 14

Types of lung injury in non-penetrating injury

Answer 14

• laceration
• contusion
• tearing off of hilus and bronchi

Question 15

Types of heart injury in non-penetrating injury

Answer 15

• lacerations
• rupture
• contusion

Question 16

How does rupture of the heart occur?

Answer 16

• sudden compression of chest wall

- rapid increase of intra-cardiac pressure (falls/ vehicle over abdomen)

Question 17

How do contusions of the heart occur?

Answer 17

• blow on chest
• falls on projecting objects
• compression in traffic accidents

Question 18

Types of large vessel injury (non-penetrating)

Answer 18

• traumatic asphyxia

- rupture of aorta

Question 19

Complications of chest injuries

Answer 19

• pneumothorax
• haemothorax
• chylothorax
• interstitial emphysema
• cardiac tamponade

Question 20

How much blood in cardiac tamponade usually causes death?

Answer 20

400-500ml

Question 21

Consequences of healing of immediately non-fatal injuries of the heart

Answer 21

• occlusion of coronary arteries with infarction
• myocardial fibrosis with cardiac aneurysm
• disturbances of conduction system
• pericarditis (constrictive)

Question 22

Non-penetrating injuries to abdominal wall

Answer 22

• skin abrasions
• bruises
• haematoma in muscles
• muscle rupture

Question 23

How do non-penetrating injuries to stomach and intestine occur?

Answer 23

• compression
• traction forces
• disruption/bursting

Question 24

Types of non-penetrating injuries to the liver

Answer 24

• transcapsular lacerations
• subcapsular lacerations
• central lacerations

Question 25

Types of non-penetrating injuries to the spleen

Answer 25

- compression (transcapsular/subcapsular) | - traction ( haemorrhage)

Question 26

Complications of non-penetrating injury to pancreas

Answer 26

- profuse haemorrhage | - traumatic pancreatitis

Question 27

Complications of abdominal injuries

Answer 27

- shock - internal haemorrhage - peritonitis - paralytic ileus

Question 28

Complications of penetrating injury to kidneys and adrenal glands

Answer 28

- haemorrhage - sepsis - damage to adrenal glands

Question 29

How to non-penetrating injuries to the kidneys occur?

Answer 29

- direct blow to loin - crushing against lower ribs by forces transmitted through liver - fall from height

Question 30

Pathology seen in non-penetrating injuries to kidneys

Answer 30

- contusions (transcapsular) - lacerations (subcapsular, transrenal) - tears of renal artery - rupture of adrenal gland

Question 31

Complications of penetrating injury to the bladder

Answer 31

- haemorrhage | - extravasation of urine with pelvic cellulitis

Question 32

Causes of non-penetrating injury to bladder

Answer 32

- direct blow to distended bladder | - fractured pelvis

Question 33

General effects of injuries to limbs

Answer 33

- haemorrhage and shock - wound infection - pulmonary embolism - lower nephron necrosis - fat embolism

Question 34

Sources of embolic fat

Answer 34

- bone marrow - plasma fat - depot fat

Question 35

Treatment of fat embolism

Answer 35

- oxygen - hydrocortisone - dextran 40