W1 Student assignment - Shock and truncal injuries
Presenting symptom: Shock
Traumatic aortic Tension Liver rupture Spleen rupture + Type C pelvic T12 spine fracture +
rupture Pneumothorax pneumothorax fracture + bladder pancreas injury
(contained) rupture
Patho- Ligamentum arteriosum Valve damage to lungs Damage to liver with Penetrating trauma of Unstable vertical Fracture of T12 and
physiology slowing down part of causing air to move bleeding into liver left side of body. shear injury: posterior pancreas injury.
aorta. into pleural space but capsule or into and anterior fracture, Bone fragments from
not out. abdomen. with rupture of vertebra might
ligaments. damage pancreas.
Penetration of (full)
bladder.
Tests X-ray: widened Clinical FAST: free fluid FAST: Free fluid X-ray pelvis: fracture FAST: normal in ⅓ of
mediastinum X-ray: blackened area, Lab: abnormal liver (acute) (→ FAST: free fluid cases.
CT: bleeding shifted mediastinum values diagnostic Catheter: no urine CT scan
BP: different right and (away from tension) laparotomy) or output. X-ray: spinal fracture.
left arm. subcapsular
hematoma
(delayed).
If hemodynamically
stable: contrast CT
Signs and Tearing chest pain, loss Dyspnoea, cyanosis Ecchymosis on right LUQ pain, dyspnea, Legs in odd position, Deep abdominal
symptoms of consciousness. No breath sounds on chest, referred pain to left shoulder pain. haematoma, reduced pain, fever, vomiting,
Low BP, high HR affected side. right shoulder, range of motion, unexplained
Decreased chest abdominal guarding unequal leg length. hypotension. Signs of
movements. Increased Urethral damage. spinal cord damage:
JVP. impaired sensation
and movement.
Accident Fast deceleration (high Penetrating trauma Any velocity trauma Lateral falls, any Motorcycle accident Motor vehicle
, history velocity car crash, fall (e.g. by broken rib) Steering wheel velocity (blunt) (high energy), collisions, falls from
from heights), blunt Any velocity blunt Penetration by broken trauma, penetration standing fall from great heights, force
trauma, penetrating trauma rib by broken rib, heights. into middle of
trauma explosions. abdomen (steering
wheel)
Medical Beta-blockers, - Alcoholism (increases Beta-blockers, Beta-blockers, -
history (that anticoagulation, likelihood and changes anticoagulation, anticoagulation,
influences antiplatelet liver values), antiplatelet. antiplatelet
diagnosis) antiplatelet,
anticoagulation
Shock Yes Yes Yes Yes Yes Yes
Hypovolemic shock Obstructive shock Hypovolemic shock Hypovolemic shock Hypovolemic shock Hypovolemic/
Neurogenic shock
Typical onset Prior hypertensive Patient on mechanical Broken rib damages Splenic rupture may Pelvic fractures may Fall from great
patient with chest pain ventilator or blunt liver or stab wounds to present late. go unnoticed. Think height.
trauma. right flank. of them in patients
who remain
hypotensive despite
fluids and stopping
other bleedings.
Treatment Clamp & sew, bypass Stab with hollow Packing of liver to stop Drain with chest tube Pelvic binder with ?
or endovascular needle in the second the bleeding. and consider later surgery.
surgery. intercostal space. splenectomy.
Vertebral fractures:
● Stable: structural stability, no neurological damage.
● Unstable: spine moves as two or more independent units, may result in neurological damage.
○ Dorsal spine injury (vertebral arches, processes and ligaments) is always unstable and has a high risk of spinal cord injury.
Types of vertebral fractures:
● Vertebral compression fracture: due to axial force with flexion. Most common type. Loss of vertebral height. Usually stable.
○ Wedge compression fracture: subtype. Loss of height is worse on one side of vertebra than on other.
● Burst fracture: due to compression trauma with axial loading. Fracture of vertebra in multiple locations. Bone fragments might enter the spinal canal.
Presenting symptom: Shock
Traumatic aortic Tension Liver rupture Spleen rupture + Type C pelvic T12 spine fracture +
rupture Pneumothorax pneumothorax fracture + bladder pancreas injury
(contained) rupture
Patho- Ligamentum arteriosum Valve damage to lungs Damage to liver with Penetrating trauma of Unstable vertical Fracture of T12 and
physiology slowing down part of causing air to move bleeding into liver left side of body. shear injury: posterior pancreas injury.
aorta. into pleural space but capsule or into and anterior fracture, Bone fragments from
not out. abdomen. with rupture of vertebra might
ligaments. damage pancreas.
Penetration of (full)
bladder.
Tests X-ray: widened Clinical FAST: free fluid FAST: Free fluid X-ray pelvis: fracture FAST: normal in ⅓ of
mediastinum X-ray: blackened area, Lab: abnormal liver (acute) (→ FAST: free fluid cases.
CT: bleeding shifted mediastinum values diagnostic Catheter: no urine CT scan
BP: different right and (away from tension) laparotomy) or output. X-ray: spinal fracture.
left arm. subcapsular
hematoma
(delayed).
If hemodynamically
stable: contrast CT
Signs and Tearing chest pain, loss Dyspnoea, cyanosis Ecchymosis on right LUQ pain, dyspnea, Legs in odd position, Deep abdominal
symptoms of consciousness. No breath sounds on chest, referred pain to left shoulder pain. haematoma, reduced pain, fever, vomiting,
Low BP, high HR affected side. right shoulder, range of motion, unexplained
Decreased chest abdominal guarding unequal leg length. hypotension. Signs of
movements. Increased Urethral damage. spinal cord damage:
JVP. impaired sensation
and movement.
Accident Fast deceleration (high Penetrating trauma Any velocity trauma Lateral falls, any Motorcycle accident Motor vehicle
, history velocity car crash, fall (e.g. by broken rib) Steering wheel velocity (blunt) (high energy), collisions, falls from
from heights), blunt Any velocity blunt Penetration by broken trauma, penetration standing fall from great heights, force
trauma, penetrating trauma rib by broken rib, heights. into middle of
trauma explosions. abdomen (steering
wheel)
Medical Beta-blockers, - Alcoholism (increases Beta-blockers, Beta-blockers, -
history (that anticoagulation, likelihood and changes anticoagulation, anticoagulation,
influences antiplatelet liver values), antiplatelet. antiplatelet
diagnosis) antiplatelet,
anticoagulation
Shock Yes Yes Yes Yes Yes Yes
Hypovolemic shock Obstructive shock Hypovolemic shock Hypovolemic shock Hypovolemic shock Hypovolemic/
Neurogenic shock
Typical onset Prior hypertensive Patient on mechanical Broken rib damages Splenic rupture may Pelvic fractures may Fall from great
patient with chest pain ventilator or blunt liver or stab wounds to present late. go unnoticed. Think height.
trauma. right flank. of them in patients
who remain
hypotensive despite
fluids and stopping
other bleedings.
Treatment Clamp & sew, bypass Stab with hollow Packing of liver to stop Drain with chest tube Pelvic binder with ?
or endovascular needle in the second the bleeding. and consider later surgery.
surgery. intercostal space. splenectomy.
Vertebral fractures:
● Stable: structural stability, no neurological damage.
● Unstable: spine moves as two or more independent units, may result in neurological damage.
○ Dorsal spine injury (vertebral arches, processes and ligaments) is always unstable and has a high risk of spinal cord injury.
Types of vertebral fractures:
● Vertebral compression fracture: due to axial force with flexion. Most common type. Loss of vertebral height. Usually stable.
○ Wedge compression fracture: subtype. Loss of height is worse on one side of vertebra than on other.
● Burst fracture: due to compression trauma with axial loading. Fracture of vertebra in multiple locations. Bone fragments might enter the spinal canal.
