Cervical Spine Injury

Cervical Spine Injury

 

Philadelphia collar



Philadelphia collar

When there are Abrasions and Lacerations on Forehead, specifically  look for the Cervical Spine Injury.

Cervical Spine Injury is suspected when there is

•      Tenderness over cervical spine

•       Step Deformity of the spine on palpation

•      Paresthesia of hands

•      Weakness of Upper / Lower limb

 

When cervical spine injury is suspected specific care must be given for the stability of the spine.

Atleast three persons must be there to shift the patient just like lifting a log of wood.

The patient with spine injury must be transported on a Hard Stretcher or a Hard Platform or  a Spine Board.

Philadelphia collar  is the ideal mode of immobilization of Cervical Spine.

                                                               
                                                                         Courtesy: Trisurge2013

Dos and Don’ts in Head Injury

Dos and Don’ts in Head Injury

Impacted foreign body-Head and Neck

Impacted foreign body-Head

  

Decompressive Craniotomy

Dos and Don’ts in Head Injury

ž External Bleeding-Pressure Bandage

ž Internal Bleeding or CSF Leak-Do not try to stop

ž Head to be Tilted to one side- To avoid Aspiration

ž Do not pull out an impacted foreign body-At the site of the Event!

Classification of Brain Injury -Primary and Secondary

Primary brain injury -Injury caused at the time of impact- acute neuronal damage & cell death---directly due to      traumatic force-and is irreversible in nature.

  Examples:-

       Cerebral concussion ( No anatomical damage)

       Cerebral contusion ( Both anatomical & Functional damage)

       Laceration

       Diffuse axonal injury

Secondary brain injury  -occurring anytime after the primary impact and it is preventable from of head injury.

     Causes of secondary brain injury

      ■ Hypoxia: PO2 < 8 kPa

      ■ Hypotension: systolic blood pressure (SBP) < 90 mmHg

      ■ Raised intracranial pressure (ICP): > 20 mmHg

      ■ Low cerebral perfusion pressure (CPP): < 65 mmHg

      ■ Pyrexia

      ■ Seizures

      ■ Metabolic disturbance

Clinical situations in Trauma

Situation 1.

  HYPERTENSION + BRADYCARDIA= HEAD INJURY

Situation 2.

  HYPOTENSION +BRADYCARDIA=  SPINAL  INJURY

Situation 3.

  HYPOTENSION +TACHYCARDIA= HYPO VOLUMEA

  Suspect - Thoracic/Abdominal-injury/Poly trauma

Situation 4.            

  HYPERTENSION +TACHYCARDIA= STRESS/ HYPOXIA

           

 

Differential Diagnosis of Obstructive Jaundice

Differential Diagnosis of Obstructive Jaundice

Possibility 1.

Painless progressive Jaundice with Palpable Gall Bladder- Cause is Carcinoma Head of Pancreas.

Possibility 2.

Painless waxing and waning type of Jaundice with or without Palpable Gall Bladder-Peri Ampullary Carcinoma Pancreas.

Possibility 3.

Intermittent Jaundice and Pain ( Charcot’s Triad) with no palpable Gall Bladder- Obstructive Jaundice due to Cholelithiasis.

Possibility 4.

Jaundice and Pain with Palpable Gall Bladder-Double Impaction of Stone.

( Exception to Courvoisier's law)

Possibility 5.

Painless Progressive Jaundice with No palpable Gall Bladder -Cause is Klatskin’s Tumour.

What is London Sign ?

London Sign  


Patterned Abrasion of Tyre Mark: Left Flank

 

Patterned Abrasion of Tyre Mark: Left Flank

London sign is the Patterned Abrasion seen in Trauma. The importance of London Sign is that such patients may have underlying solid organ injury. Hence such patients should be closely monitored and evaluated using an Ultra Sound Scan or a CT Scan of the Abdomen.

The parameters used for monitoring include:-

1. Pulse rate
2. Blood Pressure
3. Respiratory Rate
4. Temperature
5. Abdominal Girth Measurement
6. Abdominal Rigidity
7. Hemoglobin
8. PCV

What is Incision of Indecision?

 Incision of Indecision

Mid midline incision / Incision of Indecision



Mid midline incision / Incision of Indecision



Incision of Indecision :-When  the cause of Acute Abdomen is not clear, in an Emergency set up, the Abdominal cavity is opened by a Mid Midline Incision. Mid midline incision means Midline Incision centering the Umbilicus.

Depending on the necessity the Incision can be extended upwards or down wards.

For example, if the pathology is Acute Appendicitis or Meckel’s Diverticulitis, the Mid midline incision is extended downwards to deal with the particular pathology.

If the pathology is a Perforated Duodenal Ulcer the Mid midline incision is extended upwards to do the definitive repair of the perforation.

A Mid midline incision is otherwise known as Incision of Indecision.

Mobile Phone Burns

Mobile Phone Burns

             Mobile Phone Burns

             Mobile Phone Burns

A new type burns has been added to the causes of Burns. It is the Mobile Phone Burns. Nowadays it  is not uncommon that the mobile phone can get heated up by its own. The commonest region among the  reported cases of Mobile Phone Burns, is the left upper chest – the site of shirt pocket.

NB:- If your mobile gets heated up by its own the immediate step you should do is to remove the mobile phone battery.

First Aid:

Pour clean cold water to the burnt area.

Never try to peel off the burnt cloth at the site of event.

Never try to rupture the Blebs before reaching the hospital.

Treatment:

• Tetanus Toxoid Injection
• Local Antiseptic Cream- Silver Sulpha Diazine
• Closed wound dressing
• Analgesic agents
• Systemic Antibiotics in high risk patients such as Diabetics

                                                                 Courtesy: Madurai CME 2012

What is Indian Saree Cancer ?

 Indian Saree Cancer

Hyper Pigmentation Seen Around the Waist Due to Saree Tying

Indian Saree Cancer - Squamous Cell Carcinoma

Saree Cancer is seen typically in Indian women. It is due to the tight wearing of Saree which produces chronic irritation of the skin at the site of tying the saree to waist region of the body.

First manifestation of constant irritation is hyper pigmentation along the line of contact of saree tie around the waist. Later it can result  in ulceration.

Non healing ulcer in such site must be biopsied. The malignancy associated is called Indian Saree Cancer.  Histopathologically  Saree Cancer is a type of Squamous Cell Carcinoma.

Treatment of Saree Cancer is Wide Local Excision under proper anesthesia.

                                                           Courtesy: Madurai CME 2011