Color Atlas of Emergency Trauma

329 Pages·2011·33.77 MB·English

by  Demetrios Demetriades

Color Atlas of Emergency Trauma
second edition

COLOR ATLAS OF
EMERGENCY TRAUMA
SECOND EDITION
Edited by
Demetrios Demetriades, MD, PhD, FACS
ProfessorofSurgery,UniversityofSouthernCalifornia’sKeckSchoolofMedicine,and
Vice-ChairmanofSurgeryandDirectoroftheTraumaProgramandSurgicalIntensive
CareUnitattheLosAngelesCounty–USCMedicalCenter
Edward J. Newton, MD, FACEP, FRCPC
ProfessorandChairmanofEmergencyMedicine,UniversityofSouthernCalifornia’s
KeckSchoolofMedicine,andChairmanoftheLosAngelesCounty–USCMedical
Center’sDepartmentofEmergencyMedicine
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Firstpublished2011
PrintedintheUnitedKingdomattheUniversityPress,Cambridge
AcataloguerecordforthispublicationisavailablefromtheBritishLibrary
LibraryofCongressCataloging-in-PublicationData
Demetriades,Demetrios,1951–
Coloratlasofemergencytrauma/DemetriosDemetriades,EdwardJ.Newton.–2nded.
p. cm.
Rev.ed.of:Coloratlasofemergencytrauma/DikuP.Mandavia,EdwardJ.Newton,DemetriosDemetriades.2003.
Includesbibliographicalreferencesandindex.
ISBN978-1-107-00152-7(Hardback)
1. Medicalemergencies–Atlases. 2. Emergencymedicalservices–Atlases. 3. Woundsandinjuries–Atlases. I. Newton,Edward,
1950– II. Mandavia,DikuP.,1965–Coloratlasofemergencytrauma. III. Title.
[DNLM: 1. WoundsandInjuries–Atlases. 2. Emergencies–Atlases. WO517]
RC86.7.M34782011
616.02050222–dc22 2011013009
ISBN978-1-107-00152-7Hardback
CambridgeUniversityPresshasnoresponsibilityforthepersistenceoraccuracyofURLsforexternalorthird-partyinternetwebsites
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Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformationwhichisinaccordwithaccepted
standardsandpracticeatthetimeofpublication.Althoughcasehistoriesaredrawnfromactualcases,everyefforthasbeenmadeto
disguisetheidentitiesoftheindividualsinvolved.Nevertheless,theauthors,editors,andpublisherscanmakenowarrantiesthatthe
informationcontainedhereinistotallyfreefromerror,notleastbecauseclinicalstandardsareconstantlychangingthroughresearchand
regulation.Theauthors,editors,andpublishersthereforedisclaimallliabilityfordirectorconsequentialdamagesresultingfromtheuseof
materialcontainedinthisbook.Readersarestronglyadvisedtopaycarefulattentiontoinformationprovidedbythemanufacturerofany
drugsorequipmentthattheyplantouse.
Dedicated with thanks to my family and colleagues. To my students of
trauma and emergency care, may the collected experience contained in
this atlas assist your pursuit of excellence.
E. Newton
To my parents, my wife Elizabeth, my daughters Alexis and Stefanie,
and my son Nicky.
D. Demetriades

Contents
List of contributors x
Foreword by David B. Hoyt and Sandra M. Schneider xi
Preface xiii
Acknowledgments xiv
1 3
HEAD INJURY 1 NECK INJURY 50
DemetriosDemetriadesandLeslie DemetriosDemetriadesandLydiaLam
Kobayashi Penetrating Neck Injuries 52
1.1 Scalp Injuries 4 3.1 Anatomical Zones of the Neck 52
1.2 Skull Fractures 4 3.2 Epidemiology of Penetrating Neck
1.3 Intracranial Hematomas 11 Trauma 54
1.4 Penetrating Head Injury 20 3.3 Physical Examination of Penetrating Injuries
1.5 Transtentorial Herniation 24 of the Neck 54
1.6 Diffuse Cerebral Edema 26 3.4 Protocol for Initial Evaluation and
1.7 Pediatric Head Injury 27 Management of Penetrating Injuries to the
1.8 Diffuse Axonal Injury 28 Neck 56
3.5 Radiological Investigations for Penetrating
Neck Trauma 57
3.6 Evaluation of the Vascular Structures in the
2
FACIAL INJURY 30
Neck 59
EdwardJ.Newton 3.7 Evaluation of the Aerodigestive Tract in the
2.1 Eye Injuries 33
Neck 63
2.2 Periorbital Lacerations 37
3.8 Airway Establishment in the Presence of a
2.3 Facial Fractures 37
Neck Hematoma 65
2.4 Nasal Injuries 42
3.9 Bleeding Control in the Emergency
2.5 Penetrating Facial Trauma 42
Department 66
2.6 Complex Oromaxillofacial
3.10 Penetrating Trauma to the Carotid
Trauma 44
Artery 68
2.7 Facial Nerve Injury 47
3.11 Penetrating Trauma to the Vertebral
2.8 Parotid Gland Injury 48
Artery 69
vii
3.12 Penetrating Trauma to the Subclavian 5.16 Penetrating Splenic Injuries 149
Vessels 70 5.17 Penetrating Pancreatic Injuries 150
Blunt Neck Trauma 71 5.18 Penetrating Renal Injuries 150
3.13 Vascular Injuries 72 5.19 Penetrating Colorectal Injuries 152
3.14 Blunt Laryngotracheal Trauma 74 5.20 Abdominal Vascular Injuries 153
5.21 Abdominal Trauma in Pregnancy 154
4
THORACIC INJURY 75
6
MUSCULOSKELETAL INJURY 160
DemetriosDemetriadesandPeepTalving
4.1 Chest Wall, Soft Tissues 78 EdwardJ.Newton
4.2 Rib Fractures 78 6.1 Classification of Fractures 161
4.3 Hemo-Pneumothorax 81 6.2 Open Fractures 162
4.4 Lung Contusion 89 6.3 Mangled Extremity 163
4.5 Subcutaneous Emphysema 90 6.4 Open Joint Injury 164
4.6 Penetrating Cardiac Injury 92 6.5 Epiphyseal Injuries 165
4.7 Blunt Cardiac Trauma 100 6.6 Torus and Greenstick Fractures 166
4.8 Blunt Thoracic Aortic Injury 101 6.7 Supracondylar Fracture 167
4.9 Penetrating Thoracic Outlet Injuries 105 6.8 Amputations 168
4.10 Transmediastinal Gunshot Wounds 107 6.9 Tendon Injury 170
4.11 Diaphragmatic Injuries 109 6.10 Peripheral Vascular Injury 170
4.12 Esophageal Injuries 114 6.11 Peripheral Nerve Injury 174
4.13 Thoracic Duct Injury 116 6.12 Metacarpal Fractures 177
4.14 Traumatic Asphyxia 117 6.13 Scaphoid Fractures 178
4.15 Impaled Thoracic Foreign Bodies 118 6.14 Scapholunate Dislocation 179
6.15 Lunate and Perilunate Dislocation 179
6.16 Wrist Fractures 180
6.17 Forearm Fractures 181
5 ABDOMINAL INJURY 119 6.18 Elbow Dislocation 183
6.19 Radial Head Fracture 183
DemetriosDemetriadesandKenjiInaba
6.20 Humeral Fracture 184
Blunt Abdominal Trauma 122
6.21 Shoulder Dislocation 185
5.1 Mechanism of Injury 122
6.22 Clavicle Fracture 187
5.2 Diagnosis of Hemoperitoneum 123
6.23 Sternoclavicular Dislocation 188
5.3 Splenic Injuries 125
6.24 Scapula Fracture 188
5.4 Liver Injuries 127
6.25 Pelvic Fractures 189
5.5 Pancreatic Injuries 131
6.26 Hip Dislocation 193
5.6 Renal Injuries 133
6.27 Hip Fractures 195
5.7 Bladder Injuries 135
6.28 Femoral Shaft Fracture 196
5.8 Urethral Injuries 137
6.29 Patellar Fracture 197
5.9 Duodenal Injuries 139
6.30 Tibial Plateau Fracture 198
5.10 Small-Bowel Injuries 140
6.31 Knee Dislocation 198
5.11 Colorectal Injuries 141
6.32 Maisonneuve Fracture Complex 200
Penetrating Abdominal Trauma 142
6.33 Ankle Dislocation 201
5.12 Mechanism of Injury 142
6.34 Subtalar Dislocation 202
5.13 Investigations in Penetrating Abdominal
6.35 Lisfranc Fracture 203
Injury 144
6.36 Metatarsal Base Fractures 204
5.14 Transpelvic Gunshot Injuries 145
6.37 Calcaneal Fractures 205
5.15 Penetrating Injuries to the Liver 146
viii Contents
8.4 Fourth-Degree Burn 262
7
SPINAL INJURIES 207
Special Considerations of Burn Injury 263
MarkJ.SpoonamoreandDemetrios 8.5 Inhalation Injury 263
Demetriades 8.6 Abdominal Compartment Syndrome 264
Spinal Cord Injuries 211 8.7 Circumferential Burn 265
7.1 Complete Spinal Cord Transection 211 8.8 Scald Burns 266
7.2 Central Cord Syndrome 213 8.9 Chemical Burns 267
7.3 Brown-Se´quard Syndrome 215 8.10 Electrical Burns 268
7.4 Anterior Cord Syndrome 216 8.11 Outcome of Burn Injury 269
Upper Cervical Spine Dislocations 216
7.5 Atlanto-Occipital Dislocation 217
7.6 Atlantoaxial Dislocation 218
9
SOFT TISSUE INJURIES 271
7.7 Rotatory Subluxation of C-1 on C-2 219
7.8 Ligamentous Injuries 220 DemetriosDemetriadesandMarkoBukur
9.1 Dog Bite Injury 273
Cervical Spine Fractures 222
9.2 Cat Bite Injury 275
7.9 C-1 Burst Fracture (Jefferson Fracture) 222
9.3 Human Bite Injury 276
7.10 Odontoid (Dens) Fractures (C-2) 224
9.4 High-Pressure Injection Injury 278
7.11 Hangman’s Fracture (C-2) 226
9.5 Retained Foreign Body 279
7.12 Fractures of the Lower Cervical Spine
9.6 Extremity Compartment Syndrome 280
(C-3–C-7) 228
7.13 FlexionandExtensionTeardropFracture 229
7.14 Compression or Burst Fracture of the
Vertebral Body 231 10
BALLISTICS 284
7.15 Clay Shoveler’s Fracture 232
RamonCestero,DavidPlurad,andDemetrios
7.16 Fractures of the Pedicles, Laminae, and
Demetriades
Lateral Masses 233
10.1 Definitions 284
7.17 Facet Dislocation 234
10.2 Low-Velocity Projectiles 286
7.18 Cervicothoracic Spinal Injury 237
10.3 High-Velocity Projectiles 288
Thoracic Spine Injuries 239
10.4 Shotgun Injuries 291
Lumbar Spine Injuries 242 10.5 Blast Injuries 295
7.19 Lumbar Compression Burst Fractures 242 10.6 Nonlethal Weapons 299
7.20 Chance Fractures 245 10.7 Myths and Facts about Bullets 300
7.21 Fracture-DislocationoftheLumbarSpine 247
Pediatric Spinal Injury 248
PenetratingInjuriestotheSpinalCord 250 11
DISASTER MEDICINE 301
EdwardJ.Newton
11.1 Epidemiology of Injuries in Mass
8 Disasters 301
BURN INJURIES 253
11.2 Triage 302
AndrewTang,CharityWip,WarrenGarner,
11.3 Specific Injuries 304
andDemetriosDemetriades
11.4 Guidelines for Rescue Efforts 306
Extent of Burn Injury 256
8.1 First-Degree Burn 256
8.2 Second-Degree Burn 257
Index 308
8.3 Third-Degree Burn 261
Contents ix