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Injuries; Poisoning

Approach to the Trauma Patient
- Approach to the Trauma Patient
Abdominal Trauma
Altitude Diseases
- Altitude Diseases
Bites and Stings
Burns
- Burns
Cold Injury
Drowning
- Drowning
Electrical and Lightning Injuries
- Electrical Injuries
- Lightning Injuries
Eye Trauma
Facial Trauma
Fractures, Dislocations, and Sprains
Genitourinary Tract Trauma

Heat Illness
Injury During Diving or Work in Compressed Air
Lacerations and Abrasions
- Lacerations
- Abrasions
  - Treatment
Mass Casualty Weapons
Motion Sickness
- Motion Sickness
Poisoning
Radiation Exposure and Contamination
- Radiation Exposure and Contamination
Spinal Trauma
- Spinal Trauma
- Spinal Cord Injury in Children
  - Diagnosis
  - Treatment
Sports Injury
Thoracic Trauma
Traumatic Brain Injury (TBI)
- Traumatic Brain Injury
- Sports-Related Concussion

Unintentional injuries are among the top causes of death worldwide. Calling such injuries “accidents” implies that they are random events about which nothing can be done. In reality, many unintentional injuries result from factors that are both predictable and preventable. This section covers many organ system-related injuries (for example, traumatic brain injury, injuries to the eye, face, genitourinary tract, and spine). Also included are such specific injuries as fractures, burns, electrical and lightning injuries, hypothermia and other cold-related injuries, snake bites, and insect stings, as well as poisoning.

Injuries; PoisoningSections (A-Z)

Abdominal Trauma

(See also Approach to the Trauma Patient .)

Overview of Abdominal Trauma
Hepatic Injury
Splenic Injury

Altitude Diseases

Altitude diseases (AD) are caused by the decreased availability of O 2 at high altitudes. Acute mountain sickness (AMS), the mildest form of AD, is characterized by headache plus one or more systemic manifestations; it may occur in recreational hikers and skiers and others traveling to high altitude. High-altitude cerebral edema (HACE) is encephalopathy in people with AMS. High-altitude pulmonary edema (HAPE) is a form of noncardiogenic pulmonary edema causing severe dyspnea and hypoxemia. Diagnosis is clinical. Treatment of mild AMS is with analgesics and acetazolamide. Severe AMS may require descent and supplemental O 2 if available. Both HACE and HAPE are potentially life-threatening and require immediate descent. In addition, dexamethasone may be useful for HACE, and nifedipine or phosphodiesterase inhibitors may be useful for HAPE. Prevention of AMS is by gradual ascent and use of acetazolamide.

Altitude Diseases

Approach to the Trauma Patient

Injury is the number one cause of death for people aged 1 to 44. In the US, there were 199,756 trauma deaths in 2014, about two thirds being accidental. Of intentional injury deaths, more than 70% were due to self-harm. In addition to deaths, injury results in about 41 million emergency department visits and 2.3 million hospital admissions annually.

Approach to the Trauma Patient

Bites and Stings

Some larger centipedes can inflict a painful bite, causing swelling and redness. Symptoms rarely persist for more than 48 h. Millipedes do not bite but may secrete a toxin that is irritating, particularly when accidentally rubbed into the eye.

Centipede and Millipede Bites
Human and Mammal Bites
Insect Stings
Puss Moth Caterpillar (Asp) Stings
Overview of Marine Bites and Stings
Cnidaria (Coelenterates , such as Jellyfish and Sea Anemones ) Stings
Mollusk Stings
Sea Urchin Stings
Stingray Stings
Mite Bites
Scorpion Stings
Snakebites
Alligator, Crocodile, Iguana, and Venomous Lizard Bites
Spider Bites
Tick Bites
Tick Paralysis
Other Arthropod Bites

Burns

(See also Ocular Burns and Caustic Ingestion .)

Burns

Cold Injury

Exposure to cold may cause decreased body temperature ( hypothermia ) and focal soft-tissue injury.

Overview of Cold Injury
Frostbite
Hypothermia
Nonfreezing Tissue Injuries

Drowning

Drowning is respiratory impairment resulting from submersion in a liquid medium. It can be nonfatal (previously called near drowning) or fatal. Drowning results in hypoxia, which can damage multiple organs, including the lungs and brain. Treatment is supportive, including reversal of respiratory arrest and cardiac arrest, hypoxia, hypoventilation, and hypothermia.

Drowning

Electrical and Lightning Injuries

Electrical injury is damage caused by generated electrical current passing through the body. Symptoms range from skin burns, damage to internal organs and other soft tissues to cardiac arrhythmias and respiratory arrest. Diagnosis is based on history, clinical criteria, and selective laboratory testing. Treatment is supportive, with aggressive care for severe injuries.

Electrical Injuries
Lightning Injuries

Eye Trauma

(See also Retinal Detachment .)

Overview of Eye Trauma
Ocular Burns
Corneal Abrasions and Foreign Bodies
Eye Contusions and Lacerations
Posttraumatic Iridocyclitis

Facial Trauma

Trauma to the external ear may result in hematoma, laceration, avulsion, or fracture.

External Ear Trauma
Fractures of the Mandible and Midface
Fractures of the Nose
Temporal Bone Fractures

Fractures, Dislocations, and Sprains

Musculoskeletal injuries include

Overview of Fractures, Dislocations, and Sprains
Pediatric Physeal (Growth Plate) Fractures
Clavicle Fractures
Proximal Humeral Fractures
Distal Humeral Fractures
Radial Head Fractures
Distal Radius Fractures
Scaphoid (Navicular) Fractures
Metacarpal Neck Fractures (Except Thumb)
Fingertip Fractures
Vertebral Compression Fractures
Pelvic Fractures
Hip Fractures
Femoral Shaft Fractures
Ankle Fractures
Calcaneal Fractures
Fracture-Dislocation of the Midfoot (Lisfranc Injury)
Fractures of the 5th Metatarsal Bone
Toe Fractures
Compartment Syndrome
Shoulder Dislocation
Elbow Dislocations
Radial Head Subluxations
Perilunate and Lunate Dislocations
Finger Dislocations
Hip Dislocations
Knee (Tibiofemoral) Dislocations
Patellar Dislocations
Acromioclavicular Joint Sprains
Ulnar Collateral Ligament Sprains
Mallet Finger
Knee Extensor Mechanism Injuries
Ankle Sprains
Achilles Tendon Tears
Knee Sprains and Meniscal Injuries

Genitourinary Tract Trauma

External bladder injuries are caused by either blunt or penetrating trauma to the lower abdomen, pelvis, or perineum. Blunt trauma is the more common mechanism, usually by a sudden deceleration, such as in a high-speed motor vehicle crash or fall, or from an external blow to the lower abdomen. The most frequently accompanying injury is a pelvic fracture , occurring in > 95% of bladder ruptures caused by blunt trauma. Other concomitant injuries include long bone fractures and CNS and chest injuries. Penetrating injuries, most often gunshot wounds, account for

Bladder Trauma
Genital Trauma
Renal Trauma
Ureteral Trauma
Urethral Trauma

Heat Illness

Heat illness encompasses a number of disorders ranging in severity from muscle cramps and heat exhaustion to heatstroke (which is a life-threatening emergency). Heat illness, although preventable, affects thousands of people each year in the US and can be fatal; it is the second leading cause of death in young athletes. When heatstroke is not treated promptly and effectively, mortality approaches 80%.

Overview of Heat Illness
Heat Cramps
Heat Exhaustion
Heatstroke
Malignant Hyperthermia
Neuroleptic Malignant Syndrome
Serotonin Syndrome

Injury During Diving or Work in Compressed Air

More than 1000 diving-related injuries occur annually in the US; > 10% are fatal. Similar injuries can befall workers in tunnels or caissons (watertight retaining structures used for construction), in which pressurized air is used to exclude water from work sites.

Overview of Diving Injuries
Barotrauma
Ear and Sinus Barotrauma
Pulmonary Barotrauma
Gastrointestinal Barotrauma
Dental, Mask, and Eye Barotrauma
Arterial Gas Embolism
Immersion Pulmonary Edema
Decompression Sickness
Gas Toxicity During Diving
Recompression Therapy
Diving Precautions and Prevention of Diving Injuries

Lacerations and Abrasions

Care of lacerations

Lacerations
Abrasions

Mass Casualty Weapons

Mass casualty incidents (MCIs) are events that generate sufficiently high numbers of casualties to overwhelm available medical resources. They include natural disasters (eg, hurricanes) and several types of intentional and unintentional man-made events, including transportation disasters, releases of dangerous substances, explosions, and mass shootings.

Overview of Incidents Involving Mass Casualty Weapons
Chemical Warfare Agents
Toxins as Mass-Casualty Weapons
Biological Agents as Weapons
Radiological Weapons
Explosives and Blast Injuries

Motion Sickness

Motion sickness is a symptom complex that usually includes nausea, often accompanied by vague abdominal discomfort, vomiting, dizziness, pallor, diaphoresis, and related symptoms. It is induced by specific forms of motion, particularly repetitive angular and linear acceleration and deceleration, or as a result of conflicting vestibular, visual, and proprioceptive inputs. Behavioral change and drug therapy can help prevent or control symptoms.

Motion Sickness

Poisoning

Poisoning is contact with a substance that results in toxicity. Symptoms vary, but certain common syndromes may suggest particular classes of poisons. Diagnosis is primarily clinical, but for some poisonings, blood and urine tests can help. Treatment is supportive for most poisonings; specific antidotes are necessary for a few. Prevention includes labeling drug containers clearly and keeping poisons out of the reach of children.

General Principles of Poisoning
Acetaminophen Poisoning
Aspirin and Other Salicylate Poisoning
Carbon Monoxide Poisoning
Caustic Ingestion
Mushroom Poisoning
Plant Poisoning
Fish Poisoning and Shellfish Poisoning
Hydrocarbon Poisoning
Organophosphate Poisoning and Carbamate Poisoning
Iron Poisoning
Lead Poisoning
Specific Poisons

Radiation Exposure and Contamination

Ionizing radiation injures tissues variably, depending on factors such as radiation dose, rate of exposure, type of radiation, and part of the body exposed. Symptoms may be local (eg, burns) or systemic (eg, acute radiation sickness). Diagnosis is by history of exposure, symptoms and signs, and sometimes use of radiation detection equipment to localize and identify radionuclide contamination. Management focuses on associated traumatic injuries, decontamination, supportive measures, and minimizing exposure of health care workers. Patients with severe acute radiation sickness receive reverse isolation and bone marrow support. Patients internally contaminated with certain specific radionuclides may receive uptake inhibitors or chelating agents. Prognosis is initially estimated by the time between exposure and symptom onset, the severity of those symptoms, and by the lymphocyte count during the initial 24 to 72 h.

Radiation Exposure and Contamination

Spinal Trauma

Trauma to the spine may cause injuries involving the spinal cord, vertebrae, or both. Occasionally, the spinal nerves are affected . The anatomy of the spinal column is reviewed elsewhere.

Spinal Trauma
Spinal Cord Injury in Children

Sports Injury

Screening for Sports Participation
Approach to Sports Injuries
Rotator Cuff Injury/Subacromial Bursitis
Glenoid Labral Tear
Lateral Epicondylitis
Medial Epicondylitis
Piriformis Syndrome
Knee Pain
Shin Splints
Achilles Tendinitis
Stress Fractures
Popliteus Tendinitis
Hamstring Strain

Thoracic Trauma

Thoracic trauma causes about 25% of traumatic deaths in the US. Many chest injuries cause death during the first minutes or hours after trauma; they can frequently be treated at the bedside with definitive or temporizing measures that do not require advanced surgical training.

Overview of Thoracic Trauma
Aortic Disruption (Traumatic)
Blunt Cardiac Injury
Cardiac Tamponade
Flail Chest
Hemothorax
Pneumothorax (Open)
Pneumothorax (Tension)
Pneumothorax (Traumatic)
Pulmonary Contusion
Rib Fracture

Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI) is physical injury to brain tissue that temporarily or permanently impairs brain function. Diagnosis is suspected clinically and confirmed by imaging (primarily CT). Initial treatment consists of ensuring a reliable airway and maintaining adequate ventilation, oxygenation, and blood pressure. Surgery is often needed in patients with more severe injury to place monitors to track and treat intracranial pressure elevation, decompress the brain if intracranial pressure is increased, or remove intracranial hematomas. In the first few days after the injury, maintaining adequate brain perfusion and oxygenation and preventing complications of altered sensorium are important. Subsequently, many patients require rehabilitation.