- Abdominal Aortic Aneurysm
- Aortic Dissection
- Aorto-Enteric Fistula
- Cardiac Contusion
- Closed Head Injury
- Concussion (Mild Traumatic Brain Injury)
- Deep Vein Thrombosis
- Epidural Hematoma
- Flail Chest
- Liver Laceration
- Pelvic Fracture
- Peripheral Arterial Occlusion
- Phlegmasia Cerulea Dolens
- Pulmonary Contusion
- Retroperitoneal Hemorrhage
- Spinal Cord Injury
- Splenic Laceration
- Subdural Hematoma
- Tension Pneumothorax
- Thoracic Aortic Aneurysm
- Trauma Aortic Dissection
Abdominal Aortic Aneurysm
An abdominal aortic aneurysm (often referred to as a ‘triple A’), is an abnormal dilation of the abdominal segment of the aorta. Smoking is a significant risk factor for development of this condition. As the aneurysm grows, there is an increased risk of rupture, which can be life threatening.
The aorta is the largest blood vessel of the body and carries blood away from the heart. An aortic dissection occurs when the lining of the aorta begins to separate. Type A dissections move towards the heart and are a surgical emergency. Type B dissections move away from the heart and may be managed with medication to control blood pressure and heart rate.
An aorto-enteric fistula is a life threatening condition in which the aorta becomes abnormally in which the aorta becomes abnormally connected to the gastrointestinal tract, leading to massive bleeding. It most commonly occurs due to a AAA (aortic aneurysm) or an aortic graft (such as from an aneurysm repair)
A cardiac contusion is a blunt injury directly to the heart muscle. It can lead to hemodynamic instability, impaired cardiac contraction or arrhythmia. However, in the trauma patient, tachycardia (rapid heart rate) should be assumed to be due to blood loss until proven otherwise.
Closed Head Injury
Closed head injury is a spectrum of traumatic brain injury that ranges from mild (blunt head injury, concussion) to severe (epidural hematoma, diffuse axonal injury). Mild symptoms include headache, nausea/vomiting, or dizziness. Severe symptoms can lead to loss of consciousness, seizure or coma. If a more specific diagnosis applies (e.g. concussion, subarachnoid hemorrhage, subdural hemorrhage), then that diagnosis should be applied instead.
Concussion (Mild Traumatic Brain Injury)
A concussion, also referred to as a mild traumatic brain injury (TBI). is a minor head injury, caused by direct head injury or rapid acceleration/deceleration. It is characterized by normal or near normal mental status measured shortly after injury. Concussion symptoms include headache, light sensitivity, nausea, difficulty concentrating, and fatigue. CT imaging is typically normal and the diagnosis is made clinically.
Deep Vein Thrombosis
A deep vein thrombosis is a clot that forms in one of the body’s veins, which carry blood back to the heart. These clots often form in the legs, but can also form in the veins of the pelvis and in the arms. The most feared complication of a DVT is a clot that travels to the lungs, called a pulmonary embolism (PE)
Epidural hematoma is caused by bleeding in the potential space between the skull and tough dural membrane around the brain. Typically from blunt injury such as a fall with head strike, the bleeding can cause headache, confusion, weakness, vomiting, and coma. It is often associated with a skull fracture in the parietal region causing laceration of the middle meningeal artery. Treatment is based on severity, potentially requiring emergency neurosurgical evacuation.
Flail chest is a condition that can develop when multiple rib fractures are present. This creates a floating segment of the chest wall that moves paradoxically with breathing (inward in inhalation). Management may require positive pressure ventilation, including intubation and sedation for respiratory management.
Hemarthrosis is bleeding into a joint, causing acute severe pain. It is most commonly seen in patients with hemophilia and requires administration of clotting factors. It can also occur in the setting of intra-articular fracture. Treatment may require orthopedic consultation for consideration of joint aspiration.
A hemothorax is a collection of blood around the lung. This condition is most often due to trauma, such as rib fracture or injury to the blood vessels of the chest. However, it can also be seen in some cancers and as a result of clotting dysfunction.
Liver lacerations occur from blunt force trauma and can cause severe intra-abdominal hemorrhage, leading to low blood pressure (hypotension) and tachycardia. Treatment is based on the anatomy of the laceration and may range from monitoring to blood transfusion to surgery depending on severity and clinical course. Early diagnosis can be made by bedside ultrasound (FAST)
There are a variety of different types of fractures to the pelvis that can occur from falls, motor vehicle accidents or other trauma. More serious fractures can cause severe bleeding into the retroperitoneal space and hemorrhagic shock. They can also lead to injuries to the bladder, urethra, colon and other pelvic organs
Peripheral Arterial Occlusion
Peripheral arterial occlusion can occur from plaque deposition of peripheral arteries or an acute occlusion from a blood clot travelling from the heart (e.g. from an un-anticoagulated atrial fibrillation), causing a cool pale and painful limb. It requires anticoagulation and potentially surgical correction with thrombectomy in severe cases.
Phlegmasia Cerulea Dolens
Phelgmasia cerulea dolens (PCD) is a condition of severe extremity deep vein thrombosis that causes neurovascular compromise of the limb. Patients may require thrombectomy (clot removal) or thrombolysis (use of ‘clot busting’ medication) to treat the condition in addition to blood thinners. PCD can lead to amputation, PE and significant mortality.
Pulmonary contusions are causing by blunt force trauma to the chest, often associated with rib fractures. Injury to the lung tissue leads to shortness of breath and can cause a bloody cough (hemoptysis). Treatment is with pain control and respiratory support/monitoring
Retroperitoneal hemorrhage is bleeding into the potential space between the abdomen and back. It can cause severe back pain and hypotension from acute blood loss. Causes include pelvic fracture, kidney injury, or spontaneous hemorrhage from the blood vessels in the retroperitoneal space. Patients on long term anticoagulant therapy are at increased risk for the latter.
Spinal Cord Injury
Spinal cord injury is caused by acute trauma to the cervical, thoracic, and/or lumbar spine causing loss of sensation and/or motor function to the body and extremities based on the level injured. In children, this can occur without any evidence of bony injury to the spine (SCIWORA). Injury to the associated sympathetic nervous system chain can cause spinal shock (hypotension and paradoxical bradycardia). Treatment may involve surgical stabilization of associated bony injury.
Splenic lacerations occur from blunt force trauma and can cause severe intra-abdominal hemorrhage, leading to low blood pressure (hypotension) and tachycardia. Treatment is based on the anatomy of the laceration (grades 1-5) and may range from monitoring to blood transfusion to surgery depending on severity and clinical course. Early diagnosis can be made by bedside ultrasound (FAST)
Subdural hematoma is caused by bleeding from bridging veins in the potential space underneath the tough dural membrane around the brain. Typically from blunt injury such as a fall with head strike, the bleeding can cause headache, confusion, weakness, vomiting, and coma. Treatment is based on severity, potentially requiring emergency neurosurgical evacuation.
Tension pneumothorax is a life threatening form of collapsed lung (pneumothorax). Pressure continues to build up in the chest as the size of the pneumothorax increases. Eventually this leads to compression of blood vessels returning to the heart leading to circulatory collapse and death.
Thoracic Aortic Aneurysm
Thoracic Aortic Aneurysms occur in a region of the proximal aorta from the aortic valve to the diaphragm. They can cause aortic regurgitation and life-threatening emergencies of both dissection and free wall rupture.
Trauma Aortic Dissection
Traumatic aortic dissection is caused by blunt force injury (classically rapid deceleration) causing the aorta to tear. Treatment is based on the anatomy of the injury, with injuries to the ascending aorta typically requiring operative intervention. Close hemodynamic monitoring and blood pressure control to limit extension of the dissection flap is extremely important.