• Tetanus is caused by anaerobic spore forming GPR and is transmitted via contaminated wounds and tissue injury.
• Consider the diagnosis in patients presenting with trismus, which is the cardinal feature.
• There are very few disorders of generalized stiffness in patients with preserved consciousness: stiff personsyndrome, tetanus, drug induced dystonia, hysteria, and strychnine poisoning (rat poison)
• Verify tetanus immunization history in all trauma patients and IV drug users.
• Leishmeniasis is a vector born disease transmitted by the sandfly.
• 2nd largest parasitic killer in the world!
• Incubation period: weeks to months
• Classic presentation: Pink-colored papule -> enlarges into a nodule or plaque-like lesion (often with central softening) -> painless ulceration with an indurated border
Guillan Barre Syndrome
• Guillan Barre Syndrome is the most common acute paralytic disease in the west.
• Diagnosis requires clinical suspicion, LP, and EMG studies.
• LP classically shows albumino-cytologic dissociation (elevated protein); however, normal protein level does NOT rule-out the condition.
• Patients in the early stage of their illness may not have reflex changes.
• Criteria for intubation: 1 major or 2 minor criteria:
– MAJOR: Hypercarbia, arterial CO2 > 48 mm Hg, Hypoxemia, paO2 < 56 mmg Hg, FVC < 15 cc/kg or NIF < -25 cm H20
– MINOR: Inefficient cough, Impaired swallowing, and Atelectasis
The “Chest” exam should include:
- Assessment of neck veins
- Search for paradoxical movement (flail)
- Respiratory distress
- Palpation for fractures
- Assessment for unequal breath sounds or decreased vocal fremitus
Needle decompression in the field for presumed tension pneumothorax is indicated when hypotension is present.
Two most important studies in the first several minutes of evaluation are CXR and FAST Exam (to include a search for pleural sliding).
Up to 15% of patients with thoracic aortic injuries have a normal CXR.
The treatment of traumatic aortic injury may include control of heart rate and blood pressure prior to transfer.
Multiple rib fracture in the elderly trauma victim often requires admission to the ICU.