Dr. Gibbs' Trauma Pearls

• Neck trauma - zones of the neck:

    I - Inferior aspect of cricoid cartilage to thoracic outlet
    II - Cricoid to angle of mandible
    III - Angle of mandible to base of skull
   *Zone II is more easily evaluated by surgical intervention; zones I and III by
    imaging"

• Traumatic Eye Injuries:
  

    1. Hyphema - needs optho follow up - possible complications include
        a. Corneal staining, Increased pressure and acute glaucoma, Rebleeding
    2. Globe rupture - DO NOT MEASURE PRESSURES
    3. Medial canthus injury - think about damage to lacrimal duct

• Face Injuries:
  

    1. Lefort Fractures:
        I. Fracture line passes through the alveolar ridge, lateral nose and inferior
            wall of maxillary sinus.
        II. Fracture arch passes through posterior alveolar ridge, lateral walls
            of maxillary sinuses, inferior orbital rim and nasal bones
        III. Fracture line passes through nasofrontal suture, maxillo-frontal
             suture, orbital wall and zygomatic arch.
    2. Mandibular Fractures - things to look for:
        a. Sublingual hematoma (pathognomonic), malocclusion, tongue depressor
           test (pain with biting down), limited mouth opening, mental nerve
           paresthesias
    3. Auricular Hematoma & septal hematomas - drain to avoid pressure necrosis
        and cauliflower ear & saddle nose deformity respectively

• Aortic Injury - CXR findings
  

    1. Mediastinal widening
    2. Loss of aortic knob
    3. R mainstem bronchus misplaced
    4. Apical cap
    5. Tracheal deviation
    6. L pleural effusion

• Neuro Trauma:
  

    1. Hangman's Fracture - pedicle of C2 - caused by extension mechanism
    2. Jefferson's Fracture - fracture through posterior & anterior arches of C1 > caused by axial loading - the ring breaks outward
    3. Pseudosubluxation -  normal mobility of C-2 on C-3 in flexion which  be mistaken for pathologic motion; (is normal in children < 8 years old);
    4. When managed properly SDH = greater morbidity than epidurals

---