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Emergency Medicine (Blunt traumas and RTAs (Blunt aortic Injury and…
Emergency Medicine
Blunt traumas and RTAs
Blunt aortic Injury and Rupture
- happens in the 2 places where the aorta is firmly attached
--> ligamentum arteriosum = isthmus of aorta
--> the ascending aortic is less common but still firmly attached there
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Isthmus
- isthmus of aorta = where the ligamentum arteriosum attaches
- isthmus = a narrow strip of land with sea on either side, forming a link between two larger areas of land.
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Stab Chest case
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Notes:
- note that the right ventricle is just on the left sternal border
- reason why the pulmonary valve is on the left side of the chest
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*Cardiac Emergencies
Tachycardias
- Ventricular Tachycardia = V-Tach
- Supraventricular Tachycardia = Supra V Tachy
Supraventricular TAchycardias
- Supra V Tach
- give SUPRA fast drug = Adenosine
- Adenosine works in 15 seconds
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Hypertensive Emergency
- BP > 180 /120
--> systolic is the most important
- can present with general edema, papilodema, retinal hemorrhages, AKI
Clinical Case
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Onion Skin changes to artiole endothelial walls from fibrinoid necrosis and hyperplastic arteriosclerosis
- this can happen from hypertensive emergencies
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*Lightning Electric Shock Injury
- heart arrhythmias
- respiratory failure
- Litchenburg figures = fern pattern of burn on skin
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*Fractures
*Rib Fractures and surrounding structures
- Spleen is most affected from rib fractures in the posterior left chest
--> especially sports injuries and blunt traumas
- posterior, the 11 and 12 ribs go right over the kidneys
*Rib Fractures 11 and 12 posterior
- posterior, the 11 and 12 ribs go right over the kidneys
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*heat Stroke
- dehydration
- headache
- can also cause siezures
- dehydration and high temperature causes the body to shunt blood to the skin to try and cool it down
--> this causes shock and also causes DIC
- DIC
--> when the blood is shunted the ischemia and necrosis from internal organs causes release of anticoagulation factors
--> this leads to depletion of clotting factors proteins C and S and DIC
--> prolongued PT + PTT
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