AIS Components for ISS Scaling-Body Region 1. Head/Neck 2. Face 3. Chest 4. Abdominal/Pelvic Contents 5. Extremities/Pelvic Girdle Severe 6. External- Skin and Burns The adult skeletal system 206 bones Skull base fractures orbital roof, ethmoid, basilar process of occipital bone, petrous and squamous process of temporal bone (mastoid or petrous) Skull Vault fractures frontal, parietal, occipital, temporal bones (specifies squamous) Brain Hematomas EPH, SAH, SDH, IPH, ICH uncal herniation, transtentorial (cerebellum) - code ICD-10 - cord contusion = AIS code of 140202.5 = 5 squared = 25 ISS score. Meninges three protective membranes that surround the brain and spinal cord dura mater, arachnoid, and pia mater Intracranial Injuries-Focal injuries picked up on CT scan. Contusion, epidural hematoma, subdural hematoma, subarachnoid hematoma, intracerebral/intraparenchymal hemorrhage Intracranial Injuries-Nonfocal Head Injuries concussions, shear injury, diffuse axonal injury (DAI), anoxic brain injury (ABI) - these go down to the cellular level. Facial Bones • Orbits • Nasal bones • Maxillae • Mandible • Palatine • Vomer Facial Mechanisms of Injury deep lacerations, deformity, difficulty speaking, visual changes, entrapment of muscles, rhinorrhea, otorrhea, trismus Facial Diagnostics and Procedures CT scan, MRI scan, X rays, ORIF, Enucleation or removal of the eyeball. Neck Injury Indicators • Bleeding • Stridor • Difficulty Breathing • Bruising to the Neck • Deviated Trachea • Subcutaneous emphysema • Zones of the Neck: 1. Angle of the mandible to base of the skull 2. Cricothyroid Cartilage Neck Trauma procedures • Cricothyroidotomy - needle through a catheter • Tracheostomy - done when a patient is stabilized • Neck Exploration • Intubation Vertebral Column Dislocation • Ligamentous injuries - ligaments' purpose is to keep spine aligned. • Dislocations - unilateral facet, bilateral facet • Subluxation- partial dislocation Vertebral Column Fractures - • Simple • % compression or wedge • Comminuted or burst - broken into pieces • Tear drop Spinal Cord Injuries - • Concussion - numbness and tingling • Contusion- bruising • Transection • Interruption in vascular supply • SCIWORA - spinal cord injury with radiological arteries Spinal Injury Diagnostics and Procedures CT scan, MRI Procedures- cervical collar, tongs, halo traction, spinal decompression Cervical Spine • 7 vertebrae • C1-atlas, c2- axis - responsible for assisting with movement of the head. • If spinal cord injured at c1-C2- typically quadriplegic Thoracic Spine • Contains 12 vertebrae • If spinal cord injured here, typically Paraplegia Lumbar Spine • Contains 5 vertebrae • Spinal cord ends L1 to L2 level Sacral Spine • 5 fused vertebrae • Joins with the pelvic bones coccyx • 3-5 very small fused bones • Tail bone Thoracic Bone Structures • Spinal column • Ribs • Clavicles • Scapulae - if this bone is fractured, be suspicious for lung contusion. • Sternum • Xiphoid process - tip of the sternum Rib fracture documentation very important to know the number of ribs fractured on each side. Segmental - flail Thoracic Muscular Structures Diaphragm - muscle separating the chest and its contents from abdomen and its contents Intercostal - assists in breathing Thoracic Organs lungs, heart, esophagus, trachea, thymus glands Thoracic Injury Descriptors • Shortness of breath • Cyanotic- bluish • Deviated Trachea • Subcutaneous Emphysema • Abdominal Breathing • Paradoxical Movement - also known as flail chest, the ribs seem to be floating or moving. • Pale and clammy Thoracic Trauma diagnostics • FAST exam • Pericardiocentesis • CT scan • Ct angiography - uses dyes • Aortography • Needle Thoracentesis Thoracic Trauma Procedures chest tube/thoracostomy thoracotomy cardiac massage defibrillation pericardial window median sternotomy cross- clamp aorta Thoracic Injuries • Tension Pneumothorax - usually results from a blunt injury • Rib Fractures • Flail Chest - be careful when looking at the medical record as segmental indicates flail. • Sucking Chest Wounds • Pneumothorax - chest tube is inserted. • Hemothorax- chest tube is inserted • Pulmonary contusions • Blunt cardiac injury • Aortic transection- aortography is used to detect this. • Pseudoaneurysm • Cardiac tamponade is pressure on the heart muscle, which occurs when the pericardial space fills up with fluid faster than the pericardial sac can stretch. It is detected by an angiography and usually is treated by pericardiocentesis-- a needle is inserted into pericardial sac. • Diaphragmatic rupture • Aortic rupture - aortography is used to detect this. Rib Fractures