1 Beth Israel Deaconess Medical Center Harvard Medical School December 2009 Traumatic Diaphragmatic Rupture Kapil Verma, Harvard Medical School Year III Gillian Lieberman, MD
2 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
3 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
4 Background: Epidemiology of Traumatic Diaphragmatic Rupture Trauma is the 4th most common cause of death in the USA and the leading cause of fatalities in those younger than 45 years-old Traumatic diaphragmatic rupture (TDR) injuries occur in 0.8 to 8% of patients who sustain blunt (MVC and fall from height) and penetrating trauma Mortality from TDR is 14-50%. This increases to 77% when associated with shock and head injury Sangster G, Ventura V, Carbo A, et. al
5 Background: Complications and common associations of TDR Diagnosis of TDR missed in up to 48% of blunt trauma patients on routine chest films and 30% of body CT scans. Failure to identify the abnormality may cause acute or delayed severe complications Cardiovascular-respiratory respiratory insufficiency Bowel strangulation and ischemia Left hemidiaphragm injured 4 times more commonly than the right. Bilateral cases are rare (5-8%) Most commonly herniated organs: stomach > small and large bowel > spleen > liver Associated intra-abdominal abdominal injuries common (75% of TDR patients have associated intra- abdominal injury) Eren S, Kantarci M, Okur A.
6 Background: Clinical symptoms as poor indicators of detecting TDR Most commonly experienced clinical symptoms of TDR include dyspnea,, chest pain, abdominal pain, vomiting The clinical diagnosis of TDR is difficult and missed in up to 65% of patients Therefore, imaging is essential Sangster G, Ventura V, Carbo A, et. al
7 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
8 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
9 Menu of Tests: Plain Chest Film Plain film chest radiography 1 st test of choice to evaluate suspected TDR Sensitivity of the chest plain film for the detection of the DR range from 27 to 60% for left-sided hernias and 17 to 33% for the right The most specific radiographic findings of DR include intrathoracic herniation of hollow viscera (small bowel, stomach, or colon) and identification of the nasogastric tube above the level of the left hemidiaphragm Gelman R, Mirvis SE, Gens D.
10 Menu of Tests: Plain Chest Film, differential diagnosis for NG tube seen in left thorax Differential diagnosis for NG tube tip overlying the chest on plain film: 1) Tip is still inside the stomach diaphragmatic rupture 2) Tip is outside of the GI tract in a bronchus or the pleural space 3) Tube is outside the patient Supine AP Portable Plain Chest Film with NG tube tip in left thorax
11 Menu of Tests: Plain Chest Film, Limitations Failure to diagnose TDR on plain films range from 12 to 66% Concurrent pulmonary abnormalities such as pleural effusion, pulmonary contusion and atelectasis can mimic or mask TDR on plain chest films A herniation at the costo-phrenic angle may be misdiagnosed as a pleural effusion or hemothorax on the initial chest radiograph, and a thoracic drainage tube could accidentally be placed into the herniated organs Shapiro MJ, Heidberg E, Durham RM, et. al.
12 Menu of Tests: CT Multidetector CT (MDCT) has TDR detection rates of 73 92% = Gold standard for diagnosis Because TDR is rarely isolated, CT is advantageous in the evaluation of other associated injuries Nchimi A, Szapiro D, Ghaye B, et. al.
13 Menu of Tests: CT Findings for TDR Diaphragm discontinuity and Dangling diaphragm sign 73% sensitivity, 90% specificity Intrathoracic herniation of abdominal contents 55% sensitivity, 100% specificity Collar sign: Constriction of the herniated abdominal viscera 67% sensitivity, 100% specificity Dependent viscera sign: Visualization of the herniated viscera against the posterior chest wall 100% sensitivity, 90% specificity Desser TS. Edwards B, Hunt S, et. al.
14 Companion Patient 1: The Collar and Dangling Diaphragm Signs on CT Axial contrast CT through the abdomen. Arrowhead shows construction of the stomach as it passes through the diaphragmatic defect, this is the Collar sign. The relatively newly discovered dangling diaphragm sign is seen with the arrow, representing the torn free edge of the left hemidiaphragm Axial C+ CT through abdomen Desser TS. Edwards B, Hunt S, et. al.
15 Companion Patient 2: The Dependent Viscera Sign on CT Axial contrast CT through the thorax, showing the Dependent viscera sign. The stomach is lying adjacent to the posterior ribs instead of within the expected confines of the dome of the diaphragm Axial C+ CT through thorax Desser TS. Edwards B, Hunt S, et. al; Bergin D, Ennis R, Keogh C, et. al.
16 Menu of Tests: Lesser Used Studies to evaluate TDR A barium study can be performed as a complement to diagnosis if the patient can tolerate the study. If intestinal passage is normal, barium filling intestinal loops are detected within the thorax MRI also used, but not a practical imaging technique in acute emergency setting for multi- trauma patients, as it is a slower modality than CT Surgical laparotomy may detect any unseen, subtle tears in the diaphragm. Preferred over thoracotomy Sangster G, Ventura V, Carbo A, et. al.
17 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
18 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
19 Our Patient J.C: History of Present Illness 23 M helmeted, riding a scooter at 15 mph struck by a motor vehicle and thrown from scooter 10 feet No LOC, with GCS of 14 at scene Negative FAST ultrasound
20 Our Patient J.C: Plain Chest Film PACS, BIDMC AP Supine Portable Chest Film
21 Patient J.C: Plain Chest Film Findings AP chest supine plain film Lungs are clear with no pneumothorax The right hemidiaphragm appears intact Partial herniation of the stomach into the chest AP Supine Portable Chest Film Detailed evaluation limited by underlying trauma board PACS, BIDMC
23 Our Patient J.C: CT Axial Image PACS, BIDMC CT C+ Axial Image through the thorax
24 Our Patient J.C: CT Axial Image Findings Confirmation of herniation of stomach partially into the thorax CT C+ Axial Image through the thorax No comment made about potential liver elevation from axial images PACS, BIDMC
25 Our Patient J.C: CT Sagittal Image PACS, BIDMC Sagittal C+ CT image through level of the stomach and left hemidiaphragm
26 Our Patient J.C: CT Sagittal Image Findings Discontinuity of left hemidiaphgragm with herniation of stomach into left chest PACS, BIDMC Sagittal C+ CT image through level of the stomach and left hemidiaphragm
27 Normal Patient vs. Our Patient J.C: CT Sagittal Images NORMAL OUR PATIENT J.C. PACS, BIDMC Sagittal C+ CT images through level of the liver Normal patient on the left, Our Patient J.C on the right
28 NORMAL Normal Patient vs. Our Patient J.C: CT Sagittal Image Findings OUR PATIENT J.C. Elevation of the dome of the liver into the chest in patient JC, compared to normal smooth confines of upper dome of liver in normal patient on the left Confirmation of right hemidiaphragm tear with herniation of dome of liver not made on imaging, but later by the surgeon during emergency laparotomy Sagittal C+ CT images through level of the liver Normal patient on the left, Our Patient J.C on the right PACS, BIDMC
29 Our Patient J.C: Post diaphragmatic repair CXR and CT PACS, BIDMC Upright plain film of the chest Sagittal C+ CT Image through the liver
30 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
31 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
32 Companion Patient A.B. 22 M unrestrained rear seat passenger in high speed MVC, with GCS of 5 at scene Rhonchi appreciated in left lung on auscultation
33 Companion Patient A.B: Plain Chest Film PACS, BIDMC AP Supine Portable Chest Film
34 Companion Patient A.B: Plain Chest Film Findings AP chest supine plain film Complete opacification of the left chest. Multiple rib fractures including 2 nd, 3 rd, 4 th left ribs The mediastinum is shifted to the right Impression: Given the trauma history this could well represent pulmonary contusion or hemorrhage AP Supine Portable Chest Film PACS, BIDMC
35 Companion Patient A.B: CT Scout Image Left diaphragm rupture with herniation of the spleen, stomach, small bowel and a portion of the large bowel into the left thorax PACS, BIDMC CT C- Scout Image
36 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
37 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
38 Embryology of the Diaphragm The diaphragm is created by the fusion of four discrete structures at the 7th week of development: Septum transversum Pleuroperitoneal membrane Lateral body wall mesoderm Dorsal mesentery Several Parts Make the Diaphragm Sugarbaker DJ: Adult Chest Surgery,
39 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
40 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
41 Diaphragmatic Trauma Fake-out 1: Congenital Hernias Bochdalek (90%) Back of diaphragm, left (5:1) Posterolateral and result from failed fusion of pleuroperitoneal folds at the eighth week of gestation Morgagni Middle of diaphragm Foramen of Morgagni hernias are located posterior to the xiphoid process and are caused by failed migration of the cervical somites Hanna W, Ferri L, Fata P, et. Al.
42 Diaphragmatic Trauma Fake-out 1: Congenital Hernias on CXR In newborns, if massive defect, apparent on plain film; morbidity related to degree of pulmonary hypoplasia Supine plain film of the chest; Bochdalek hernia Differentiate from TDR by absence of trauma Images courtesy of Dr. Julia Rissmiller, BIDMC Supine plain film of the chest; Morgagni hernia
43 Diaphragmatic Fake-out 2: Diaphragmatic Eventration Congenital absence of functional diaphragmatic musculature with incomplete muscularization of the diaphragm and a thin membranous sheet replacing a portion of the diaphragmatic muscle Frequently involves the anteromedial portion of the right hemidiaphragm Diaphragm retains its continuity and attachments to the costal margin Weakened hemidiaphragm is displaced into the thorax, which can compromise breathing Sangster G, Ventura V, Carbo A, et. al.
44 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
45 Agenda Background Menu of Tests Patient J.C. Companion Patient A.B. Embryology of the Diaphragm Diaphragmatic Trauma Fake-outs Conclusions
46 Conclusions TDR is an uncommon injury (0.8 8% of traumas), but with a high mortality (14-50%) TDR is difficult to diagnose clinically, and frequently missed on supine plain films CT is the gold standard noninvasive diagnostic modality and allows visualization of other associated intra-abdominal abdominal injuries Beware TDR fake-outs in the absence of trauma: congenital hernias and diaphragmatic eventration Always wear a seatbelt
47 Acknowledgements Gillian Lieberman, MD Diana Ferris, MD Julia Rissmiller,, MD James Kang, MD Maria Levantakis
48 References 1. Sangster G, Ventura V, Carbo A, et. al. Diaphgragmatic rupture: a frequently missed injury in blunt thoracoabdominal trauma patients. Am Soc Emergency Radiol 2007; 13(5): Eren S, Kantarci M, Okur A. Imaging of diaphragmatic rupture after trauma. Clin Radiol 2006; 61(6): Gelman R, Mirvis SE, Gens D. Diaphragmatic rupture due to blunt trauma: sensitivity of plain chest radiographs. AJR 1991; 156: Nchimi A, Szapiro D, Ghaye B, et. al. Helical CT of blunt diaphragmatic rupture. AJR 2005; 184: Shapiro MJ, Heidberg E, Durham RM, et. al. The unreliability of CT scans and initial chest radiographs in evaluating blunt trauma induced diaphragmatic rupture. Clin Radiol 1996; 51: Larici AR, Gotway MB, Litt HI, et. al. Helical CT with sagittal and coronal reconsutructions: accuracy for detection of diaphragmatic injury. AJR 2002; 179: Bergin D, Ennis R, Keogh C, et. al. The dependent viscera sign in CT diagnosis of blunt traumatic diaphragmatic rupture. AJR 2001; 177: Desser TS. Edwards B, Hunt S, et. al. The dangling diaphragm sign: sensitivity and comparison with existing CT signs of blunt traumatic diaphragmatic rupture. Emerg Radiol 2010; 17(1): Hanna W, Ferri L, Fata P, et. al. The current status of traumatic diaphragmatic injury: lessons learned from 105 patients over 13 years. Ann Thorac Surg 2008; 85: Reda E. Al-Refaie, Ebrahim Awad, Ehab M. Mokbel. Blunt traumatic diaphragmatic rupture: a retrospective observational study of 46 patients. Interact CardioVasc Thorac Surg 2009; 9:45-49.
January 2007 An Unusual Presentation of Diaphragmatic Hernia Daniel B. Horton Harvard Medical School Year III Patient LG: Clinical Presentation, Nov. 2004 52 year old woman presents with new nonproductive
Emerg Radiol (2012) 19:225 235 DOI 10.1007/s10140-012-1025-4 REVIEW ARTICLE Diaphragmatic injuries after blunt trauma: are they still a challenge? Reviewing CT findings and integrated imaging Giorgio Bocchini
Imaging of Thoracic Trauma: Tips and Traps Arun C. Nachiappan, MD Associate Professor of Clinical Radiology University of Pennsylvania None Disclosures Objectives Describe blunt and penetrating traumatic
.. Acute Diaphragmatic Injuries John A. Drews, M.D., Elliott C. Mercer, M.D., and John R. Benfield, M.D. ABSTRACT A 5-year experience with 43 patients with acute diaphragmatic injuries is reviewed. Thirty-three
September 2014 Dr. Norman Ackerman served the University of Florida, College of Veterinary Medicine with distinction as Professor of Radiology from 1979 to 1994. A concerned teacher of veterinary students
Clinical Chest Radiography Interpretation Part I Anthony M. Angelow, PhD(c), MSN, ACNPC, AGACNP-BC, CEN Associate Lecturer, Fitzgerald Health Education Associates Clinical practice Division of Trauma Surgery
Nuts and Bolts of Thoracic Radiology October 20, 2016 Carleen Risaliti Objectives Understand the basics of chest radiograph Develop a system for interpreting chest radiographs Correctly identify thoracic
CASE REPORT Laparoscopic Repair of a Traumatic Intrapericardial Diaphragmatic Hernia SreyRam Kuy, MD, MHS, Jeremy Juern, MD, John A. Weigelt, DVM, MD ABSTRA Introduction: Intrapericardial diaphragmatic
3 4 5 6 7 8 9 0 Chapter 8: Abdomen and Genitalia Injuries Abdominal Injuries Abdomen is major body cavity extending from to pelvis. Contains organs that make up digestive, urinary, and genitourinary systems.
Congenital Malformation of the Lung and Airways HelmiLubis, RidwanMuchtarDaulay, WismanDalimunthe, Rini Savitri Daulay DivisiRespirologiDepartemenIlmuKesehatanAnak FakultasKedokteran Universitas Sumatera
A Severely Injured Pediatric Trauma Patient: Case Presentation and Discussion Christopher Butts PhD, DO Surgical Critical Care Fellow Cooper University Hospital H&P 10 year old female presents as a trauma
Tubes, Lines & Drains: Using chest radiography to assess support devices Ryan Pouliot, HMS Gillian Lieberman, M.D. Core Clerkship in Radiology May 2010 Objectives To understand the importance & develop
A DEATH DUE TRANS-DIAPHRAGMATIC HERNIA YEARS AFTER FIREARM INJURIES Dayapala A. District General Hospital, Negombo INTRODUCTION Effects of penetrating injuries including firearm injuries can be very variable.
Pitfalls of the Pediatric Chest and Abdomen SPR 2017 Richard I. Markowitz, MD, FACR Children s Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania No Disclosures Cognitive Perceptual
Chapter Overview Chapter 1 An Introduction to the Human Body Define Anatomy and Physiology Levels of Organization Characteristics of Living Things Homeostasis Anatomical Terminology 1 2 Anatomy Describes
September 2004 Blunt Thoracic Aortic Injury Richelle Williams, Harvard Medical School, Year III Blunt Aortic Injury ~8000 deaths/year in the U.S. Most common cause of sudden death following: - high-speed
August 2011 Cecal Volvulus: Case Presentation and Review of CT Findings Omar Pardesi, Harvard Medical School Year III Our Patient LD: History & Physical HPI: 28 y.o. female presents with diffuse abdominal
Northern California Emergency Ultrasound Course Objectives The Extended FAST Exam Rimon Bengiamin, MD, RDMS UC SF Discuss the components of the EFAST exam Evaluate the utility of the EFAST Review how to
Gastrointestinal Emergencies CEN REVIEW 2017 MARY RALEY, BSN, RN, CEN, TCRN, TNSCC Gastrointestinal Emergencies is 7% of the CEN A. Acute abdomen B. Bleeding C. Cholecystitis D. Cirrhosis E. Diverticulitis
SPLIT NOTOCHORD SYNDROME ASSOCIATION DR. Hasan Nugud Consultant Paediatric Surgeon CASE PRESENTATION :- New born baby, boy, referred to the paediatric surgical team at the age of 14 hours. Birth History
CHEST TRAUMA Dr Naeem Zia FCPS,FACS,FRCS Learning objectives Anatomy of chest wall and thoracic viscera Physiology of respiration and nerve pathways for pain Enumerate different thoracic conditions requiring
Acquired pediatric esophageal diseases Imaging approaches and findings M. Mearadji International Foundation for Pediatric Imaging Aid Acquired pediatric esophageal diseases The clinical signs of acquired
1 2 3 4 5 6 7 8 9 National EMS Education Standard Competencies (1 of 5) Trauma Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely
AP1 Lab 1 Cavities, Organs, Serous Membranes, Quadrants, Regions, and Directional Terms, Planes & Sections Project 1 Directional Terminology Step 1: Define/Describe what is known as the "ANATOMICAL POSITION."
Hong Kong Journal of Emergency Medicine Free fluid accumulation following blunt abdominal trauma: potential for expansion of the FAST protocol N Simpson, P Page, DM Taylor Objective: To determine sites
Pneumothorax Defined as air in the pleural space which can occur through a number of mechanisms Traumatic pneumothorax Penetrating chest trauma Common secondary to bullet or knife penetration Chest tube
Penetrating Trauma in Pediatric Patients Heidi P. Cordi, MD, MPH, MS, EMTP, FACEP, FAADM EMS WEEK 2017 Introduction Trauma is the leading cause of death between ages of 1-18 years Penetrating injury accounts
Gastroschisis Sequelae and Management Mary Finn Gillian Lieberman, MD Primary Care Radiology Beth Israel Deaconess Medical Center Harvard Medical School April 2014 Outline I. Definition and Epidemiology
Lung sequestration and Scimitar syndrome Imaging approaches M. Mearadji International Foundation for Pediatric Imaging Aid Rotterdam, The Netherlands Pulmonary sequestration Pulmonary sequestration (PS)
Shenandoah Co. Fire & Rescue Injuries to the Head and Spine December EMS Training Bill Streett Training Section Chief C.E. Card Information BLS Providers 2 Cards / Provider Category 1 Course # Blank Topic#
ALGORITHMS Algorithms for managing the common trauma patient J John, MB ChB Department of Urology, Frere Hospital, East London Hospital Complex, East London, South Africa Corresponding author: J John (email@example.com)
In the event of a conflict between a Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. Plan documents include,
Bowel obstruction Introduction and Definitions Accounts for 5% of all acute surgical admissions Patients are often extremely ill requiring prompt assessment, resuscitation and intensive monitoring Obstruction
Thorax (1974), 29, 329. Pericardial rupture from blunt chest trauma J. BORRIE and I. LICHTER Department of Thoracic Surgery, Otago Medical School, Dunedin, New Zealand Borme, J. and Lichter, I. (1974).
Cardiopulmonary Imaging Original Research Kitazono et al. Chest Radiography of Pleural Effusions Cardiopulmonary Imaging Original Research Mary T. Kitazono 1 Charles T. Lau Andrea N. Parada Pooja Renjen
Pediatric Trauma Karim Rafaat, MD Goals Time is short I m going to presume you know your basic ATLS (that s that whole ABCD thing, by the way) Discuss each general trauma susceptible region Focus on: Epidemiology
Radiology Undergraduate Radiology Sample Questions April 2012 The following examples are offered of questions that might be used to assess undergraduate radiology. There are 3 different styles: An OSCE
X-Rays Kunal D Patel Research Fellow IMM The 12-Steps } 1: Name 2: Date 3: Old films 4: What type of view(s) 5: Penetration } Pre-read 6: Inspiration 7: Rotation Quality Control 8: Angulation 9: Soft tissues
Selective Spine Assessment & Spinal Motion Restriction Supersedes: 02-09-15 Effective: 10-20-15 Spinal cord injury may be the result of direct blunt and/or penetrating trauma, compression forces (axial
Penetrating abdominal trauma clinical view Ari Leppäniemi, MD Department of Abdominal Surgery Meilahti hospital University of Helsinki Finland Meilahti hospital - one of Helsinki University hospitals -
Chapter 3 General Anatomy and Radiographic Positioning Terminology General Anatomy Definition of Terms Anatomy- term applied to the science of the structure of the body Physiology- study of the function
MANAGEMENT OF DIAPHRAGMATIC HERNIAS Theresa W. Fossum DVM, MS, PhD, Diplomate ACVS Professor of Veterinary Surgery; Vice President for Research and Strategic Initiatives, Midwestern University, Glendale,
Pitfalls in Shortness of Breath Stuart Swadron, MD FRCPC FACEP Vice-Chair of Education and Program Director Department of Emergency Medicine Los Angeles County-University of Southern California Medical
Radiology of the respiratory disease [ Color index: Important Notes Extra ] [ Editing file Feedback Share your notes Shared notes ] Resources: - 435 Slides - 434 Team - 435 Notes Done by: - Mai Alageel
Anatomy of the Thorax A) THE THORACIC WALL Boundaries Posteriorly by the thoracic part of the vertebral column Anteriorly by the sternum and costal cartilages Laterally by the ribs and intercostal spaces
Hernias Umbilical Hernia An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. Umbilical hernias are common and typically harmless. They
Focused Assessment with Sonography in Trauma (FAST) UC Irvine School of Medicine Purpose of FAST exam Quickly evaluate patient s status in emergency situations Blunt or penetrating trauma Visualize fluid
Eva M. Escobedo 1 William J. Mills 2 John. Hunter 1 Received July 10, 2001; accepted after revision October 1, 2001. 1 Department of Radiology, University of Washington Harborview Medical enter, 325 Ninth
The Focused Assessment with Sonography for Trauma, (FAST) procedure. ROBERT H. WRIGLEY Professor Veterinary Diagnostic Imaging University of Sydney Veterinary Teaching Hospital Professor Emeritus Colorado
Radiology of the abdomen Lecture -1- Objectives To know radiology modalities used in abdomen imaging mainly GI tract. To know advantages and disadvantages of each modality. To know indications and contraindications
Director, Burn Center MetroHealth Medical Center Professor of Surgery Case Western Reserve University BLAST INJURY Which of following statements concerning blast lung injury are FALSE? 1)Blast lung injury
account for 10% to 15% of all traffic fatalities majority fatal at the scene 50% who survive the initial injury die in the first 24 hours 90% die within the first month if aorta not repaired 30-90% overall
Perforation of a Duodenal Diverticulum 2008 4 Elective Student S. C. Case History An elderly male presented to the Emergency Department with abdominal pain. Chief Complaint: Worsening, diffuse abdominal
SWISS SOCIETY OF NEONATOLOGY Delayed-onset right-sided congenital diaphragmatic hernia and group B streptococcal septicemia September 2003 2 Saner C, Burtscher R, Hunziker U, Zimmermann-Bär U, Department
1. Standard ed 2. Standard ed & Abdomen 3. Standard ed, Abdomen, & Pelvis 4. Aortic Dissection arch dome thru adrenals apex arch + 2 arch dome thru abdomen apex arch + 2 arch dome to crests apex arch +
Chapter 22 Review Review 1. Kinetic energy is a calculation of: A. weight and size. B. weight and speed. Caring for victims of traumatic injuries requires the EMT to have a solid understanding of the trauma
A spinal fracture is a serious injury. Nader M. Hebela, MD Fellow of the American Academy of Orthopaedic Surgeons http://orthodoc.aaos.org/hebela Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Neurological
Radiology Corner Case # 42 Gun Shot to Thorax Resulting in Localized Hemothorax and Lung Contusion Guarantor: COL Les Folio, USAF, MC, SFS 1 Contributors: COL Les Folio, USAF, MC, SFS 1, 2D LT Duane Robinson,
C H A P T E R 1 The Human Body: An Orientation An Overview of Anatomy Anatomy The study of the structure of the human body Physiology The study of body function Anatomy - Study of internal and external
November 2005 Stress Fractures Chealon Miller, Harvard Medical School Year IV Our Patient G.F. 29 year old female runner c/o left shin pain and swelling Evaluated at OSH with MRI showing a mass Referred
Signs in Chest Radiology Jonathan H. Chung, MD Disclosures No pertinent disclosures Jonathan H. Chung, MD Assistant Professor Institute t of fadvanced d Biomedical Imaging National Jewish Health Denver,
Chapter 28 Review Review 1. Peritonitis would MOST likely result following injury to the: A. liver. B. spleen. C. kidney. D. stomach. Review Answer: D Rationale: In general, solid organs bleed when injured
Exploring Anatomy: the Human Abdomen PERITONEUM AND PERITONEAL CAVITY PERITONEUM The peritoneum is a thin serous membrane that lines the abdominal cavity and covers, in variable amounts, the viscera within
1 2 3 4 5 6 7 8 9 10 11 12 13 Cine loop of tomosynthesis slice images through the chest. 14 Standard PA chest radiograph (left) and single slice from the tomosynthesis image dataset (right) of a patient
Free Esophageal Perforation Following Hybrid Visceral Debranching and Distal Endograft Extension to Repair a Ruptured Thoracoabdominal Aortic Aneurysm History A 56-year-old gentleman, who had been referred
ULTRASONIC EVALUATION OF INTRATHORACIC MASSES by Alan H. Wolson, MD ABSTRACT B mode ultrasound can be used to evaluate intrathoracic masses that contact the chest wall. It provides a noninvasive technique
Henry: EMT Prehospital Care, Revised 3 rd Edition Lecture Notes Chapter 10: Focused History and Physical Examination of Trauma Patients Chapter 10 Focused History and Physical Examination of the Trauma
Gunshot Wounds to the Abdomen: From Bullet to Incision Patrick M Reilly MD FACS Master? I Do Get The Chance to Practice What Are We Not Discussing? Stab Wounds Prehospital Care Management of Specific Injuries
TITLE: CHEST TRAUMA PURPOSE: Provides a standardized treatment algorithm for patients with chest trauma PROCESS: I. INITIAL ASSESSMENT OF THORACIC TRAUMA A. Penetrating Thoracic Trauma 1. Hemodynamically
BIOE221 Session 5 Examination of Thorax- Respiratory system Bioscience Department Session Objectives Understand the structure of the thorax and the organs contained in this cavity Understand the importance
Radiology Corner Case # 26 Lung laceration with active bleeding, contusion and hemothorax Guarantor: LT Christopher Backus, USAF* Contributors: LT Christopher Backus, USAF*, COL Les Folio, MC, USAF, SFS*