CIP - C12 (4).txt

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  1. 1st Party claims:
    focus on entitlement to benefits
  2. 3rd Party claims:
    • demand verification that insd is covered & claims fall within coverage period
    • assess insureds legal liable to TP 
  3. Policy Coverage: 
    • insurer must prove; exclusions, limitations, breaches
    • confirm coverage
    • insured to show claim falls within insuring agreement
    • DOL must be within policy period
    • review exclusions, limitations & policy conditions 
  4. Coverage Questions:
    • Auto
    • policy covers vehicle
    • accident arose out of ownership, use or operation
    • Liab
    • confirm if incident resulting in claim was accident or occurrence 
    • bodily injury as defined in policy & is insured legally liable 
  5. Information Gathering:
    • scene investigation
    • obscured vision of roadway/signs
    • lighting
    • diagram & photos
    • Police report
    • facts of accident:
    • statements; insd, claimant, witnesses (all)
    • Subrogation; municipality, city etc. may have differeint limitation periods 
    • signed authorizations 
  6. Statements:
    • important facts, relevant & in style of language of provide
    • determine location (office; home)
    • record untruthful statements
    • describe & identify - detailed
    • claimant, pre-accident, accident,injury, disabilities, limitations, damages (out of pocket, wage loss past/future)
    • identify other eligible claimants 
    • statements are memory tool
    • if recorded, explain process, questions, request complete answers & ask permission on tape
  7. Keys to taking Statements:
    • use pen
    • no blank spaces
    • no underlining
    • number each page
    • delete w/single line
    • initial each page, correction
    • signature witnessed; utilize interpreter
  8. Information to be obtained:
    • injury info from claimant, Dr's, IME, employer
    • apportion liability
    • type of impact;  rear end, side impact; seatbelts/airbags
    • position of claimant in the veh; looking where? forward/turned? warning? LOC? Hit any other part of body?
    • Injury:
    • what hurts, where, symptoms, pre-existing
    • initial treatment; where, by who, instructins given, diagnosis/prognosis
  9. Diagnosis:
    • conclusion reached by Dr. after examination. Classifies/identifies nature of condition.
    • identified by phyiscical exam
  10. Prognosis:
    • forecast made by Dr. as to probable recovery based on nature of injury, symptoms.
    • outlines when recovery is expected 
  11. Fact verification:
    • Background info:
    • age
    • family
    • lifestyle
    • job
    • hobbies
    • dependants 
  12. Activities Check:
    • if disability longer than reasonable & injury subjective
    • interview neighbours, employers
    • hire PI/IA, obtain video
    • assign forensic expert 
  13. Forensic Expert:
    called upon to establish a legal case or prove certain specific points based on info they've gathered, organized & analyzed within the field of their expertise
  14. Private Investigator:
    • establish trend, timeline
    • set foundation for admissible evidence 
    • proffessional expert involved if claim is large or fraud suspected
    • details required to admit as evidence 
  15. Liability:
    • damages must arise from accident
    • insd must be legally liable
    • defendant represented by insurer
    • plaintiff is whoever brings action
    • review & apply various acts;
    • occupiers liab
    • WCB
    • other insurance
    • establish defenses
    • voluntary assumption of risk
    • author of own misfortune
    • inevitable act
    • apportion fault
    • contributory negligent
    • put everyone on notice to secure subrogaton rights
    • joint & several liab
    • foreseeability
    • remoteness of damage
  16. Congenital: 
    • refers to conditions present at birth regardless of causation
    • pre-existing conditions affect recovery and settlement 
  17. Functions of Skin:
    • protects agains trauma & infection
    • regulates body tempurature
    • helps eliminate fluids (sweat glands)
    • prevents dehydration
    • conserve electrolytes (potassium & sodium)
    • manufactures vitamin D 
  18. Melanin:
    Pigment that colours the skin
  19. Cutaneous:
    refers to anything pertaining to the skin
  20. Epidermis:
    • outermost layer of skin
    • made up of several layers of cells
    • constantly being replaced 
  21. Dermis: (corium)
    • lower, main layer of skin
    • contains:
    • blood vessels
    • nerves
    • glands
    • hair roots
    • fat cells
    • extremely elastic
    • stretches when injury causes fluid build-up
    • decompression: surgically released fluid
    • pain is felt through the nerves & when nerves are damaged, cause neurological  deficit
  22. Neurological Deficit:
    nerve involvement which manifests itself through pain, tingling or numbness
  23. Bedsores:
    • decubitus ulcur
    • prolonged deficiency of blood flow 
  24. Trauma to Skin:
    • abrasions, scrapes, road rash/skin burns
    • contusions - skin not  broken = bruises
    • haematoma - pooling of blood from damaged blood vessels
    • incise - surgical cut to affected area, drains blood 
  25. Ligation:
    tying or bonding of blood vessels to control bleeding
  26. Lacerations:
    • tears of the flesh - irregular/jagged
    • often severe contusion around wound
    • depth measured in centimitres
    • do not bleed as freely as clean incisions or cuts
    • can result in shredding of blood vessels
    • clotting occurs rapidly
    • can cause significant damage & can leave scars
  27. Debridement:
    process to cleanse a wound by removing dirt, contamination & badly damaged tissue.
  28. Haemorage:
    • excessive discharge of blood either internally or externally
    • blood can be from viens (venous) or arterial blood vessels
    • must apply pressure
    • requires cleansing, bandages & application of cold to constrict blood vessels
  29. Facial Scars:
    • can be improved and healed with plastic surgery
    • physical and psychological involvement
  30. Hypertrophic scar:
    composed of dense, fibrous tissue that is usually elevated
  31. Hypertrophy:
    refers to enlargement of an organ or structure
  32. Keloid:
    • prominent scar, caused by excessive amounts of collagen forming in the corium (dermis) during healing
    • itches, grows & reoccuring
  33. Skin Grafting:
    transplanting healthy tissue to replaced damaged skin
  34. Dermabrading:
    sanding the skin
  35. Transverse laceration:
    • may sever the cutaneous nerves resulting in numbness @ site of injury
    • may result in a dull, cold feeling
  36. Burns:
    • common injury
    • caused by exposure to excessive heat (flame, oil, steam, hot water)
    • chemicals
    • electricity
    • severity is determined by the amount of skin loss & depth of burn
  37. Burn severity:
    • 1st Degree:
    • superficial, skin reddened & inflamed on the surface, imflammation subsides in few days & outer most layer of skin peels
    • -
    • 2nd Degree:
    • causes blistering, some distruction of the superficial layers of the skin & is susceptible to infections
    • -
    • 3rd Degree:
    • causes severe damage tothe thickness of hte skin & underlying tissues. Damage may extend to the bone.
    • Secondary & life threatening effects:
    • loss of water, plasma, plasma protiens which can lead to shock
  38. Secondary & life threatening effects of a burn:
    • loss of water, plasma, plasma protiens which can lead to shock
    • bacterial infection
    • reduced circulation of blood
    • decrease in urine production
  39. Shock:
    Brought on by collapse of the circulatory system, a condition often caused  by a severe injury. The symptoms include pallor, sweating, weak pulse & very low blood pressure.
  40. Burn treatment: 
    • replace lost fluids to prevent shock
    • clean wound, remove all dead tissue so antibacterial agents gain direct contact w/the burn surface to prevent infection
    • skin grafts
    • scarring & physical deformatation can lead to psychological distress & counselling is recommended 
  41. Musculature:
    • over 600 muscles in the body
    • divided into three groups; skeletal, smooth & cardiac
  42. Skeletal muscles:
    • move the bones of the body
    • must be stimulated by nerves to function
    • know as voluntary muscles or striated muscles
    • heal well due to large number of blood vessels/supply
    • injuries of muscles & skin referred to as soft tissue injuries
    • soft tissue is any non bony part of the body
    • Fascia:
    • the tough connective tissue that covers, supports & seperates muscle
  43. Smooth muscles:
    • found in blood vessels & internal organs
    • small & delicate
    • not under voluntary control 
  44. Cardiac muscles:
    • heart tissue
    • striated involuntary muscle with a single nucleus
  45. Muscle composition:
    • composed of cells & muscle fibers
    • fascia & muscles taper into tendons
    • tendons = cords of tissue
    • tendons are attached to bones
    • work together in groups
    • cause joints to bend & straighten
  46. Skeletal muscles - 2 groups:
    • flexion & extension
    • flexion: flexing or bending part of the body
    • extension: extending or straightening
    • toes bent upwards - dorsi flexion
    • toes bent downwards - planter flexion
  47. Arm/hand muscles:
    • Biceps: flexor, bend arm @ elbow
    • Triceps: extensor: straighten arm
    • 19 muscles attached to the radius & ulna which move the wrist & fingers
    • 35 muscles control the hand
    • 15 in forearm - reducing bulk in the hand
    • muscles become thin cord like tendons @ the wrist
    • muscles in the palm & palm side of forearm allow closing of the hand
    • muscles in the forearm that run along backside of hand cause hand to open 
  48. Leg/Knee Muscles:
    • Quadricep muscle group:
    • located in front of femur
    • powers & controls leg straightening @ the knee & hip bending
    • Hamstrings muscle group:
    • powers & controls knee bending & straightening of the thigh
    • Gastrocnemius muscles (calf)
    • powers & controls point of foot downward (plantar flexion) & is connected to the foot by the achilles tendon
    • 4 muscles in the front of the leg bend foot/toes upward (dorsi flection) 
  49. Neck muscles - sternomastoid:
    • attached to the clavical & involved in the movement of the head
    • trapezius: upper back area, involved in raising the shoulders
  50. Ligaments:
    • bands of fibrous tissue that connects bones or cartilage
    • surround joints to give them stability w/help of muscles
    • ligament - also used to describe cord-like tissue structures that hold organs in place
  51. Treatment of wounds from simple laceration of muscles:
    • removal of foreign materail & tissue that can not be saved
    • closure of the deep fascia of the skin
    • short term immobilization & subsequent active rehab 
  52. Ectopic bone:
    • bleeding into the muscle & scarring from the haematoma may turn into ectopic bone
    • bone tissue is bone forming where it normally does not
    • pain & tenderness associated can be debilitating
    • not common, early diagnosis often missed, requires surgery 
  53. Sprains to the extreme:
    • muscles, tendons & ligaments possess a certain elasticity & when exceeded limit of stretching = damage
    • overstretching or tears to muscles or tendon fibers
    • strain - can be mild, moderate, severe
    • sprain - tearing of the ligament & often called torn ligament
    • also mild, moderate, severe
    • twisting may be combined w/pulling & stretching 
  54. Strain:
    overstretching & possible tearing of muscle or tendon fibers
  55. Sprain:
    partial or complete tearing of the ligament
  56. Symptoms of Strain/Sprain:
    • mild pain usually accomponies a simple muscle or tendon strain
    • Sprain:
    • usually severe, localized pian at the involved joint where tearing & stretching has occurred
    • severe swelling & inflammation from fluid moving into the surrounding tissue
    • small blood vessels are damaged
    • blood accumulates under the skin causing signifiant swelling
    • discolouration from decomposing blood
    • weight bearing may be difficult 
  57. Surgery required for sprain:
    • muscles, tendons, ligaments torn away & ruptured
    • when capsule surrounding joint is penetrated, chip fractures occur
    • sprains to knee joint:
    • complex joint
    • can be more disabling than a fracture
  58. Severe Sprain -
    Sprain Fracture: 
    • ligaments, tendons, capsule, cartilage & bones which form the joint may be damaged
    • sprain # - w/enough force, ligament can be pulled away from the bone, taking small piece of bone w/it
    • strength usually returns w/time & proper rehab
    • re-occurrences not unusual & possible to have partial permanent disability 
  59. Muscle Strains:
    • over stretching of muscles w/varying degrees of severity
    • treatment depends on extent of injury
    • main thrust is to prevent scar tissue @ site of injury
    • thickness of tissue @ site or adhesions to the joint are potentially debilitating
    • extraneous fibrous tissue can often be removed w/appropriate surgical treatment or injection of drugs
    • treatment directed at increasing blood supply to the injured part 
  60. Spasm, Atrophy, Deformity:
    • objective observations or consequence of injury in muscles
    • spasm = involuntary sudden movement or convulsive muscular contraction
    • muscle is tense/rigid, painful w/decreased ROM
  61. Myalgia:
    tenderness or pain in muscles
  62. Atrophy:
    • wasting or shrinkage of parts that are not used
    • common following immobilization of joints from fracture
    • can be cured w/normal usage of muscles
    • physiotherapy 
  63. EMG
    Surface Electromyogram: 
    • records electrical activity of skeletal muscles buy attaching electrodes to the body
    • shows if muscles are contracting or not 
  64. Cervical & Lubar Strains:
    • flexion - extension strain to cervical area may involve lumbar area as well
    • referred to w/ambiguous term "whiplash"
    • result of rapid acceleration/deceleration
    • mechanics of injury: when veh accelerated forward, body moves backwards causing cervical & lumbar strain
    • soft tissue injury can occur in both cervical & lumbar areas
    • pain associated w/muscle spasm, stiffness & decreased ROM should resolve w/in a few weeks
    • should resolve w/in a few weeks
    • drug therapy may induce depression, anxiety & inability to exercise
    • may need phsychiatric help for chronic pain
    • prolonged symptems may be due to complications of original injury or may be psychosomatic
  65. Cervical & Lumbar strains continued ...
    • w/acceleration injury, discs between vertebrae can be compressed
    • compression may be accompanied by nerve impingment, causing transitory numbness in arms, legs & fingers
  66. X-Rays / Degerneration:
    • x-rays may show degenerative changes in the spine
    • indication of pre-existing arthritic conditions
    • common & found in middle aged or older people
    • degenerative changes can hinder recovery and complicate treatment
    • x-rays do not reveal flexion-extension injury
    • identifies pre-existing conditions such as bone spurs from arthritis
    • small fracture may continue to cause disability and complications
    • tenuously related to original injury
    • despite extensive treatment, subjective complaints remain
  67. Fibromyalgia
    aka Chronic Pain Syndrome
    • disabling pain that persists over 3-6 months
    • beyond normal recovery period for STI
    • diagnostic criteria w/in medical field is vague
    • may require Rheumatologist or Neurologist for diagnosis
    • fairly insignificant STI's sustained in minor collision can become chronic pain syndrome
    • intensity & duration not medically reasonable sonsidering the relatively minor physical injury
    • pre-existing condition may be cause
    • must establish injury arose from accident
  68. Fibro/chronic pain treatment
    • must establish condition is directly related to the accident
    • may be treated w/pain managment process, analgesics, muscle relaxants, anti depressants
    • rehab programs that specialize in fibro/chronic pain syndrome
    • may be a substantial psychological element inlvolved
    • Psychiatric evaluations sometimes needed
    • pre-existing condition may be cause
    • determine causation.  Must be causualy related to accident
    • clmt must demonstrate desire to recover
    • clmt has obligation to mitigate
  69. Bones:
    • 206 in human skeleton
    • forms frame of the body & protects organs
    • provides frame work for soft tissue, shuch as skin & muscle 
  70. Fully developed bones are composed of 3 parts:
    • 1. Sheath - periosteum
    • 2. bones outer shell - compact or cortical bone
    • 3. inner part - medulla
  71. Sheath - Periosteum:
    • bones are sheathed by a membrane; the periosteum
    • where bony surfaces form joints, the protective covering is articular cartilage
    • Periosteum has outer layer of fibrous tissue & inner layer of cells called osteoblasts
  72. Bones outer shell - cortex
    • bone's outer shell of soft tissue: compact/cortical bone (cortex)
    • tightly packed layers of tissue w/in which are spaces of containing blood vessels and nerves
  73. Inner part -medulla
    • composed of cancellous or spongy bone
    • bone marrow is found narrow spaces in the sponge like bone 
  74. Cartilage:
    • tough non-vascular connective tissue present in joints & certain other body parts
    • non-vascular: does not have blood vessels
  75. Osteoporosis:
    • disease that results in the decline of bone mass
    • bones become more brittle & fracture easily
    • often associated with normal aging
    • condition in which bones contain less bone tissue (calcium) than normal bones 
  76. Senile osteoporosis:
    • found in elderly
    • leads to painless hip & vertebral multipal wedge type fractures that cause abnormal curvature of the spine
    • kyphosis / hunchback
    • appears in women sooner & more often than in med 
  77. Post traumatic osteoporosis:
    • occurs after injury
    • localized osteo (sudek's atrophy) may occur if there has been nerve damage
    • healing process is slow if osteo is a factor 
  78. Bone tissue:
    4 classifications of bone according to shape
    • long bones
    • short bones
    • flat bones
    • irregular bones 
  79. Long Bones:
    found where support & leverage are required
  80. Short bones:
    found where strength & only limited motion is needed
  81. Flat bones:
    forms walls around the viscera (internal organs) affording extensive attachments for muscles
  82. Irregular bones:
    vertebrae, coccyx, cranium, & certain bones of the face
  83. Locating bones:
    Identify part & location
    • Proximal
    • Distal
    • Costal
    • Dorsal
    • Inferior
    • Superior or Supra
    • Anterior
    • Posterior
    • Medial/middle
  84. Proximal:
    close to the torso of the body
  85. Distal:
    further away from the torso
  86. Costal:
    used to show relationship to a rib
  87. Dorsal:
    towards the back surface / same as posterior
  88. Inferior:
    low surface or lower part of 2 or more surfaces
  89. Superior / Supra:
    upper or above & refers to top end
  90. Anterior:
    nearer to the front of the body
  91. Posterior:
    nearer to the back of the body
  92. Medial / Middle:
    refers to the parts closer to the middle
  93. Rib Cage:
    • encases & protects the organs of the upper body or thorax
    • 24 Ribs
    • 12 on each side connected to the vertebrae by coastal cartilage
    • 14: upper true ribs are connected @ the front of the chest to the sternum or breastbone
    • 6: lower false ribs are connected by cartilage to the rib above
    • 4: bottom ribs (floating ribs) are connected to the vertebrae only
  94. Sternum/breastbone:
    flat & narrow bone linked to the clavicals (collar bone) and the 14 upper true ribs
  95. Rib Fractures:
    • common fractures
    • pain meds prescribed if uncomplicated fracture of 1 or 2 ribs
    • aggravated by sneezing, coughing, bending
    • inactive job = 5-10 day recovery
    • longer recovery if job has physical demands
    • chest cavity penetrated by compound fracture may affect lung structure & interfere w/breathing
    • sternum also vunerable to injury
    • often hairline fracture & respnds quckly to rest & conservative treatment 
  96. Shoulder:
    • each sholder has 2 bones
    • Scapula: shoulder blade; broad flat bone in the upper back
    • Clavicle: collar bone; slender bone in front of the scapula lying very close to the surface of the body @ the top of the shoulder
    • clavicle most frequently fractured bone in the body
    • usual fracture site is the junction of the middle & outer 3rds 
  97. Pelvis:
    • fused bone framework providing protection for the lower organs & support of the abdomen
    • located in the lower part of the trunk & supports the spinal column
    • aka pelvic girdle
    • most likely traumatic injuries are fractures & dislocations
    • pelvis has 3 main parts
    • ilia, ischia, pubes 
  98. Ilia (ilium sing.):
    • 2 large wing shaped Ilia
    • aka hip bone
    • fracture is usually a fragment that splits off the bone mass
    • normally not serious & heals w/out perp disability
    • has cup shaped deperssion, the acetabulum, which forms the socket for the femur (leg bone) 
  99. Ischia (ischium sing.):
    • 2 forming loops of bone that extend downward posteriorly from the ilia
    • bears most of the body weight while sitting
    • fractures usually the result of a blow to the side or back
  100. Pubes (pubis sing.)
    • 2 pubes extend in front of the base of the wings of the ilia forming arches above the ischia
    • fracture is usually the result of a blow to the front
    • articulate in the symphysis pubis; a joint which is composed of fibrocartilage 
  101. Arms:
    • made up of the humerus, radius, ulna
    • vulnerable because it is used to do so many functions
    • blows & falls cause fractures & dislocations
    • ulna & radius (forearm) more often fractured than the humerus 
  102. Humerus:
    • long upper arm bone
    • attaches to the scapula on its proximal end & extends to the elbow @ its distal end
    • prominences/processes called condyles
  103. Radius:
    attached to the lower end of the humerus extending to the hand in line with the thumb
  104. Ulna:
    attached to the humerus @ lower (distal) end & extends to the hand
  105. Condyles:
    rounded projections found on the humerus, femur, tibia & scapula
  106. Hand:
    • wrist, palm & fingers
    • consists of 3 groups of bones:
    • wrist: carpal
    • palm: metacarpal
    • fingers: phalanges
    • dislocations of finger joints or thumb are common & disability depends on work duties
    • fractures of the wrist, fingers/thumb are common
    • redness/swelling w/discolouration follow pain
    • hand bones heal faster than the wrist which often affects a # of bones
    • disability can be up to 10 weeks or longer 
  107. Wrist = Carpal bones:
    • 8 carpal bones in the wrist
    • fracture of the carpal scaphoid often does not unite properly when healing
  108. Palm = metacarpal:
    • 5 metacarpal bones
    • long cylindrical bones make up the palm
    • join the carpal @ the proximal end & phalanges @ the distal end where metacarpal heads for knuckles
  109. Fingers/digits = phalanges
    • 14 phalanges on each hand
    • 3 in each digit
    • 2 in each thumb
  110. Leg:
    • leg includes the thigh (between knee & hip)
    • made up of the femur, patella, tibula, fibula
    • fractures at the lower end of the tib/fib often involve the bones of the ankle
    • referred to as broken ankle or Pott's fracture
    • when tibia or both tib/fib are fractured, weight bearing  is impossible
    • disability period depends on complications, type of fracture & whether it extends into the knee or ankle joint
  111. Femur:
    • extends from the ilium to the knee
    • prominences are trochanters
    • greater and lesser trochanter
    • neck of femur has alignment problems when broken
  112. Patella:
    • knee cap
    • fractures are most often from direct force
    • severe pain & swelling followed by substantial swelling
    • fluids appear in the joint & then extensive discolouration and swelling up the thigh and down the leg
    • disability can be 6-8 or 10-12 weeks, depending on job
  113. Tibia:
    • shin bone
    • extends from femur to ankle
    • larger inner bone
    • lower 3rd often doesn't heal well after a break
    • fracture of the upper portion of may result in injury to the knee joint
    • fracture of the lower end often involve the ankle
    • serious injury w/long disability period
  114. Fibula:
    • connects to the top of the tibia and extends to the outside of the ankle
    • fracture of the lower end often involve the ankle
    • secondary importance as far as weight bearing
  115. Foot:
    • 26 bones on each foot
    • 7 Tarsal bones that make up the ankle
    • 5 metatarsal bones make up the instep
    • 14 phalanges make up the toes. Each toe has 3 and big toe has 2
    • functions to bear the weight of the body
    • ends of the phalanges join the underside of the metatarsal to form the ball of the foot
    • Talus aka astragalus, second largest tarsal bone & supports the tibia & rests on the largest talus bone, aka calcaneus.
    • calcaneus - also known as the heel bone
  116. Joints:
    • points where 2 or more bones meet or articulate
    • moveable and immovable joints
    • immovable joints occur when bones are in direct contact with each other
    • 3 types of joints
    • Hinge, Pivot & Ball socket
  117. 3 types of Joints:
    • Hinge: knees & fingers; bend
    • Pivot: elbows & head; pivot/turn
    • Ball & Socket: shoulder & hip
  118. Moveable Joints:
    • protected by shock absorbing layer of smooth cartilage over the ends of the bone
    • lubricated by synovial fluid which is which is encased with in a membrane
    • Bursae lubricate muscles or tendons where they glide over one another or are liable to rub on another muscles or tendon
    • bursae: small fluid filled sacs which lie between joints to facilitate movement
    • joints are held together by ligaments
  119. Ligaments:
    • fibrous tissue that connect bones or cartilage
    • instrumental in maintaining structural integreity of joints 
  120. Trauma & joints:
    • knees, elbows & fingers are often injured
    • some cases may require artificial joints to replace damaged ones
    • knees can be the most difficult to resolve
    • superficial injury may resolve quickly on its own
    • dmg to membrame lining can lead to complications, disabiling patients for months 
  121. Injuries to ligaments of the knee:
    • treat with immobilization with or without early controlled passive movement
    • sometimes surgery to repair
    • plateau in rehab process can be reached in a year or more
    • specific complaints; swelling, stiffness; pain & 'giving way'
    • joint injuries often associated w/sprains
    • sprains involve partial tearing to the ligaments 
  122. Synovitis:
    • inflammation of the synovial membrane which lines the capsule of a joint
    • can be releaved by aspiration of the fluid or by cortisone injection 
  123. Bursitis:
    • can be caused by blow to the muscle or bursae
    • inflammation of the bursae
    • pain w/movement in the joint 
  124. Elbow:
    • close fitting complex joint
    • exposed to injury because body points are prominent
    • ligaments are taut
    • muscular attachments are crowed into restricted bony surfaces surrounded by important blood vessels & nerves
    • injury to the elbow may be complicated by synovitis, curculation problems & formation of bony tissue; ectopic bone 
  125. Wrist sprain:
    • may be undiagnosed carpal fracture
    • may require surgery to;
    • repair ligaments
    • transfer tendons
    • preform ligamentous grafts
    • inter-carpal fusions
    • carpectomies or joint replacement
    • carpectoy = surgical removeal of the carpal bone 
  126. Arthritis:
    • inflammation of the joint caused by either non-traumatic or traumatic origins
    • nontraumatic arthritis; rheumatoid arthritis which is a progressive disease
    • traumatic arthritis; caused by a blow or pulling of a joint, eg: knee
    • trauma disrupts the smooth movement of the joint by;
    • creating rough surrfaces & irritation
    • inturupting blood supply to the joint
    • injuring the guy wires; tendons w/muscles which keep the joint in proper alignment 
  127. Injuries to Extremities:
    • extremities refer to arms, hands, legs, feet & shoulders
    • subject to;
    • abrasions
    • contusions
    • lacerations
    • fractions
    • dislocations
    • sprains and strains
  128. Reflex sympathetic dystrophy:
    • may follow a sprian, fracture or injury to nerves or blood vessels
    • disturbance of the sympathetic nervous system & can arise after traumatic injury, heart attack, stroke
    • symptoms; pallor, sweating, edema or skin atrophy, thin or shiny skin in affected area
  129. Dislocations:
    • most occur from trauma to shoulders, elbows or hips
    • dislocation: disturbance in the normal relationship of the bones which form a joint
    • surgery sometimes necessary to repair ligament damage
    • subluxation; partial dislocation
  130. Reduction:
    process of realigning bones when a dislocation or fracture occurs
  131. Adhesion:
    • fibrous band or structure abnormally uniting parts of the body
    • happens within the joint iflong interval of time passes before reduction and the joint remains inactive too long after reduction
    • may lead to permanent loss of movement
  132. Hip dislocation:
    • occurs when the femur head is pulled from the socket in the ilium and rammed back causing bone chipping, stretched ligaments & ruptured blood vessels
    • can also result in a fracture of the acetabelum or other part of the pelvic structure
  133. Avascular necrosis:
    • death of a bone fromthe absence or restricted flow of blood
    • upper head of femur forcibly removed & returned causing a flattening portion of the femur head affects normal rotation & wearing effect may cause avascular necrosis
    • may necissitate implant of artificial joint
  134. Fractures:
    • 2 main types:
    • simple
    • compound
  135. Simple Fracture:
    simple fracture of bone does not pierce the skin and is not exposed to the air
  136. Compound fracture:
    • bone is exposed to the air
    • skin is pierced
    • compound only when direct comminicaton exists between body surface and fractured bone ends
    • Degree of fracture:
    • fracture does not pass through the bone = partial or incomplete fracture
    • fracture does  pass through the bone - complete fracture
  137. 7 Common Patterns of Fractures:
    • 1. Comminuted #
    • 2. Transverse #
    • 3. Oblique #
    • 4. Spiral #
    • 5. Greenstick #
    • 6. Longitudinal #
    • 7. Impacted #
  138. Comminuted Fracture:
    complete break in 2,3 or more fragments w/the smaller fragments found between the two main fragments
  139. Transverse Fracture:
    complete break straight accross @ right angle to the shaft of the bone
  140. Oblique Fracture:
    complete break diagonally through the shaft of the bone
  141. Spiral Fracture:
    • complete break resembling the spiral in a cork screw
    • result of twisting force
  142. Greenstick Fracture:
    • incomplete break that splits in either direction from the break, resembling a break in a green twig
    • unbroken side is ent
    • usually occurs in children
  143. Longitudinal Fracture:
    runs from jont end of the bone towards the mid section
  144. Impacted Fracture:
    • bone forced into itself, splintering its mid section
    • may result from landing heavily on the feet
  145. Fracture Treatment:
    • under either general or local anesthesia
    • reduction: realigning of the broken bone
    • open reduction: surgical intervention necessary to bring bone into proper alignment
    • retention: holding reduced bone in alignment to ensure proper union
    • splintage: mechanical means of holding reduced bone fragments together
    • Post retention apparatus; look for
    • pain or discomfort
    • any sign of pressure on a nerve
    • any indication curculation is inadequate, which can result in avascular necrosis
  146. Internal Fixation:
    • secures bone
    • mechanical devices used = positioned plates fixed by screws, wires, rods or nails
    • removal of hardware not always necessary unless it caused difficulty
    • union ocurrs w/in 1-2 months w/out infection
    • firm union occurs w/in 3-4 months
    • callus: bony material formed when bone forming cells grow in blood clots around the fracture
  147. Imperfect healing of the fracture:
    • Imperfect healing results in partial union, fibrous union, mal-union or non-union
    • Partial unions: callus does not grow over entire fracture area
    • Fibrous union: callus not hardening
    • Mal-union: fragments unite but bone does not functon normally
    • Non-union: bone does not heal & fragments held together by tissue alone
    • usually resolved w/bone grafting; removing bone from other parts of the body and inserting it where fusion has faild
  148. Hip Fractures:
    • diagnosis usually refers to a fracture of the head of the
    • femur about the trochanters
    • pins, nails, rods & braces allow bones to be held in proper alignement so complete recovery is possible
    • fractures named based on location:
    • transcervical #
    • intertrochanteric #
    • subtrochanteric #
  149. Transcervical fracture:
    passes through the neck of the femur at a slant and is easily reduced
  150. Intertrochanteric fracture:
    • extends across the head of the femur from greater to lesser trochanter at the base of the neck of the femur
    • more severe than transcervical 
  151. Subtrochanteric fracture:
    • occurs at high point on the proximal end of the shaft of the femur just below the lesser trochanter
    • actually a fracture of the shaft of the femur
    • treated as a hip fracture due to is close proximity to the head 
  152. Amputation:
    deliberate surgical removal or accidental cutting off of a body part
  153. Amputation of a body part considered when:
    • A body part is:
    • practically severed by an accident
    • badly mangled w/extensive comminuted fractures and lacerations
    • has extensive injury to blood vessels associated with open joint fracture wound
    • is not resonding to treatment to stop an aggressive, destructive infection
    • If infection doesn't heal, speticemia may set in and the loss of blood and bacterial infectionof a wound may lead to gangrene 
  154. Gangrene:
    destroys body tissue
  155. Septicaemia:
    disease caused by pathogenic microorgananisms invading the body
  156. Myoplastic procedure:
    • used to remove circulation inthe extreme end of the stump to achive better muscular control
    • accomplished by closing the end of the bone w/an osteoplastic flap & connecting muscles to the end of the bone
    • used at initial amputation and for correction
    • prosthesis = artificial limb 
  157. Reattachment of the severed limb:
    • only attempted when appropriate medical expertese available & all other conditions are favorable
    • injury must be limted to the limb itself 
    • hospital must have necessary skill & experience
    • bone fixation w/nails and arteries and veins must be joined
    • severed limb must be preserved until curculation can be restored by reattachment
  158. Trauma during pregnancy:
    • abortion = premature expulsion of the fetus before it is sufficiently developed to survive outside the mohter's womb
    • violent trauma such as multiple fractures or serious internal injuries can result in abortion or premature birth
    • interval between accident & premature birth usually between a few hours to a few days
    • fetus will abort w/in minutes to a few hours following trauma
    • more than one week suggests not trauma related
  159. Premature labour:
    • can be brought on by traumatic injury
    • usually visible signs of external contusions or bruising
    • could be induced by violent jarring
    • bleeding often present & blood clot usually found in behind the placenta
    • violent injury to abdominal area could result in death of the fetus
  160. 3 Conditions that can occur in abnormal labour:
    • Placenta abruption:
    • premature detachment of a normally situated placenta
    • often caused by violent labour, disease & chronic nephritis (inflammation of the kindeys)
    • Placenta previa:
    • implantation of the placenta in the lower uterine segment
    • afterbirth delivers before the baby
    • Abnormal fetus presentation or unusual positioning of the fetus
    • cesarean section will done if required
  161. Spinal  column:
    • forms part of the skeletal system
    • made up of 33 vertebrae
    • vertabrae divided into 5 groups
    • 7 cervicle in the neck
    • 12 thoracic in the chest area
    • 5 lumbar in mid to lower back
    • 5 sacral in lower back (fused in adults)
    • 4 coccyx or tail bone (also fused)
    • 1st cervical is atlas, top vertabrae - supports the skull
    • cervical, thoracic & lumbar form moveable joints
    • sacral & coccyx are fused in adults
    • spine united with the pelvis @ the sacral vertebrae
  162. Vertebral foramen / foramina:
    • each vertibra has an opening called the vertebral foramen.
    • the foramina make a verticle passageway (vertebral canal) through wisch the spinal cord runs.
    • Sensory and motor nerves from the spinal cord travel between each verebrae linking the brain to all body parts
  163. Vertebrae processes:
    • cervical & thoracis vertebrae haev 3 bony extensions or
    • processes
    • single fin like spinous process is often referred to as the spine
    • each vertebra consists of 2 transverse processes, wing like projections from the bone
  164. Intervertebral disc:
    • doughnut shaped
    • separates each vertebra & acts as a shock absorber for the spinal column
    • made up of an outer layer of tough fibrous cartilage containing inner gelatenous mass of fine white elastic fibers = nucleus pulposis
  165. CT & MRI Scans:
    • CT - Computerized Tomography
    • MRI - Magnetic Resonance Imaging
    • used to provide images of damged disc structures and distored spinal nerves
  166. Spine injuries:
    • spine is suceptible to fracture
    • surrounding muscles & ligaments are prone to strains & sprains
    • Cervical & Lumbar areas more likley to be damaged by strain or sprain
    • other spinal regions, being more rigid & having greater protection, are more subject to fracture
  167. Inter-vertebral Disc Injury:
    • in any type of back injury can damage intervertebral disc or worsen a pre-existing condition
    • forces are exterted on the cervical or lumbar area, possible for the intervertebral disc will crack or rupture
    • = herniated disc syndrom
    • if spaces collapse, the vertebrae may impinge on the nerves causing pain to radiate down the arms or legs depending of the location of the injury
  168. Treatment of Intervertebral/herniated disc:
    • treatment consists of rest, massage, graduated exercise, heat, braces and drugs to releive pain & relax muscles
    • discecomy: removal of entire or part of a damged intervertebral disc.  Usually only the nucleus pulposus is removed
    • laminectoy: removal of part of the vertebrae to provide adequate space for bulging intervertebral disc
  169. Spinal Fusion:
    • fusing or rigid joining of 2 or more vertabrae
    • surgical proceedure and may follow a discectomy
    • may result in decreased range of motion
    • type of bone graft
    • area strengthed by fusion
    • fragment of bone from pelvis to reinforce or strengthen the spine
    • one vertebra above and one below the site of the nucleus pulposus removal
  170. Pseudo-arthritis:
    • weak or unsatisfactory union known as a false joing
    • fusion causes area above and below to be subjected to greater activit & further discs may require surgery
  171. Subluxation:
    • common result of flexion-extension injury
    • Subluxation: partial displacement of bone resulting in misalignment in the joint
    • Kyphosis: exaggerated increase in hte thoracic curve
    • Lordosis: increased forward curve in the lumbar area
    • Scoliosis: refers to lateral curvature of the spine
  172. Backache:
    • can be symptoms of disease or trauma
    • x-rays can reveal congenital problems or degenerative changes associated w/aging
    • degenerative changes can be symptomless until the accident
  173. Osteomyelitis:
    • Disease of hte spine
    • Inflammation of bone caused by a pus producing organisim
    • treated with antibiotics
  174. Psychogenic factors / back pain:
    • psychogenic factors can cause back pain
    • unconcious motivation
    • attracted to the attention pain generates
    • may conciously or unconciously connect pain with larger claim settlement
    • successful treatment depends on mental attitude
    • pending claims can have adverse psychological effect
    • Tx: rest, massage, graduated excercise & drugs
    • should return to activity as soon as possible
  175. Spine Fractures:
    • spine susceptible to fractures, strains or sprains
    • cervical and lumbar areas more likely damaged by strain or sprain
    • other spinal regions, more subject to fracture 
  176. Fractures: Cervical spine
    • most serious injury involving the spinal column due to relationship to spinal cord & vertebrae
    • fractures and dislocations often result in permanent disability to the spinal cord causing permanent paralysis below the injury site
    • surgery & traction used to realign fracture 
  177. Fractures: Toracic & Lumbar spine:
    • compression fractures don't usually involve the spinal cord
    • force that produces fracture usually results in compression of the vetebrtae from squeezing action to the bone
    • resolve themselves w/treatment - 3-6 months
    • no permanent disability 
  178. Fracture: Coccyx
    • treatment is conservative
    • fracture usually caused by fall or blow
    • never involves the spinal cord
    • if pain persists - coccygectomy removes the coccyx
    • no function value 
  179. Head: Teeth
    • primary teeth @ 24 months, 10 upper & 10 lower
    • placeholders for permanent teeth
    • permanent teeth @ 6-7 years, 16 upper & 16 lower
    • 32 permanent teeth in 4 groups
    • 8 incisors @ front
    • 4 canine beside incisors
    • 8 bicuspids behind canines
    • 12 molars @ back
  180. Teeth composition:
    • teeth composed of 4 types of tissue:
    • Enamel, dentine, dental pulp, cementum
    • -
    • Enamel: hard material covering the crown or exposed part of the teeth
    • Dentine: ivory material that makes up the body of the teeth
    • Dental Pulp: soft tissue that fills the core of the tooth & contains blood vessels and nerves
    • Cementum: hard material covering the root
  181. Temporomandibular Joint (TMJ)
    • lower horse shaped bone of the jaw that articulates with the skull
    • temporomandibular joint area cushioned by fluid filled cartilaginous discs
    • injury usually includes other face trauma
  182. Trauma to teeth:
    • usually includes other face trauma
    • affected by trauma depending on the seriousnes of injury & condition of the teeth pre-injury
    • injury conditions classified into; existing teeth, periodontitis, the jaw, prosthetic appliances & primary teeth
  183. Existing teeth:
    • need to know if teeth are vita/non-vital to assess damage
    • vital tooth: internal strength because pulp and dental tissue are alive
    • non-vital tooth: has had the nerves & blood vessels (pulp) destroyed or removed.  
    • root canals & fillings weaken teath
  184. Periodontitis:
    • disease of the connective tissue, bone & cum surrounding and supporting the teeth
    • causes inflammation of the gums (gingivitis) & loss of bone tissue around the tooth
    • disintegration of bone loosens teeth & trauma can loosen further
  185. Jaw, Adjacent Soft Tissues & Temporomandibular Joint:
    • jaw fracture leads to allegations of inability to chew, jaw joint damage and tinnitus
    • needs careful investigation - diagnosis of TMJ dysfunction is contraversial
  186. Oral Prosthetic Appliances:
    • prosthesis; any application designed to replace a missing body part with an artificial one
    • bridge work = prosthesis
    • determine quality, preaccident conditions and materials 
  187. Dental Claims:
    • can be exaggerated
    • all pre-accident dental records need to be obtained
    • IME w/dentist may be required
    • dental injuries should be treated immediately
    • cost may increase & additional work may be needed due to original decay 
  188. Ears:
    • 2 main functions: hearing & balance
    • 3 principal parts: outer ear (pinna), middle ear (tympanic) and inner ear 
  189. Outer ear (pinna)
    • visible outer protuberance
    • forms the auricle & opening to external auditory canal 
  190. Middle ear (tympanic) 
    • lies between the ear drum (tempanic membrane) and a thin partition of bone which seperates it from the inner ear
    • auditor ossicles - 3 tiny connected bones move w/in the middle ear and are essential for transfer of sound from outer - inner ear 
  191. Auditory Ossicles:
    • consist of the malleus, incus, stapes bones
    • malleus: attached to the ear drum
    • incus: connects the malleus to the inner/stapes bone
    • stapes bone: attached to the inner ear 
  192. Inner Ear:
    • consists of a number of fluid filled passageways called the labyrinth
    • located partly in the temporal bone of the skull
    • Consists of 3 main parts; vestibule, semicirculor canals, cochlea
  193. Burst eardrum:
    • tympanic membrane may burst as a result of a severe blow, compression or explosion
    • usually accompanied by severe pain, shock w/slight bleeding,
    • tinnitus, nausea & dizziness
    • damage results in some hearing impairment 
  194. Measuring Hearing Loss:
    • hearing loss measured in decibels
    • 0: sound 1st becomes audible
    • 20: whisper
    • 60: normal talking voice
    • 90: disturbingly loud noise 
  195. Eyes - Cornea:
    • easily injured by scratch or bright light
    • drops/ointments applied to prevent septic inflammation, reaction caused by decompositon of microorganism
    • scars from healing may cause loss of sight
    • any perfarating injures to eyeball extremely dangerous & often cause loss if sight
    • injuries may result in good eye developing "sympathetic ophthalmia"
    • good eye adopts the pathology of the injured eye
    • may require removal of the uninjured eye
    • Opthalmia: severe inflammation of the eye
  196. Skull:
    • bony frame work of the head
    • composed of cranial bones & bones of the face
    • Cranium includes 8 bones:
    • Occipital - back of the scull
    • Parietal - 2 at top side of skull
    • Temporal - above the ears
    • Sphenoid - at base of skull towards the front
    • Ethmoid - bone of the nose
    • Frontal - forehead 
  197. Fractures to the Skull:
    • 4 basic types of fractures to the skull;
    • basal, linear, depressed, compound 
  198. Basil fracture:
    • most common
    • involves lower part of the skull where it connects to the spinal column
    • symptoms; bleeding from 1 or both ears & hearing impairment
    • tinnitus may be present 
  199. Linear fracture:
    • minimal type of fracture
    • may cause extra dural haemorrhage
    • extra dural: outside the membrane of the brane
  200. Depressed fracture:
    • involves bone fragments driven into the intracranial cavity
    • serious fracture; may lacerate membrane covering the brain or the brain itself
    • can result in serious permanent impairment 
  201. Compound fracture:
    • opens to the exterior of the scalp
    • susceptible to infection
    • can cause loss of smell, involvement of cranial nerve, loss of vision 
  202. Complications of Skull fractures:
    • symptoms: headaches, dizzy spells, visual & speech disturbances, mental & personality changes
    • temporary or permanent paralysis
    • loss of senses such as taste, hearing, sight
    • meningitis may develop
    • a form of epilepsy may develop
    • Meningitis = inflammation of the membranes that encase the brain & spinal cord
  203. Facial Bones:
    • Nasals - make bridge of nose
    • Lacrimals - between the eyes
    • Malars - cheek bones
    • Maxillae - upper jaw bone
    • Mandible - lower jaw bone 
  204. Fracture of nasal/jaw bones:
    • most common injury to the face
    • improper healing may affect tear drainage
    • return to work in 5-10 days
    • lower jaw - mandible - treated by dentist, oral surgeon or plastic surgeon 
  205. Nervous System:
    • electro-chemical information pathway of the body
    • divided into 2 main parts: central & peripheral
    • Central:
    • brain & spinal cord
    • can not repair itslef
    • damage to any component is permanent
    • central nervous tissue destroyed in spinal column, permanent paralysis below the level of damage
    • most potentially devistating
    • Peripheral:
    • all other nerve elements
    • can repair itslef, albiet sometimes very slowly
    • peripheral nerve of leg severed, may be some degree of paralysis or interference w/sensation for months/years
    • function may be regained
    • length of time to heal & regain function can be + long
    • function can be partial or complete
  206. Brain:
    • consists of nerve cells called neurons, supporting cells, glial cells & blood vessels
    • Brain is divided into 3 main parts:
    • fore brain; mid brain; hind brain
    • Is contained w/in 3 protective membranes or menings
    • Dura: next to the skull
    • Arachnoid: beneath the dura & sperated by spinal fluid
    • Pia Mater: encases the brain, contains blood vessels 
  207. Forebrain:
    • 4 main parts
    • 2 cerebral hemisphers - involved in higher mental function, logic & creativity
    • Thalumus: sorts out sensory info & transmitts to appropriate part of the brain
    • Hypothalumus: nervous & endocrine system
    • Limbic system: memory & instinctive emotions
  208. Mid brain:
    • 1st part of the brain stem
    • where sensory & motor nerve fibers cross to supply opposite sides of the body
  209. Hind brain:
    • located at the back & base of the skul
    • includes cerebellum; involved in coordination of movement & pons - where nerve fibers interconnect
  210. General areas (lobes) of the Brain:
    • Frontal lobe - contains the cerebrum @ front of skull
    • Parietal lobe - upper back part of the skull
    • Occipital lobe - back of skul & contains part of the brain for sight
    • Temoral lobe - at sides of the skull and contains part responsible for memeor 
  211. Injury to Brain:
    • destroyed brain cells do not renew themselves
    • in some areas, undamaged cells are able to take over part of the function of the destroyed cells
    • difficult to assess brain damage
    • assessment is long & involved process 
  212. EEG - Electroencepholagram:
    • Electroencepholagram
    • measures electrical waves emitted by the brain 
  213. QEEG - Quantified Electroencephalography
    • Quantified Electroencephalography
    • analyzes brain activity 
  214. MRI & CT Scans:
    • both used to pin point tumors & visualize brain structure
    • do not provide info on brain function
  215. Closed Head Injury:
    • can occur w/out physical damage to the head, exterior signs of trauma
    • whiplash victim w/prolonged cognitive complaints may have bain damage from flexion-extension action
    • Signs of brain injury:
    • LOC, temporary amnesia, state of confusion, dizziness, vomiting
    • Early symptoms include headache and dizziness followed by progressive weakness to one side of the body & considerable instability of arms & legs 
  216. Glasgow Coma Scale:
    • used to judge the severity of brain injury
    • length of unconciousness is significant 
  217. severity table of Amnesia, Confusion, Poor orientation
    • 5 mins = very mild
    • 5 mis to 1 hour = mild
    • 1-24 hours = moderate
    • 1 day to 1 week = severe
    • 1 to 4 weeks = very severe 
  218. Effects of Brain Injuries:
    • Cause changes to cogntitive, behaviour & physical skills
    • cognitive: disoriention, memory loss, inability to make decisions & loss of concentration
    • behavioural & personality: apathy, indecision, indifference, drug & alcohol abuse
    • physical: poor balance & coordination, fatigue, headaches & dizziness
    • Post Traumatic Amnesia:
    • before injury = retrograde amnesia
    • after injury = anterograde 
  219. Subdural Haematoma:
    abnormal collection of blood  between the brain and the skull which exerts pressure on the brain, causes LOC & may result in paralysis
  220. Concussion:
    • violent jarring or blow to the head causing the brain to bounce against the inside of the skull
    • aka: contre coup injury
    • blood vessels rupture & blood can cause pressure on hte brain
    • blow may cause skull fracture w/contusions or laceratiosn of the brain
    • characterized by a periodof LOC which could be no more than a brief dazed period
    • Symptoms:
    • sudden vomiting, dizziness, sudden loss of sensation or movement
    • may be ringing in the ears & temporarily blurred vision
    • possible memory loss
    • headaches
  221. Cerebral Contusions: 
    • more serious & severe than concussions
    • may be gross lesion to  brain & skull fracture
    • may result prolonged LOC or death
    • symptoms include transitory paralysis w/motor weakness or minor sensory changes
    • serious contusions often involve upper mid brain subthalamus & result in a dazed state 
  222. Traumatic Psychosis:
    • when symptoms of psychotic impairment caused by physical injury
    • characterized by delusions and hallucinations
    • 3 major recognizable stages:
    • stupor or coma, unresponsive to feeding or nursing
    • delirium
    • restless, noisy behaviour
    • incoherent, confused & sometimes violent
    • partial or complete amnesia 
  223. Spinal Cord:
    • extension of the brain & part of the central nervous system
    • carries messages to brain
    • receives sensations from the skin
    • allows movement
    • encased in meninges & is filled with cerebospinal fluid
  224. Spinal Cord Injury:
    • Paraplegia = paralysis of both legs & lower part of the body
    • spinal cord severed at thoracic or lumbar spine
    • only lower extremeties involved
    • Quadriplegia = paralysis of arms, legs & most of body trunk
    • spinal cord severed w/in cervical area
    • level of function will depend of location of damage
    • vertebra identified by letter & #'s
  225. Location of # & resulting effect:
    • C1-2 = most serious & rare. If survives, will only have movement of the head
    • C3-4 = able to control neck as well as shrug shoulders
    • C5 = increased shoulder movements w/elbow flexion & bilateral arm function
    • C6 = some finger dextarity w/wrist extension ability
    • C7 = elbow extension & wrist flexion possible, potential for weak finger movement 
  226. Scene of Accident & Spinal cord injuries
    • unconscious or w/head injury; treated as though spinal cord injury has occured until proven otherwise
    • spinal cord may be torn, severed or compressed
    • any movement could cause para / quadriplegia
    • majority of spinal cord injuries caused by forcible & excessive flection
    • medical treatment is palliative
    • attempts to releive effects of injury rather than heal or cure
    • extensive rehab program should be implimented as soon as able 
  227. Heart & Circulatory System:
    - Heart 
    • heart is hollow, muscular organ behind & slightly to the left of the sternum
    • myocardium (myocardinal tissue) specialized cardiac muscle tissue
    • encased in membrane; pericardium
    • Divided into 4 chambers;
    • 2 atria
    • 2 ventricles
    • septum separates right atria & ventricles from left
  228. Respiration:
    • exchange of oxygen & waste products between the atmosphere & the cells of the body
    • includes breathing which oxyginates the blood by flowing through the lungs 
  229. Blood Vessels:
    • series of tubes
    • Largest blood vessels
    • arteries & veins
    • Smaller blood vessels
    • arterioles & venules
    • Smallest blood vessels
    • capillaries
    • Arteries always carry blood away from the heart and carry oxygenated & nutrient rich blood to all parts of the body 
  230. Important Arteries:
    • Aorta - main trunk artery
    • Common Carotid - supplies the brain
    • Pulmonary arteries - supply the lungs
    • Renal - supply the kidneys
    • Iliac - supply the legs 
  231. Purpose of arteries & veins:
    • arteries & arteriols always carry arteriol blood away from the heart
    • veins & venules alwasys carry venous blood to the heart
  232. Important Veins:
    • superior vena cava; colllects blood from upper part of the body
    • inferior vena cava; collects blood from lungs to heart
    • pulmonary; returns blood from lungs to heart
    • iliac veins; collect blood from the legs
  233. Pulmonary Arteries:
    carry deoxygenized blood
  234. Pulmonary Veins:
    carry oxyginated blood
  235. Trauma to Heart: 
    • cardiac tamponade; damage tothe coronary vessel or myocardium, resulting in bleeding w/in the pericardium
    • myocardial contusion; caused by blow to the chest that affects the heart musscle
    • Dysrhythmia; disturbance or abnormality of the hearts electrical conduction system
    • Arrhythmia; absence of an effective heart beat
    • myocardial infraction; heart attack. not trauma related 
  236. Blood:
    • Carries oxygen & nutrients to various tissues of the body
    • 2 main parts: liquid & solid components
    • Liquid component = plasma
    • Solid component = specialized cells
    • red, wite & platelets
    • red: carry oxygen to tissues of the body
    • primarily composed of haemoglobin
    • haemoglobin molecules carry the oxygen
    • white: primarily involved with immune system
    • fight disease & defend the body against bacteria
    • platelets: small bits of cellular material in the blood which assists in clotting
  237. Blood Pressure:
    • BP is highest during systolic: contraction phase of the heart
    • BP is lowest during the diastole: relaxion phase of the heart
    • Difference between 2 pressures: pulse pressure
    • pressure too high; hypertension
    • pressure too low; hypotension
    • Sphygmomanometer - measures blood pressure
    • Stethoscope - listens to the heart beat 
  238. Shock:
    • immediate effect of massive blood loss = shock
    • main effect of trauma on the blood is volume loss
    • leading cause of death in trauma victims
    • heart must beat faster to circulate same amount of blood to the tissues of the body
    • if blood loss severe, heart can't keep up w/demand
    • treated by stopping blood loss, rapidly replacing loss of fluids & administering drugs to stimulate heart
  239. Thrombosis:
    Blood clot in the circulatory system
  240. Embolus:
    loose clot in circulatory system
  241. Embolism:
    occlusion of a blood vessel by an embolus
  242. ECG = Electrocardiagram
    • Electrocardiam measures electrical activity generated by the heart
    • shows past & existing problems 
  243. Echo-cardiogram
    Echo-cardiogram; ultrasound that examins action of valves between heart chambers
  244. Radio-nucleotides
    • Radio-nucleotides; ingested liquid makes heart tissue conspicuous for scanning
    • aka Thallium
  245. Plethysmorgraph
    Plethysmorgraph measures variations in the size or part of organ produced by changes in the circulation of the blood within it
  246. Other organs:
    Lungs & Respiration
    • Lungs - masses of spongy tissue located w/in the thoracic cavity
    • extends from behind the collar bones to the diaphragm
    • each is encased in a membrane composed of 2 layers called pleura
    • between the layers, pleural cavity, is filled with fluid
    • alveoli pulmonis; air sacs in the lungs that diffuse oxygen from the air into the blood supply
    • trachea (windpipe) leads to air tubes; the bronchi, air
  247. Diaphragm:
    strong muscular portion betwen thoracic & abdominal cavity
  248. External respiration:
    process of inspiration (inhalation) in which oxygen is received inoto the blood stream via the lungs & expiration (exhalation) where carbon dioxide and vapour are expelled from the body
  249. Traumatic Hernia:
    protrusion of an organ or tissue through an opening of its surrounding walls
  250. Pneumothorax:
    • condition that causes a lung to collapse
    • caused by puncture to the lung
    • complications of lung collapsing can cause shortness of breath causing rapid shallow breathing resulting in cyanosis
  251. Cyanosis:
    causes skin, lips & nail beds to turn blueish due to insufficient oxygen in the blood
  252. Abdominal area:
    abdomen is encased in clear thin membrane called the peritoneum wall
  253. Peritoneum wall:
    clear thin membrane that encases the abdomen
  254. Liver
    • controls blood sugar levels, breaks down blood fats & secretes bile & filters blood
    • trauma may result in blood & bile leaking into hte peritonial cavity
  255. Pancreas
    • manufactures enzymes that help with food digestion
    • special cells scattered through the pancreas produce insulin
    • insulin; hormone that regulates sugar levels in the blood
  256. Kidneys:
    • 2 kidneys
    • back portion of the abdominal cavity just above the small of the back
    • filter waste products from teh blood & maintain body's acid-alkaline balance
    • bruised kidney may result in blood in the urine
  257. Spleen:
    • soft spogy organ, size of a fist, that lies behind the stomach just above the kidney
    • function is to producd certain blood cells, to destroy worn out blood cells & remove debrix of disintegrating blood cells
    • liver does similar purpose
    • removal is not life threatening
  258. Trauma to abdominal area:
    • blunt trauma to the abdominal area can cause tearing, perforaton or rupture of organs
    • frequency of injury to organs depends on positioning within the body & the amount of protection afforded by bone and muscle structure  
    • 1st sign of bleeding into the intestinal system is vomiting of blood or partially digested blood
  259. Laparotomy:
    incision through any part of the abdominal wall
  260. Laparoscopy:
    when endescope is used to visualize the contents of the abdominal cavity
  261. After multiple injuries;
    • immediate consideration must be given to respiration & circulation
    • air passages must be open and clear
    • haemorrhage must be controlled
    • loss of blood must be assessed & transfusion if necessary
    • exam to record blood pressure, pulse rate, respiration rate & temporature
    • x-rays to detect internal damage
  262. Tracheotomy:
    direct surgical opening of the trachea through the neck to facilitate breathing or remove secretions
  263. Thoracotomy:
    surgical incision in the chest wall
  264. Trauma & Cancer
    • controversial
    • argued that trauma will accelerate growth of cancer cells
    • trauma does not accelerate cancer cell reproduction
    • influx of white blood cells to the injured area tend to exert an inhibitory effect on surviving cancer cells & can slow down & even temorarily arrest cell reproduction 
  265. Psychological disorders:
    • psychological disorders can manifest itself in symptoms of physical illness
    • chronic pain syndrome with no organic evidence of disease detected may result from psychological disorder
    • pre-existing psychological condition may affect recovery from physical injury 
  266. DSMV-IV
    Diagnostic & Statistical Manual IV 
    • Diagnostic and Statistical Manual IV
    • lists diagnostic criterea, generaly accepted as the standard from physical injury 
  267. Neurosis:
    • disorder of the thought process w/out any sign of disease of the nervous system
    • term has been elimnated from the DSM-IV 
  268. Traumatic Nerosis:
    • nervous disorder caused by a traumatic event
    • manifests itself in emotional, psychological and occasionaly physical health of the claimant
    • claimant ends up being less successful coping w/everyday life
    • unhappy family and social life and complex medical history make claimants more vunerable 
  269. Symptoms of traumatic nerosis:
    • inability to work
    • significant weight loss
    • marital or family conflict
    • dramatic mood shifts
    • Treated with tranquilizers & psychotherapy
  270. Depression:
    • reactive depression; brought on by losses incurred by or involvment in an accident
    • depression is a diagnosis of a mental disorder = major depressive disorder  
  271. Symptoms of depression disorder
    • loss of appetite & weight
    • low energy
    • sleep problems
    • loss of self confidence and loss of self esteem 
  272. PTSD:
    Post Traumatic Stress Disorder 
    • Anxiety disorder caused by experiencing a distressingly serious event to oneself, children, spouse or close friend or relative
    • characterized by persistent re-experiencing of a very stressful event.
    • Anxiety symptoms & avoidance behaviour commonly present
    • DSM-IV relied upon to diagnose PTSD
  273. Symptoms of PTSD:
    • 1. response of intense fear, helplesness or horror
    • 2. recurrant intrusive re-experiencing of the event through nightmares or flashbacks
    • 3. avoidance of stimuli associated with trauma and numbing of general responsiveness
    • 4. persistent symptoms of arousal (could be associated with hypersensativity)
    • 5. disturbance must have lasted for more than one month
    • 6. Significant clinical impairment in important areas of functioning
  274. Phobias:
    • unrealistic fears
    • anxiety disorder that inhibits patients from engaging in a particular activity, ie: driving
    • responses are judged to be excessive or unreasonable 
  275. Psychosomatic:
    refers to the relationship between mind & body
  276. Somatoform:
    • refers to condition when psychosomatic or psychogenic-based symptoms resmble those of physical disease
    • symptoms are vague and complicated and generally include gastrointestinal problems, pain, shortness of breath, palpitations, chest pains
  277. Facticious Disorder:
    • refers to someone who consciously fabricates symptoms to fulfill an unconsious need to be sick
    • treated w/multi-disciplinary programs
    • psychiatry, psychologists, psychotherapy, counselling and drug therapy
    • group therapy sometimes usefull
    • thin line between factitious disorder & malingering
    • unconscious motivation to be sick
  278. Patient profile w/Factitious Disorder:
    • a history of many physical complaints, multiple hospitalizations
    • inconsisten cooperation provided to the treating doctor
    • acknowledgement that symptoms are controlled
    • demonstrated dependency on attention provided by medical personnel
  279. Possible treatments for Mental Disorders:
    • psychotherapy
    • desensitization
    • behaviour modification
    • drug therapy
    • councelling
    • relaxion training
    • strategies to develop coping skills
  280. Objective v. Subjective Injury:
    • Objective injury: clearly visible
    • Subjective injury: not visible but can be confirmed by detecting observable signs = objective findings
  281. Objective v. Subjective findings:
    • Objective findings: detectible by an observer or an external measure (abrasion, bruising, spasm)
    • Subjective findings: not detectible by an observer
    • symptoms verbally reported by the claimant are relied upon
    • sub findings; made when clmt does not manifest discernable physical signs to corroborate the injury
  282. Malingering:
    • wilful, deliberate & fraudulent feigning or exaggeration of a symptom of illness or injury, done for the purpose of a consciously desired end
    • some may fall into grey area
    • must be established that there is a concsious desire for financial gain
  283. Fraud warning signs:
    • prolonged recover
    • previous medical or disability claims
    • work time lost due to previous soft tissue complaints
    • poor general health
    • treatment programs w/many therapists treating the same condition
    • only recently employed or dissatisfaction with job
    • spouse currently disabled from work
    • unstable family situation
  284. Waddell Test
    • psychological test
    • sometimes used to cooberate a diagnosis or to detect exaggerated or inappropriate responses 
  285. Classifying Disabilities:
    • Based on WHO - World Heath Organization;
    • Impairment: loss or abnormality of a psychological function or anatomical structure
    • Disability: restriction or lack of ability to perform w/in a normal range, ie; loss of ability to write
    • Handicap: environmental or social barrier that impedes individuals with impairments or disabilities. eg; employer does not accomodate
  286. Disability w/in Insurance:
    the inability to engage in any gainful activity because of physical or mental impairment
  287. Disability Period:
    time interval in which a person is unable to engage in any substantial, gainful activity because of physical or mental impairment
  288. Types of disability:
    • Permanent: probably persists for duration of life
    • Temporary: will only last a limited period of time
    • -
    • Temporary Partial: temporarily unable to preform some job related tasks
    • Temporary Total: can not preform any job duties for a specific period of time
    • Permanent Partial: permanent loss of a body function has occurred. May be minor loss or could apply to loss of a part of the body
    • Permanent Total: permanently & totally incapable of preforming any job functions 
  289. CCDO:
    Canadian Classification & Dictonary of Occupation
    • Canadian Classification & Dictonary of Occupation
    • Sedentary, light, medium, heavy & very heavy
    • -
    • Sedentary work: lifting up to 10lbs, mostly sitting with occasional standing and walking necessary
    • Light work: lifting up to 20lbs & carrying objects frequently up to 10lbs. Requires significant walking or standing
    • Medium work: frequently lifitng up ot 50lbs & carrying up to 20lbs
    • Heavy work: lifting up to 100lbs & carrying up to 50lbs
    • Very Heavy work: lifting & carrying up to 100lbs 
  290. Factors affecting Disability period:
    • Health
    • Age
    • Pre-existing conditions
    • Injury Severity
    • Infection
    • Psychological attitudes
    • Occupation
    • Environment
    • -
    • Generally in everyones best interst, especially claimants, to return to work & regular activity asap
  291. Wage Loss:
    • must be appropriate time lost for injury, occupation and duties.
    • disabled but ready for work - office worker w/broken leg is able to carry out work-related duties v. construction worker w/broken leg may be totally disabled
  292. Rehabiliitation services/service providers:
    • rehab consultant/case worker
    • medical care & treatment
    • physical & occupational therapies(ists)
    • psychologists
    • training in self care
    • vocational aessment
    • social/financial counselling 
  293. Orthotic/Prosthetic Equipment:
    • equipment that has been specifically designed to help patients function more independantly
    • Orthosis: appliance or apparatus used to support, align, prevent  or correct deformities or to improve function of moveable parts of the body
    • hearing aids, glasses, special clothing & shoes
    • wheelchairs, hospital beds
    • hand controls on cars
    • ramps, special toilet & shower facilities
    • Prosthetic devices may serve cosmetic & functional purpose
    • Prosthesis: artifical substiture for a missing body part
    • artificial limb(s)
  294. Goals of Rehab:
    • restoring normal form and function or restoring best function possible
    • maximum medical recovery
    • early return to work
    • return to pre-accident lifestyle or viable alternative
    • Primary goal: return to full function or learn to operate within limits the disability imposes 
  295. Rehab assessments:
    • begins with assessment to develop appropriate rehab plan
    • impairments may include cognitive abilities, emotional control, social function in addition to physical limitations 
  296. Rehab Team:
    • treating Doctors/medical specialists/nurses
    • physical & speech therapists
    • psychologists & psychiatrists
    • social workers
    • special ed teachers
    • vocational/occupational experts
    • rehab case managers 
  297. Rehab service advisors:
    consult with adjusters about available services and how rehab process should work. Review and give directions
  298. Rehab case management:
    coordinating rehab services required and ensureing communication is maintained between all necessary parties
  299. Functional Capacity Assessment:
    review conducted by a rehab expert based on the collection of comprehensive medicle & non-medical information to determine a claimants fitness for work
  300. OT - Occupational Therapist:
    • teaching & coaching patients to relearn daily living skills
    • help patients develop motor skills & sensory functions to enable them to eat, dress, do housework & other similar things
    • teaching people to preform necesary functions in a way that that reduces pain & possibility of furhter injury
  301. OT specialties:
    • standardized and non-standardized evaluation approches
    • ergonomics/job modification/RTW strategies
    • general physical conditioning/work hardening programs
    • stress/pain management
    • cognitive retraining 
  302. Work Hardening:
    process used by vocational experts to help prepare individuals toe re-enter the workforce. Often excercises to simulate work activities are prepared so that individuals can practice work skills & increase their stamina gradually. Sometimes in their own work environment
  303. Kinesiology:
    study of human body movements
  304. Kinesiotherapy:
    uses movement and exercise to treat injuries
  305. RTW Hierarchy
    • Same employer:
    • same job
    • modified job
    • different job
    • Different employer:
    • same job
    • modified job
    • different job 
  306. Ergonomics:
    • Ergonomic assessment identifies restrictions or appropriate modifications for the workplace or at time
    • Deals with the application of scientific principles to improve the fit between people and thier jobs to achieve the best possible result in work production. A chair that can be adjusted for the employee's height and back support = operation of ergonomics
  307. Psychologists:
    • help with coping with chronic pain, fatigue and emotional problems caused by the trauma of the accident
    • may preform cognitive testing
    • preform psychometric testing: systematic measurement of mental processes and behavioural acts 
  308. Physiotherapy:
    • entails the assessment of physical function and the treatment, rehabilitation and prevention of physical dysfunction and the pain associated with it
    • used most extensivly to restore normal function of bones, joints & muscles
    • physiotherapists diagnose, assess & treat conditions which limit physical and functional independance
    • orthopedic and soft tissue injuries, including burns
    • cardiac, respritary and chronic disease
    • neurological injury 
  309. Chiropractic:
    involves assessment of conditions related to the spine, nervous systom and joints.
  310. Catastrophic Injury:
    • serious, permanent impairment of a body function or mental process.
    • rehab always necessary if accident causes clmt to become blind, paralyzed, brain impaired or results in the amputation of a body part.
    • Treatment may require involvement of skills of: Neurosurgery, Urology, Plastic Surgery, Internal Medicine, Radiography, Orthopedics, Physiotherapy, Prosthetics and specialized nursing care
    • Consideration must be made to long term care costs, equipment and other orthotic devices, nursing and housing, therapy, transportation, personal care and personal mobility
  311. Medical Information:
    • many sources, including:
    • Clinical notes
    • Hospital records
    • Emergency department records / ambulance reports
    • medical questionnaire
    • Doctor's correspondence to each other resulting from referrals and consultations from treating Dr. to specialist
    • Medical-Legal reports; completed by treating doctor
    • Independant Medical Examinations (IME); second medical opinion
    • Other related reports; psychologists, rehab specialist 
  312. Medical Legal Report:
    • Most common sourse of medical information and may be admitted as evidence to substantiate or to refute injury claims
    • Reports address causation and treatment & should be objective.
  313. Plaintiff-oriented doctor:
    tends to emphasize or dramatize the injuries, perhaps not intentioally or consciously, but rather because the sum total of thier experience leads in this direction.  Tends to be an advocate for teh patient
  314. Defence-oriented doctor:
    assumes a critical position that tends to minimize the effects of an injury. Subjective complaints are less likely to be accepted at face value unless supported with other evidence
  315. Possible v. Probable
    • Possible; may happen or develop
    • Probably; likley will happen & can often be state the degree of probability in percentage.
    • ie: 75% chance of arthritis to develop 
  316. Question medical report when:
    • lack of information
    • issue needs clariffication
    • conclusion has not  been supported
    • ambiguity or inconsistency exists
  317. Report on effects of injury:
    • what is the impairment & how does it prevent return to work
    • total disability or capable of doing other work
    • disability reasonable considering impairment and job duties
    • what was extent and duration of pain & suffering
    • how effective were drugs or other therapy in alleviating pain & suffering 
  318. Elements of a Medical-Legal Report:
    • 1. Medical Qualificatons
    • 2. Claimant Identification
    • 3. History
    • 4. Examination
    • 5. Diagnosis/Prognosis (opinion)
    • 6. Treatment Regimin
    • drugs prescribed & effects
    • recommendationof surgery or other medical treatment
    • activities: participation and restrictions
    • excercise program/therapy
    • return to work
    • 7. Follow-up Visits
    • 8. Referral to Specialist
    • 9. Prognosis
  319. Etiology:
    study of causation of injury and disease
  320. Prognosis should address:
    • length of time for injury to resolve
    • when claimant can return to work
    • further recommended treatment with expected results
    • when treatment will end
    • alternatives to be considered if treatment fails to produce results
    • lasting effects caused by injury and whether permanent disability will result
  321. Independant Medical Exam: IME
    Defence Medical
    • examiner must carry weight in judicial proceeding
    • assumptions must be listed
    • information provided/reviewed must  be listed
    • Ambulance report;
    • Emerg department report;
    • Police Report;
    • Pre-accident details of functioning & medical condition
    • * complete clinical notes from family doctor & all ohter treators
  322. Elements of a Claim:
    • facts of the accident
    • law which applies
    • nature and extent of injuries
    • damages claimed
    • damages which can be proven
    • defences available to the claimant 
  323. Claim Evaluation:
    Liability & Damages
    • establishing the value of a claim requires assessment of both liability and damages
    • evaluate range; similar claims, court decisions, best & worst case scenerios
    • liability to be determined to assess fault
    • negligence can be assessed against the parties in varying degress
    • best/worse scenarios by considering what injuries will be accepted by the court, claimants credibility and will subjective complaints be accepted
    • analyze for defences available and elements that will limit amount payable
    • remoteness of damage
    • reasonable forseeability
  324. Damages:
    • Damages: the monetary compensation recovered by the party who has suffered loss or injury to personor property, through negligence of another.
    • Compensatory Damages: compensation that will return the party to the same or similar position enjoyed prior to the accident or loss.
    • Punative or Exemplary damages: awared to punish
    • -
    • General Damages = pecuniary/nonpecuniary
    • Future Care & loss of Future Income
    • Special Damages = out of pocket
  325. Linking Damages to Negligence Act:
    • pltf must show that the damages claimed flow directly or inderectly as a resut of the defendant's negligent act.
    • Causal connection must be established between the negligent act of the defendant and the damages suffered by the plaintiff
    • consequenses must not be deemed to be remote from the act 'remoteness of damage' 
  326. Burdon of Proof:
    • generally rests with the claimant. Who alleges must prove
    • onus can shift because of statute or applicable laws
    • Plaintiff must provide proof to substantiate
    • loss of opportunity
    • loss of competative advantage 
  327. Pre-Existing Conditions:
    • Thin skull doctrine
    • crumbling skull
    •  damages assessed on basis of medical evidence which clearly establishes any exacerbation of the condition & additional expenses
  328. Mitigating Damages:
    all reasonable steps must be taken to limit damages caused by the injury
  329. Collateral Sources:
    • compensation from other sources
    • accident & sickness benefits through employer, unemployment insurance, canada pension plan, wcb, government health plans, other private medical
    • subrogation rights to eliminate duplication "double dipping"
  330. Conflicting Medical reports:
    Specialist opinion accepted over family doctor 
  331. Sympathy Factor:
    • permanent and serious injury may arouse sympathy in a judge or jury
    • very likable plaintiff v. unlikeable defendant
    • small children who are now parentless 
  332. Evaluating Pecuniary Damages:
    • Expense must be reasonalbe and directly related to injury sustained in hte accident
    • moniter for anything unusual;
    • innapropriate or excessive drugs, therapy
    • wage loss claim must be reasonable considering the duration of the injury, type of job, special duties involved, seasonal work or availability of work
    • lost overtime, repayment of sick bank or loss of sick days must be considered
    • self-employed or income based on commission will require history of earnings over a period of time through income tax records, business records
  333. Fatalities:
    • determine anticipated lifespan
    • work history;
    • when/where employed
    • earnings
    • position
    • absenteeism
    • work preformance reviews
    • any personnel information that affected long term employment
    • strikes/labour disputes
    • scheduled plant closures
    • early retirement
    • Family Situation:
    • inside/outside household roles
    • repairs/maintenance
    • children
    • income history
Card Set:
CIP - C12 (4).txt
2012-07-03 00:28:55
C32 Bodily Injury

CIP C32: Bodily Injury
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