Unit 5 (Traumatic Disease)

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nenyabrooke
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Unit 5 (Traumatic Disease)
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Unit 5: Traumatic Disease
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  1. trauma is the most common cause of death
    between the ages of:
    1-44
  2. the cost of traumatic disease to the US:
    $200 Billion
  3. list the three critical periods after injury:
    • first: occurs seconds after injury
    • second: occurs during the first four hours after
    • third: occurs days to weeks after
  4. if death occurs in the first critical time period, it is usually due to:
    lacerations of the brain
  5. list the classifications of injury in the 1st triage:
    • life-threatening
    • urgent
    • non-urgent
  6. list the classifications of injury in the 2nd triage:
    • state of consciousness
    • vital signs
    • pupil size and reaction to light
    • motor activity of extremeties
  7. list the three classifications of medical facilities and their abilities:
    • level I medical center: total care all injuries
    • level II medical center: most common trauma facility serving as community trauma centers
    • level III medical center: in remote rural areas serving communities that do not have a level II facility
  8. CDC recognizes that ERs play a major role in the treatment of minor injuries and more recently they recognize them as:
    the first line of defense against bioterrorism
  9. name three main types of trauma injuries that are being directed straight to CT:
    • acute cerebral hemorrhage
    • fractures of skull, facial bones, spine
    • blunt trauma of abdomen
  10. how likely is a kidney injury with blunt trauma of the abdomen?
    10%-15%
  11. why are CTs preferred over IVUs with blunt trauma of the abdomen?
    the contrast better helps to evaluate vascular injuries
  12. what is the canadian rule when it comes to CT for trauma injuries?
    injuries with a Glasgow Coma scale (GCS) of 13-15 need a CT
  13. new orleans helical computed tomography (HCT) rule – CT should be performed on patients with a GCS of _____ in combination with any one of the following:
    • GCS: 15
    • headache
    • vomiting
    • greater than 60 years of age
    • drug or alcohol intoxication
    • persistent amnesia
    • visible trauma above clavicle
    • seizure
  14. the national emergency x-radiography utilization study (NEXUS) concluded that CT demonstrated a ______ sensitivity for cervical fractures, while radiography has a _____ specificity for cervical injury.
    • CT: 99.6%
    • xray: 52%
  15. what are the three most common injury causes to the cervical spine in vehicular accidents?
    • 1st: no seatbelt
    • 2nd: air bag only
    • 3rd: seat belt only
  16. hyperextension injuries of the head and neck or direct trauma to the neck can injure the:
    carotid arteries
  17. most frequent type of injury involving a vertebral body:
    compression fracture
  18. most common sites of compression fracture in the spine:
    • T11 – T12 in the thoracic spine
    • T12 – L1 in the lumbar spine
  19. a fracture of the arch of the second cervical vertebra that is usually accompanied by anterior subluxation of the second cervical vertebra on the third cervical vertebra:
    • hangman's fracture
    • (may be referred to as traumatic spondylosis)
  20. a burst fracture of C-1 caused by axial force causing compression:
    • jefferson fracture
    • (MRI preferred to examine)
  21. a type of fracture that involves only one column of the spine, either the anterior column or the posterior column:
    • stable fracture
    • neck brace and bed rest until pain and swelling subsides
  22. a type of fracture that involves both columns of bone of the spine:
    • unstable fracture
    • immobilization with traction or with surgery for internal fixation devices or to remove a segment of bone that impinges on the cord
  23. evaluation of trauma cervical spine radiographs may require:
    • pillar projection
    • traumaobliques
  24. temporary neurological function is lost when there is ___________ of the spinal cord, and there is permanent loss of neurological function when the cord is ____________.
    • compression (due to contusion or hemorrhage)
    • lacerated
  25. laceration of the cord above the _____ cervical vertebra is usually fatal, while laceration below this level results in paralysis:
    5th
  26. of value in the detection of spinal fractures:
    of value for horizontal fractures:
    of value for soft tissue injury to the cord:
    • CT
    • tomography
    • MRI
  27. the brain is protected by (3):
    • diploe of skull
    • CSF
    • tough dura mater
  28. the major neurologic cause of mortality and morbidity in individuals under 50 years of age:
    head trauma
  29. review the three meninges:
    • pia: inner sheath "tender mother", highly vascular
    • arachnoid: delicate central sheath, resembles a web
    • dura: outer sheath "tough mother"
  30. skull fractures are often seen with accompanying:
    hematomas
  31. skull fractures that enter sinuses or mastoid area can cause:
    • encephalitis
    • meningitis
  32. open skull fractures are at risk for:
    • meningitis
    • brain abscesses
  33. three classification of skull fractures:
    • linear
    • depressed
    • basilar
  34. cerebral cranial fracture is a term referring to a fracture in the:
    calvaria of the skull
  35. when it comes to fractures of the skull, the _________ of the fracture is more important than the __________ of the fracture.
    • location
    • extent
  36. describe linear fractures of the skull:
    • makes up 80% of skull fractures
    • sharp, defined lines
    • radiolucent
  37. describe depression fractures of the skull:
    • appears as a curvilinear density because the fracture edges are overlapped
    • may be injury to the cerebral cortex causing bleeding into the subarachnoid space
    • tangential beam best demonstrates this fracture
  38. describe basilar fractures of the skull:
    • fracture in the base of the skull
    • air/fluid levels in sphenoid sinus or clouding of mastoid air cells is often the only clue
    • CT and MRI are helpful
  39. an injury that occurs from acceleration and rapid deceleration of the head in which there is no penetration wound:
    closed head injury
  40. name some occurrences with a closed head injury (3):
    • brain tissues are injured from compression, tension, and shearing
    • the superficial cerebrum in the frontal, temporal, and occipital regions is most often affected
    • coma, usually serious
  41. name some symptoms, recovery, and treatment associated with a concussion:
    • temporary loss of consciousness and reflexes
    • headache, vertigo, vomiting
    • impairment of higher mental functions for several hours
    • recovery: generally occurs in less than 24 hours
    • treatment: bed rest
  42. a traumatic injury that results from a direct blow to the head in which there is bruising of the brain parenchyma:
    • contusion
    • (more serious than a concussion)
  43. CT demonstrates contusions as:
    small, ill-defined foci of increased densities
  44. a contusion formed on the side of the head where the trauma occurs:
    coup lesion
  45. a contusion formed on the opposite side of the skull in reference to the site of trauma:
    contrecoup lesion
  46. symptoms of a contusion:
    • drowsiness
    • confusion
    • agitation
    • possible hemiparesis and unequal pupil size
  47. treatment for a contusion:
    • prevention of shock
    • control of edema
    • drainage of hematoma
  48. persistence of loss of consciousness for more than 24 hours:
    coma
  49. comas most commonly result from:
    • trauma to the head
    • non-traumatic metabolic malfunctions or circulatory problems
  50. modalities to determine the cause of a coma:
    • CT
    • MRI
    • PET (positron emission tomography)
    • Fusion imaging
  51. four types of hematoma:
    • epidural
    • subdural
    • subarachnoid
    • intracerebral
  52. results from a torn artery, usually the middle meningeal artery often resulting from a fracture fragment of the squamous portion of the temporal bone:
    epidural hematoma
  53. which type of hematoma has the highest mortality rate?
    • epidural hematoma
    • seen on xray 80% of the time
    • treatment: surgery
  54. delayed coma can occur with:
    • subdural hematoma
    • (occurs more slowly than epidural hematoma)
  55. name the three stages of a subdural hematoma:
    • acute stage: on CT a curvilinear area of increased density on portions or all of the cerebral hemispheres
    • subacute stage: decreased or isodense fluid collection
    • chronic  stage: surface of the hematoma becomes concave
  56. a type of hematoma that occurs most often at the vertex, resulting from tearing of small vessels and is usually limited to one or two sulci:
    subarachnoid hemotoma
  57. bleeding within the brain that can result from trauma, ruptured hemangiomas, or stroke:
    intracerebral hematoma
  58. diagnosis of hematomas is based on:
    • clinical history
    • neurologic signs and symptoms
    • CT (diagnoses bleeding)
    • angiography (diagnoses defects in the cerebral vasculature)
  59. a discontinuity of bone caused by mechanical forces:
    fracture
  60. fracture that occurs in abnormal bone weakened by a disease process:
    pathologic fracture
  61. how many projections must be made to evaluate a fracture?
    • at least two (at right angles to each other)
    • (always image the joint above and below the
    • injury)
  62. radiographic appearance of a bone fracture:
    • radiolucent line in most cases
    • radiopaque line if fragments overlap
    • step in the cortex
  63. signs indicating possible radiographic fracture (6):
    • interruption of the bony trabeculae
    • bulging or buckling of the cortex
    • soft tissue swelling
    • joint effusion
    • the relationship of the end of a bone to its shaft
    • loss of volar tilt to the distal radial articular surface with an impacted distal radial fracture
  64. volar:
    palm
  65. damages that can occur from fractures:
    • neurovascular structures
    • capsular and ligamentous tears
    • cartilage injury
    • hemarthroses
  66. blood in the joint:
    hemarthroses
  67. what type of projection is used to determine ligamentous stability?
    stress views
  68. what is the first assessment of a possible ligamentous injury?
    to check the pulse of that extremity
  69. in radiographing for fractures, give an indication that the film is too light and in indication that the film is too dark:
    • too light: no trabecular pattern
    • too dark: soft tissue structures burned out
  70. bone can reactivate processes that occur during:
    embryogenesis
  71. know the steps for bone regeneration (6):
    • initially: a clot fills the gap of the fracture
    • 2-3 days: osteoblasts appear around the injured bone
    • 1 week: provisional callus forms (mainly cartilage)
    • 2–4 weeks: bony callus replaces the provisional callus
    • 4-6 weeks: the break is rigidly united and excess bone encircles the external fracture site and is found within the marrow space
    • months: remodeling of the bone and healing, weight-bearing force tends to guide the modeling process
  72. healing process steps (5):
    • initial immobilization
    • alignment or reduction
    • proper metabolic activity
    • proper nutrition
    • normal hormone levels
  73. refers to a fracture that does not heal in the usual time:
    delayed union
  74. a fracture that heals in a faulty position:
    malunion
  75. a fracture in which healing does not occur and the fragments do not join:
    non-union fracture
  76. what can cause a non-union fracture to occur?
    • the most serious complication
    • due to lack of vacsularization
  77. types of common bone fractures (9):
    • oblique
    • occult
    • open
    • pathologic
    • segmented
    • spiral
    • transverse
    • greenstick
    • impacted
  78. a fracture that breaks through the skin:
    open/compound
  79. a fracture that does not break through the skin:
    closed/simple
  80. a rib fracture that penetrates the lung often results in:
    a pneumothorax
  81. complications of skeletal fractures include:
    muscular ossification and fat emboli occurring in bones containing yellow bone marrow
  82. classifications based on the appearance of these fracture line types (5):
    • torsion-twisting
    • transverse
    • linear
    • spiral
    • impacted
  83. fracture classifications based on location (4):
    • intertrochanteric
    • transcervical
    • supracondylar
    • transcondylar
  84. treatments of fractures (2):
    • closed reduction
    • open reduction (open reduction internal fixation - ORIF)
  85. one or more fragments separate along the edges of the major fragment, in addition to the major line of the fracture:
    • comminuted fracture
    • (looks like shattered bone)
    • differs from multiple fractures because there is no intact shaft of bone between fragments
  86. criteria to determine a comminuted fracture:
    there are at least three fragments and the fracture lines interconnect
  87. a comminuted fracture in which there are one or two wedge-shaped fragments that split off from the main fragment:
    butterfly fracture
  88. a comminuted fracture with long, sharp-pointed fragments:
    splintered fracture
  89. bone has separated into two fragments and may be named according to the direction of the fracture line:
    complete noncomminuted fracture
  90. a type of break in the bone which is very unstable and one of the rarest breaks:
    • oblique break
    • can be misdiagnosed as a spiral fracture
  91. Pathological fractures are frequently __________ fractures.
    transverse
  92. a type of fracture that occurs when a fragment of bone is pulled away from the shaft:
    avulsion fracture
  93. where do avulsion fractures usually occur?
    around joints because of ligament, tendon, and muscle tearing, as associated with a sprain or dislocation
  94. what type of fracture is a chip fracture?
    an avulsion fracture
  95. what type of fracture is a break of a spinous process?
    an avulsion fraction
  96. a fracture in which only part of the bony structure gives way, with little or no displacement:
    incomplete fracture
  97. fracture in which the cortex breaks on one side without separation or breaking of the opposing cortex:
    incomplete fracture - greenstick
  98. in what patients are greenstick fractures most common?
    children and infants under ten years of age
  99. a type of greenstick fracture in which the cortex bulges outward:
    • torus "buckle" fracture
    • incomplete fracture
    • usually occurs in metaphysis
  100. a type of incomplete fracture resulting from penetration by a sharp object:
    penetrating fracture
  101. a fracture involving the end of a long bone and may affect the growth of the bone:
    growth plate fracture
  102. a classification scale of growth plate fractures according to severity:
    • salter harris system
    • numbering I-VI
  103. a growth plate injury in which a posterior and inferior slippage of the proximal femoral epiphysis on the metaphysis through the physeal plate occurs:
    slipped capital femoral epiphysis (SCFE)
  104. when and in who does SCFE occur?
    • slipped capital femoral epiphysis
    • in adolescence, especially after a growth spurt
    • most common in obese boys, but idiopathic
  105. a type of fracture that usually occurs as a result of an abnormal degree of repetitive trauma:
    • stress fracture
    • may not be radiographically visible for up to two weeks
    • nuc med or MRI may see better
    • usually at the point of muscular attachments
  106. a type of fracture that occurs at sites of maximal strain on a bone, usually in connection with unaccustomed activity:
    • fatigue fracture
    • aka march/stretch/insufficiency fracture
  107. where is a fatigue fracture most commonly found?
    in the second metatarsal
  108. a fracture that gives clinical signs of its presence without radiologic evidence:
    occult fracture
  109. where are occult fractures most common and what is done?
    • the carpal navicular and ribs
    • MRI or nuc med may help
    • xray follow-up in 10 days reveals bone resorption or displacement at the fracture site
  110. an avulsion fracture of the ulnar styoid process  and through the distal end of the radius in which the distal fragment is usually angled backward on the shaft, with impaction along the dorsal aspect:
    • colle's fracture
    • displays a "dinnerfork" deformity
    • most common wrist fracture, caused from falling on an outstretched hand
  111. a fracture of the wrist with displacement toward the palmar aspect of the hand:
    • smith's fracture (reverse colle's fracture)
    • usually from a direct blow or fall with the wrist in hyperflexion
  112. a fracture that occurs from some type of blow to or with the hand, affecting the 4th or 5th metacarpal:
    • boxer's fracture
    • the most common type of metacarpal fracture
    • the reduction for this fracture is difficult to maintain
  113. a fracture and dislocation of the first carpometocarpal joint, resulting in an avulsion fracture of the base of the first metacarpal in association with a dislocation of the trapezium from the pulling action of the abductor pollicus longus tendon in the hand:
    • bennett's fracture
    • common in basketball players and skiers
  114. a fracture that occurs when the thumb is forced backwards while in partial flexion:
    • bennett's fracture
    • may be repaired with a closed pinning technique if the fracture displacement is less than 3mm or with an open reduction in cases of displacement greater than 3 mm
  115. where is the anatomical snuffbox located?
    in the area of the trapezium and the navicular
  116. a fracture of the fifth metatarsal bone of
    the foot that occurs in the midfoot area:
    jones fracture
  117. a fracture of the proximal third of the ulnar shaft, with anterior dislocation of the radial head:
    monteggia's fracture
  118. a fracture that occurs at the proximal radius with a dislocation of the distal radial ulnar joint (DRUJ):
    galeazzi fracture
  119. a fracture that involves both malleoli, with dislocation of the ankle joint:
    potts fracture/bimalleolar fracture
  120. involves the medial and posterior malleoli of the tibia and the lateral malleolus of the fibula:
    trimalleolar fracture
  121. a fracture that consists of a severe ankle sprain or disruption of the syndesmosis between the distral tibia and fibula with a fracture of the proximal third of the fibula:
    maisonneuve fracture
  122. an indicator of a non-visualized, underlying fracture of the bones of the elbow:
    elbow fat pad sign
  123. which fat pad is normally present, and which fat pad is only present if there is a pathology involved?
    • normally: anterior fat pads of distal humerus
    • pathology: fat pads on posterior elbow
  124. what are two dislocations of the fat pads?
    • the posterior fat pad is displaced and becomes visible when the joint capsule is distended by fluid as a result of a fracture
    • the anterior fat pad can be displaced, giving a sail-shaped appearance
  125. fractures of the facial bones:
    visceral cranial fractures
  126. any time there is a head or facial trauma, what must be done?
    cervical spine injury needs to be ruled out
  127. clinical signs of zygomatic arch fracture:
    • black eyes
    • flattening of the cheek
    • restriction of the movement of the mandible
    • may be hard to see because of edema
  128. a fracture in which the zygomatic bone is fractured at all three sutures: frontal, temporal, and maxillary and is accompanied by restricted jaw movement:
    tri-pod fracture/free-floating malar
  129. the mandible is prone to fracture because of:
    the prominence of the chin
  130. the mandible is strongest at the _______ and weakest at the _______, with the most common site for fracture at the _______, followed by the ________.
    • center
    • ends
    • angle
    • condyles
  131. what is the slowest healing bone in the body?
    • the mandible
    • shows clinical union much sooner than radiographic union
  132. why is a fracture of the maxilla considered especially serious?
    • the proximity to the nasal cavity, sinuses, and orbits
    • the close proximity of the brain
    • transmits cranial nerves and major blood vessels
  133. name the three classifications of maxillary fractures:
    • LeFort I: horizontal
    • LeFort II: pyramidal
    • LeFort III: transverse
  134. a fracture caused by direct blow to the front of the orbit that transfers the force to the orbital walls and floor:
    • blowout fracture
    • (occurs in thinnest, weakest area of orbit)
  135. what is the best projection for viewing a blowout fracture?
    • modified waters
    • (but CT is the best modality)
  136. what is the most frequently fractured facial bone?
    nasal bone
  137. how is the nasal bone usually fractured?
    • usually transverse, depressing the distal portion of the nasal bone
    • nasal septum may be fractured
    • anterior nasal spine may be fractured (ascending maxilla)
    • epitaxis may occur
  138. when the bone is out of the joint:
    • dislocation
    • common sites: hip, shoulder, AC joint
  139. a partial dislocation, often occurring with a fracture:
    subluxation
  140. shoulder dislocations are usually:
    anterior
  141. a compression fracture of the articular surface of the humeral head often associated with an anterior dislocation of the humeral head:
    • hill-sachs defect
    • occurs on the superior and posterior head of the humerus
  142. what projection best demonstrates a hill-sachs defect?
    west point method
  143. name two causes of posterior dislocations of the shoulder, and two projections that best view them:
    • seizure disorders and electric shock
    • trans-scapular Y and posterior oblique
  144. bankart fracture
    • a fracture of the anterioinferior glenoid
    • rim
  145. traumatic dislocations of the hip are usually __________ and the femoral head ___________________________.
    • posterior
    • lies against the sciatic notch
  146. on an anterior dislocation of the hip, the femoral head:
    may lie near the pubis or obturator foramen
  147. a softening of the cartilage under the patella which results in wearing away of this cartilage causing pain and tenderness of this area:
    chondromalacia patellae “runner’s knee”
  148. an inflammation of the bone and cartilage involving the anterior proximal tibia and is most common in boys ages 10 to 15:
    osgood schlatter disease
  149. a condition in which the cause is believed to be an injury that occurs when the large patellar tendon detaches part of the tibial tuberosiy to which it is attached:
    osgood schlatter disease
  150. congenital hip dislocations are usually ___________, are discovered because of __________________________, and are more common in __________.
    • unilateral
    • a shortening of the extremity
    • females
  151. in which group of patients is an AC joint separation most common in?
    children, rather than adults
  152. a physical form of child abuse that often exists with emotional and sexual abuse and is most common in children under the age of four:
    • battered child syndrome
    • affects boys and girls equally
  153. approximately how many deaths occur per year due to child abuse?
    • 2000
    • 20% who survive physical abuse suffer permanent damage (battered child syndrome)
  154. physical signs of battered child syndrome:
    • bruises
    • burns
    • abrasions
    • fractures
  155. suspicious injuries concerning battered child syndrome:
    • bruises or injury around the eyes, cheeks, mouth, buttocks, or thighs
    • bite marks
    • certain bone fractures, and cigarette burns
  156. battered child syndrome is demonstrated by a
    skeletal survey of:
    • upper extremities
    • lower extremities
    • skull
    • spine
    • ribs
    • (repeat survey may be done in two weeks for new fractures)
  157. radiographic signs of child abuse:
    • hematomas and single or multiple fractures of varying ages
    • fractures indicating twisting
    • multiple rib fractures indicate repeated traumatic injuries
  158. severe physical abuse that affects a child’s head and neck:
    shaken baby syndrome
  159. give the survival statistics of shaken baby syndrome:
    • high morbidity and mortality rate with 25% of cases resulting in death
    • no trauma externally
    • whiplash
    • brain injury such as subdural or subarachnoid hematoma
  160. bone death resulting from inadequate blood supply:
    avascular necrosis
  161. in which patients is avascular necrosis most common and what does it affect?
    • most common in men between 30 and 60
    • frequently affects the hip, knee, shoulder, or carpal scaphoid
    • nonspecific symptoms
  162. avascular necrosis is best seen in which modality?
    • MRI (can diagnose in early stages)
    • nucmed and CT may help
    • xray not too helpful in early stages
  163. what occurs in the late stages of avascular necrosis and how is it treated?
    • sclerosis and collapse of the bone and narrowing of the joint space
    • treat with analgesics and exercise to maintain range of motion
  164. what treatment can be attempted if avascular necrosis is diagnosed early?
    surgical intervention to provide cortical bone grafts or core decompresssion may help provide support and relieve pressure to allow revasularization
  165. a common form of the ischemic necrosis of bone group of diseases of unknown cause and which affects the epiphyses and may be easily mistaken for tuberculosis of the skeletal system:
    legg-perthes disease
  166. legg-perthes disease refers specifically to:
    the head of the femur
  167. in which pts is legg-perthes disease most common?
    tends to occur in boys 5–10 years of age and often follows injury or trauma to the affected hip
  168. when may pts be inserted in the 4th or 5th intercostal space without waiting for a chest radiograph?
    with patients with acute respiratory distress with suspected hemothorax or pneumothorax
  169. when do changes to the lungs due to contusion appear?
    • 4-6 hours following trauma
    • radiographic appearance changes frequently during the first 24-48 hours, so multiple images may be taken
  170. thoracic aorta traumatic injury is characterized by:
    • upper back pain, cough or wheeze, and hemoptysis
    • widened mediastinum on chest radiography, CT, MRI, and transesophageal sonography
  171. a condition in which free air is trapped in the pleural space and compresses the lung tissue, which may occur spontaneously from perforation of the visceral pleura, or by generation of gas by gas-forming organisms in an empyema:
    pneumothorax
  172. common causes of pneumothorax:
    • penetrating chest trauma
    • thoracentesis needle
    • spontaneous blowout of a bleb (a flaccid vesicle, like a blister)
  173. a flaccid vesicle, like a blister:
    bleb
  174. common symptoms of pneumothorax:
    • sudden, one sided chest pain followed by dyspnea
    • most common in tall, hyposthenic males
  175. radiographic appearance of pneumothorax:
    • a strip of radiolucency devoid of vascular lung markings, with separation of the visceral and parietal pleura
    • best demonstrated on an erect expiration PA chest
  176. an artifact that can mimic a pneumothorax, such as a wrinkle in the patient's skin:
    pseudopneumothorax
  177. a condition that occurs when air enters the pleural space but cannot leave the space because of a check valve mechanism in the fistula, results in a complete collapse of the lung and a shift of the mediastinum to the opposite side:
    tension pneumothorax
  178. a pneumothorax resulting in a collapse of ________ is usually treated by bedrest.
    30% or less
  179. name two possible treatments of pneumothorax:
    • tension pneumo might involve insetion of a needle into the chest wall to equalize air pressure
    • many pneumos are treated through decompression by a closed tube thoracostomy attached to a water-seal drain
  180. incomplete expansion of the lung as a result
    of partial or total collapse, but is not a disease itself, but a sign of an abnormal process:
    atelectasis
  181. seen after thoracic or abdominal surgical procedures:
    bibasilar atelectasis
  182. what is notable about the diaphragm with atelectasis?
    • it becomes elevated
    • (reminder: with emphysema/COPD, it flattens)
  183. examples of compression atelectasis:
    • blood, pleural effusions, pneumothoraces, or other space occupying lesions can cause collapse
    • space occupying lesions cause compression atelectasis
  184. caused from air being completely absorbed from alveoli beyond an obstructed bronchus:
    absorption atelectasis
  185. one or more linear opacities visualized on a radiograph, usually at the lung bases and parallel to the diaphragm:
    platelike atelectasis
  186. three treatments for atelectasis:
    • deep breathing and coughing are be used to treat acute atelectasis
    • bronchoscopy can be used to allow suctioning of secretions that are causing an obstruction
    • thoracocentesis can be used to relieve the  compression caused by an effusion
  187. when death occurs because of abdominal injury it usually occurs:
    • 48 hours after trauma
    • resulting from sepsis
  188. films that should be taken following an abdominal trauma:
    • supine and erect abdomen
    • erect chest
    • (CT with contrast may also be utilized to visualize lacerations, hematomas, and ruptures)
  189. portion of the GI tract most often damaged by blunt trauma:
    duodenum
  190. the presence of fee air in the peritoneum:
    pneumoperitoneum
  191. causes of pneumoperitoneum:
    • perforation of a peptic ulcer 
    • carcinoma of the stomach or colon
    • cecum perforation from distal colon obstruction
    • colonic diverticula perforation
    • traumatic rupturing of the stomach or intestines
  192. describe radiographic projections for a pneumoperitoneum:
    • amounts of air as small as 1cc can be demonstrated on an erect projection
    • left lateral decubitus position can be substituted for the erect position
    • patient should remain on the left side for approximately 5-10 minutes before the exposure to allow sufficient time for the air to ascend
  193. a lucent, oval gas collection that corresponds to the anterior peritoneal cavity indicating a pneumoperitoneum:
    football sign
  194. spasm of the feet and hands observed in hyperventilaion, calcium deprivation, and tetany:
    • carpopedal spasm
    • flexion of the hands at the wrist and of the fingers at the metacarpophalangeal joints and extension of the fingers at the phalangeal joints; the feet are dorsiflexed at the  ankles and the toes plantar flexed

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