What does traumatic injury mean
Traumatic Eye Injury Management Principles for the Prehospital Setting
Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a mental illness characterized by a long-term pattern of unstable relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behavior. They may also struggle with a feeling of emptiness, fear of abandonment, and. Abstract: The physical, emotional, and financial impact of a traumatic spinal cord injury (TSCI) can be devastating. This article discusses the pathophysiology of TSCI, medical and surgical management during the acute and subacute phases of injury, and nursing care for patients with TSCI.
Note: This report was published in and is included for historical purposes. David J. Sniezek Susan Toal, Contractor. Public Lawthe Traumatic Brain Injury Act ofauthorizes State surveillance systems to obtain information on the number of people affected by traumatic brain injury TBIthe causes of these injuries, and their severity.
As required by this Act, the following Federal report summarizes current knowledge about the incidence, causes, severity, associated disabilities, and prevalence of TBI. Traumatic brain injury TBI is a leading cause of death and disability among children and young adults in the United States. Each year an estimated 1. As a consequence of these injuries:. As the cumulative result of past traumatic brain injuries, an estimated 5. While the risk of having a TBI is substantial among all age groups, this risk is highest how to introduce new food product in the market adolescents, young adults, and persons older than 75 years.
The risk of TBI among males is how to get to msac the risk among females. The major causes of TBI are:. These injuries have both short-term and long-term effects on individuals, their families, and society and their financial cost is enormous. For the estimated 5. The long-term impairments and how to print pictures on epson printer associated with TBI are grave and the full human cost is incalculable.
Yet because these disabilities are not readily apparent to the public—unlike a broken leg, for example—TBI is referred to as the invisible epidemic. The human face of TBI is suggested by this example, which describes experiences shared by many others:. InDr. Despite symptoms including headache, fatigue, and memory loss, he returned to his counseling practice.
His clients noticed his memory and concentration problems and he had to close his practice in six months. His health insurance company raised his premium rates until he could no longer afford coverage. His wife divorced him. His applications for Social Security disability income were denied over two years, and for six months he had to live in a van. Finally, he received some Social Security benefits. Years later, he learned about and enrolled in a new college program designed for people with brain injury.
He developed ways of partially compensating for his continuing memory and concentration difficulties and re-opened a part-time counseling practice that provides minimal income. Appropriate follow-up from a State TBI registry might have led him to helpful programs earlier. Rates of TBI-related death what does traumatic injury mean declined 20 percent sincereflecting some success in efforts to prevent such injuries. The decline in TBI-related hospitalization rates has been much greater—about 50 percent since —during a period when efforts to contain health care costs may have led to changes in hospital admissions practices restricting inpatient care.
This much larger decline in hospitalization rates suggests that an increasing proportion of persons with less severe TBI may now receive only emergency department outpatient care and are sent home instead of being admitted to hospitals. If we are to measure the total impact of TBI, the needs for TBI services, and the true injury reductions due to successful prevention, we must include emergency department-based surveillance with surveillance based on hospitalization admissions.
Knowing more about the outcomes of TBIs—those treated only in emergency departments as well as those treated in hospitals—is critical in order to assure proper treatment and follow-up. State follow-up registries, built on surveillance systems, provide more information to help States and communities design, implement, and evaluate targeted, cost-effective programs for people living with TBI and their families, including programs that provide vocational rehabilitation and school and community support.
These registries what does traumatic injury mean gather the information needed to:. To implement more effective programs to prevent these injuries, we must have reliable data on their causes and risk factors. State surveillance systems can provide such data, identify trends in TBI incidence, how to make easy dessert recipes the development of cause-specific prevention strategies focused on populations at greatest risk, and monitor the effectiveness of such programs.
Traumatic brain injury is a leading cause of death and lifelong disability among children and young adults in the United States. This study could not account for the intangible costs borne by the families and friends of individuals who die prematurely from brain injury. For injured persons and their loved ones, the physical and emotional tolls from permanent disability are profound and impossible to quantify. Thus, traumatic brain injuries have a deep impact on the population and require a response from the public health community to prevent these injuries and reduce consequent disabilities.
The system supports the development, implementation, and evaluation of programs for preventing traumatic brain injury. Public Law charges CDC with implementing projects to reduce the incidence of traumatic brain injury. Specifically, the legislation mandates that CDC shall:. Ongoing, population-based surveillance systems—and registries to define disability and other outcomes associated with TBI—are essential for planning and evaluating prevention, acute care, and rehabilitation services for people with these injuries.
Yet such systems have only recently been established. Beforemost TBI data came from either hospital-based clinical case series or epidemiologic studies that were of limited duration and restricted to particular locales.
Despite the limitations of interview question what is your weakness answer data sources, they revealed some useful insights into the epidemiology of TBI.
During the s and early s, researchers estimated that each year, aboutAmericans sustained a brain injury leading to hospitalization or death. Most studies focused on limited geographic areas that were not necessarily representative of the United States as a whole. From these studies it was not possible to evaluate U.
CDC began promoting the development of a multistate traumatic brain injury surveillance system in with funding support and technical assistance, after the Federal Interagency Head Injury Task Force Report identified the need for better information on the public health impact of brain injuries. Such improved data collection can help achieve two important public health goals:. These guidelines provide a standard case definition Appendix I of traumatic brain injury craniocerebral trauma that can be summarized as an occurrence of injury to the head arising from blunt or penetrating trauma or from acceleration-deceleration forces that is associated with symptoms or signs attributable to the injury— decreased level of consciousness, amnesia, other neurologic or neuropsychologic abnormalities, skull fracture, diagnosed intracranial lesions—or death.
The Guidelines also clearly define the data elements necessary to describe the occurrence and severity of these injuries, their external causes, and associated risk factors. The core what channel is bravo on bell expressvu these data elements can be obtained from hospital discharge reports, which are readily available to most State health departments.
In Septemberwith the help of funding provided under Public LawCDC added 11 States to the system, bringing the total number of participants to Together, these States are quite representative of the diversity of populations found throughout the United States. From throughhow to not psych yourself out TBI-associated death rate in the United States decreased 20 percent, from Most of the decrease resulted from a 38 percent decline in transportation-related deaths, from Rates of TBI-associated death due to falls and other causes also decreased during this period.
However, firearm-related TBI deaths increased 11 percent during this period, from 7. Because of this increase, firearms-use surpassed transportation crashes as the leading cause of death from TBI in Indeath rates among males were 3.
Rates were highest among persons aged what does traumatic injury mean years and older Teens, young adults, and people over 75—especially males—are far more likely than others to die of traumatic brain injury.
Leading causes of TBI-associated death among males varied with age in Figure 3. Firearm-related injuries were the leading cause of TBI-associated death among males aged years, transportation-related injuries among those under 15 years of age, and falls among those 85 years of age and older. Brain injuries that kill boys and young men are often the result of shootings or motor vehicle crashes.
For females, the leading causes of TBI-related deaths also varied with age. Transportation-related injuries were the leading cause of TBI among females from birth to 74 years of age, although death rates related to firearms and transportation were almost identical among women aged years Figure 4. As in the older what is the average cost of an electric bill population, falls were the leading cause of TBI-associated death among women 75 years of age and older.
Brain injuries that kill women over 85 are usually the result of falls, whereas brain injures that claim the lives of teenage girls and young women most often occur in motor vehicle crashes.
TBI-associated death rates in differed by race as well Figure 5 : Among African Americans, firearm-use was the leading cause of TBI-associated death, with a rate of This rate was more than two times higher than the rate for the next leading cause, transportation.
Firearm-related injuries were also the leading cause of TBI-associated death among whites, with a rate of 7. Transportation was the leading cause of TBI-associated death among all other racial groups 6. African Americans have a much greater risk of dying from firearm-related traumatic brain injury than do people of other races.
As a result, these States have been able to provide more complete descriptions of the incidence, severity, causes, and outcomes of TBI currently occurring among their residents.
Duringthe seven States had 32, reported cases of TBI collectively; among persons with these injuries, 5, Among those who were hospitalized, 1, 5. Thus, a total of 7, TBIs The annual unadjusted incidence rate of TBI for all seven States combined was The crude rate of hospitalizations for TBI in the seven States combined was The overall TBI-related death rate was In an assessment of State-specific rates of TBI, serious nonfatal injuries requiring hospitalization were far more common than injuries resulting in death in all seven States.
The median age at the time of injury was 32 years. The incidence rate of TBI was highest among persons 75 years of age and older Most TBIs 21, or Serious nonfatal traumatic brain injuries requiring hospitalization greatly outnumber fatal traumatic brain injuries in seven States. Teenagers, young adults, and people over 75 are far more likely than others to sustain a traumatic brain injury, primarily because of motor vehicle crashes and violence among youths, and falls among the elderly.
Transportation-related crashes involving motor vehicles, bicycles, pedestrians, and recreational vehicles accounted for 49 percent of all TBIs; falls accounted for an additional 26 percent Figure 8. Firearm-use accounted for 10 percent of all TBIs in the seven States, and assaults not involving firearms accounted for 8 percent of reported injuries. Nearly two-thirds of firearm-related TBIs Motor vehicle crashes are by far the leading cause of traumatic brain injury in these seven States and nationally as well.
Shootings cause less than 10 percent of all traumatic brain injuries, yet they are the leading cause of TBI-related death. The majority of firearm-related traumatic brain injury represent suicides or suicide attempts, although more than a fourth are the result of assaults by others. The leading causes of TBI varied by age in the seven States. Falls were by far the leading cause of TBI among persons aged 75 years and older at a rate of
Traumatic brain injury (TBI) is a form of nondegenerative acquired brain injury resulting from a bump, blow, or jolt to the head (or body) or a penetrating head injury that disrupts normal brain function (Centers for Disease Control and Prevention [CDC], ). TBI can cause brain damage that is focal (e.g., gunshot wound), diffuse (e.g., shaken baby syndrome), or both. Doctors say that traumatic brain injury (TBI) is a catastrophic condition, like burns, amputations, and spinal cord injuries. But TBI is different. It upsets life on multiple levels: physical, psychological, social, and even spiritual. The impact of a brain injury is often life-changing for survivors, families and caregivers. This fact sheet discusses traumatic brain injury and its consequences and provides information about the helpful resources available to families caring for a loved one affected by TBI. Definition. Traumatic brain injury is considered an Acquired Brain.
There are over 2. Eye injuries are often accompanied by other traumatic injuries and can be easily overlooked, especially in the prehospital setting where rapid stabilization and transport take priority.
In the prehospital setting, the most important management principle is to protect the eye from further trauma during transport. In this article, we describe the diagnosis and initial management of six common eye injuries recognizable in the prehospital setting and associated with significant morbidity when not managed appropriately.
Figure 1a: As is typical with open globe injuries, the teardrop points toward the corneal injury. Photos courtesy Lawrence B. Stack and R. Jason Thurman. Case 1: Open Globe Injuries You are called to a construction site by the foreman of the crew stating that one of his team members was hammering a nail and then immediately felt pain in his right eye. The man states he has blurry vision in his right eye. Question : Why does the pupil look irregular and what should you do during transport to the hospital?
The iris is drawn to the corneal defect, causing the iris to stretch and the pupil to appear like a teardrop. As is typical with these injuries, the teardrop points toward the corneal injury.
A teardrop pupil is a sign of an open globe injury and the eye should be shielded without any pressure on the eye itself to prevent further injury during transport.
Photo courtesy Ted Brenkert. The goal of management for open globe injuries in the prehospital setting is to avoid secondary injury by preventing any increase in intraocular pressure IOP.
A protective shield should be placed over the eye for transport, being especially careful not to place any pressure points of the shield onto the eye itself, but instead onto the bones surrounding the eye. If a commercial metal or plastic eye shield is not available, a Styrofoam or plastic cup can be taped over the eye for protection. Because pain, agitation, uncontrolled hypertension and Valsalva maneuvers can elevate IOP, appropriate analgesic, antiemetic and sedative therapy should be provided.
Treatment in the hospital typically includes continued protection of the globe to prevent worsening injury, intravenous antibiotics to prevent post-traumatic endophthalmitis, tetanus prophylaxis and emergent ophthalmology consultation for surgical repair of the injury. Figure 2a: A chemical burn can cause irreversible damage to the eye in minutes.
Photo courtesy R. Question: After ensuring scene safety, what are your management priorities for this eye injury? Answer: Initiate thorough irrigation of the affected eye. Discussion: This patient has an alkali chemical burn of the cornea from exposure to a pipe-cleaning agent. Both acids and alkalis can cause severe chemical burns to the eye.
Table 1 contains a list of chemicals that commonly cause these burns. Alkali substances lead to very rapid and deep eye injury by a process called liquefactive necrosis, in which cells are completely digested by the chemical and turn into liquid. Irreversible damage to the eye can occur within a few minutes of alkali exposure. Acid burns tend to be less severe, but still can result in significant eye damage, especially if the chemical is not rapidly removed.
Hydrofluoric acid—commonly found in etchant, rust-removing compounds and wheel-cleaning agents—is an exception to this rule, behaving like an alkali with rapid penetration and damage to the eye. Figure 2b: Severe chemical eye burns can cause a large corneal defect.
Photo courtesy Lawrence B. Most patients with chemical eye burns complain of severe pain, decreased vision, blepharospasm inability to open the eyelids and watery eyes. In severe cases of alkali injury, the eye may appear white due to conjuctival ischemia or a large cornea defect may be visible. See Figure 2b. The essential aspect of managing chemical eye burns is immediate and copious irrigation of the eye to dilute and remove as much of the chemical as possible.
Irrigation should begin in the prehospital setting. Delays in initiating irrigation by as little as 20 seconds have been associated with more severe injury in animal models of alkali eye burns. Figure 2c: When positioning nasal cannula tubing for eye irrigation, the cannula prongs should be placed at the medial aspect of the affected eye. Then, irrigation solution can be injected through the tubing to wash out the eye. The eye should be quickly examined and particulate matter removed with a moist cotton swab.
See Figure 2c. The patient should be asked to look in all directions during irrigation to ensure complete removal of chemicals from the entire surface of the eye. Adequate pain control is also important, and may require parenteral doses of opioids. If possible, prehospital personnel should identify the chemical that caused the burn and relay this information to hospital providers. All patients with chemical eye burns should be transported to the ED. ED providers will measure the pH of tears coming from the burned eye and continue irrigation until the pH has returned to a normal range 7.
Case 3: Retained Foreign Body You respond to a call from a fishing dock and find a year-old boy with a fishing hook lodged in his eye. See Figure 3, at top.
Answer: No. Discussion: This patient has sustained an open globe penetrating injury with a retained intraocular foreign body.
No attempts to remove intraocular foreign bodies should be made in the prehospital setting. The distal end of an intraocular foreign body may be lodged deep within the eye, in a paranasal sinus or even in the intracranial space. In the hospital setting, radiographic imaging, such as computed tomography, is often used to identify the precise location of the foreign body. The objects are usually removed by ophthalmologists in an operating room, where damage to surrounding structures can be minimized.
Prognosis of penetrating eye injuries is very poor, with over one-third of patients requiring enucleation or having no light perception. Case 4: Hyphema A year-old girl was struck in the left eye with a tennis ball two days ago. See Figure 4a. She states she initially had red-tinged blurry vision in the left eye, which has now improved. Bright lights hurt her eye. She frequently takes ibuprofen for knee pain.
Answer: This patient has a traumatic hyphema. This red sliver is blood that has pooled in the anterior chamber, which is the space between the cornea and iris. Discussion: Hyphema is the term used to describe bleeding into the anterior chamber of the eye. Most hyphemas are the result of trauma to the eye, but hyphemas can also occur spontaneously, especially in patients with sickle cell disease and other blood disorders.
Traumatic hyphemas are caused by tearing of the blood vessels in the iris and other structures in the anterior part of the eye due to transiently increased IOP. Many hyphemas, such as the one pictured in Figure 4a, are visible with simple inspection of the eye while the patient is sitting up. However, trauma patients are regularly placed supine for spinal precaution during transport.
In this position, a hyphema is difficult to diagnose as the blood layers over the iris. Therefore, prehospital providers should perform open globe precautions as outlined in Cases 1 and 3 when they see a patient with a traumatic hyphema. Long-term management principally involves preventing re-bleeding by avoiding NSAIDs and other antiplatelet agents and minimizing repeated constriction and dilation of the iris either with cycloplegic medications or by having the patient stay in a dark room.
Figures 5a and 5b: Prehospital management of retrobulbar hematomas includes rapid transport and minimizing IOP. Case 5: Retrobulbar Hematoma You respond to a high-speed motor vehicle crash and discover a year-old man on the side of the road after hitting his left eye on the steering wheel.
During transport he develops progressive swelling and proptosis of his left eye and his pupil becomes nonreactive to light. See Figures 5a and 5b. Answer: He has developed a retrobulbar hematoma, which is a bleeding posterior to the eye causing the eye to push forward. Discussion: Retrobulbar hematoma occurs when veins draining the posterior of the eye are injured and bleed into the space between the eye and skull. Blunt trauma to the face is the typical mechanism of injury, but retrobulbar hematoma can also occur as a complication of orbital or sinus surgery.
Displaced orbital wall fractures can protect against retrobulbar hematoma, because bleeding inside the orbit can drain through the fracture. Symptoms of a retrobulbar hematoma typically develop over a few hours as the expanding hemorrhage exerts increasing pressure on the eye, resulting in elevated IOP.
Principles of prehospital management include rapid transport and minimizing IOP. Vomiting and Valsalva maneuvers can lead to increased IOP, so prevention with antiemetics and pain control is especially important with retrobulbar hematomas. Definitive treatment in the hospital involves surgical drainage of the hematoma. This procedure is typically performed by an ophthalmologist in an operating room. If an ophthalmologist is not immediately available, experienced emergency physicians or surgeons may perform an emergency lateral canthotomy and cantholysis in the ED in attempt to relieve the elevated IOP and prevent permanent blindness.
Figure 6: Anisocoria occurs when one eye has a defect that prevents either normal pupillary constriction or normal pupillary dilation.
Police called for an EMS response when they noticed her pupils were not equal. See Figure 6. She reports no trauma today but does say she was struck with a fist in the right eye two days ago. She complains of mild pain to the right eye and photophobia. Her mental status is normal. Other than these pupillary findings, her neurologic exam is normal, including extraocular movements. Question: Should you begin treatment to decrease intracranial pressure, such as intravenous mannitol?
Because the patient is well-appearing and her neurologic exam is otherwise normal, a severe intracranial injury is less likely and a potentially harmful medication, such as mannitol, should not be administered. This patient has traumatic mydriasis, not an intracranial hemorrhage. Discussion: This patient has anisocoria, defined as pupils of unequal size.
Anisocoria occurs when one eye has a defect that prevents normal pupillary constriction the affected pupil is dilated, called mydriasis , or prevents normal pupillary dilation the affected pupil is constricted, called miosis.
Mydriasis is caused by either injury to the sphincter muscle in the iris or the parasympathetic nerves innervating the iris.
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