![]() Disruptive injuries to cervical vertebrae contribute to select patterns of zone I vascular trauma as well. Similar mechanisms are proposed to explain blunt injury to the carotid and vertebral arteries in recent years. Either mechanism may lead to disruption of the intima with or without injury to part or all of the media and adventitia. This mechanism occurs as the victim slides under the shoulder harness and may cause stretching and avulsion of the innominate artery. Another mechanism involves hyperflexion, hypertension, and lateral rotation of the cervical spine away from the side of the shoulder harness. The proposed mechanism for this injury is direct compression to the upper sternum into the artery itself with partial or complete avulsion off the aortic arch. Feliciano, in Rich's Vascular Trauma (Third Edition), 2016 Blunt Traumaīlunt injuries to the innominate and subclavian arteries most commonly occur in individuals wearing shoulder-harness restraints in frontal motor-vehicle crashes. The clinician must maintain a high index of suspicion for both placental abruption and uterine rupture in any patient with blunt abdominal trauma, especially in late gestation.ĭavid V. 3 Although uterine rupture is life-threatening to both the mother and the fetus, its diagnosis is often difficult, given the variable and sometimes subtle clinical presentation. Uterine rupture occurs less commonly than placental abruption but increases in incidence with gestational age. The estimated incidence of abruption is 2%–3% for minor trauma and up to 40% for severe blunt abdominal trauma. Since the uterus is elastic and the placenta is not, sheering forces can result in placental abruption, even in otherwise minor blunt abdominal trauma. The leading cause of fetal mortality after blunt trauma is maternal mortality followed by placental abruption. 4ĭirect injury to the fetus from blunt trauma is rare (<1%). Up to 25% of pregnant blunt trauma patients sustain significant splenic or hepatic lacerations. Splenic, hepatic, and retroperitoneal injuries occur more frequently in gravid trauma patients, due in part to the increased vascularity associated with pregnancy as well as to the displacement of the abdominal contents by the uterus. Pregnant patients injured in MVCs are more likely to sustain significant abdominal injuries and less likely to sustain head injuries than their nonpregnant counterparts. Although mortality rates are similar for pregnant versus nonpregnant blunt trauma patients, with equivalent Injury Severity Scores (ISS), their patterns of injury are notably different. Chiu, in Current Therapy of Trauma and Surgical Critical Care, 2008 Blunt Traumaīlunt trauma is the leading cause of both maternal and fetal death and is usually a consequence of MVCs, assaults, or falls. ![]() Both the skin and the subcutaneous layer may be avulsed from the underlying fascia or bones by shearing forces so that a blood-filled pocket is formed, typically in combination with a crush damage to the adjoining fatty tissue.Īmy C. Subcutaneous bruises of surviving victims are often followed by gravity shifting of the hemorrhage leading to a secondary downward movement of the hematoma.Ī special type of blunt injury to the soft tissues is frequently seen in pedestrians who have been struck or run over by motor vehicles. On the other hand, the absence of an externally visible injury does not necessarily mean that there was no relevant trauma. Elderly people or patients suffering from bleeding diathesis may get bruises from slight knocks or for other minor reasons. The size of an intradermal or subcutaneous hematoma is not always indicative of the intensity of the force applied to the affected area. Note the yellow color on the periphery of the bruises. ‘Black eyes’ inflicted by a single fist blow to the root of the nose (6 days before the photograph was taken).
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