Medical Consultation Report

Angie's preliminary medical assessment after Emergency OR treatment and admission to ICU.
Note: After surgery to Angie's left arm and shoulder there were more complications found than those listed here.
For an explanation of medical terms used in this report, see "Glossary Of Terms" at bottom of page.

See Dad's Report for a breakdown of this report in english (with pictures).
See The Spine for a much clearer view and a pictoral explanation of the Spine.
See Brain Trauma for a much clearer view and a pictoral explanation of Brain Trauma.

ASSESSMENT:

Motor vehicle crash
Post trauma respiratory failure, severe left pulmonary contusion.
Mildly displaced left lateral mass fracture of C2, fracture extending into left foramen.
Transverse and moderately displaced fracture of the lateral C7 transverse process.
Large right scalp hematoma.
Contusion of the right posterior temporal lobe, and small anterior subarachnoid hemmorage.
High right parietal image.
Small right pneumothorax.
Comminuted fracture of the left proximal humerus, open.
Small laceration of the spleen.
Fracture of the left inferior pubic rami.
Fracture of the left sacrum
Fracture of the right pubis
Small anterior hemorrage, anterior to bladder.

COMMENTS:

Continue mechanical ventilatory support and Diprivan.
Status and plan breifly discussed with the neurosurgeon.
A followup CT scan of the brain will be obtained.
A halo will be applied.
Vent bundle initiated.
Status discussed with RN staff.

BRIEF HISTORY AND PHYSICAL:

This 30-year-old female was involved in a rollover motor vehicle crash and sustained the above injuries. Following initial evaluation and OR treatment for I & D of the open fracture, she was hospitalized for further evaluation and management.

PAST MEDICAL HISTORY:

Unknown.

REVIEW OF SYSTEMS:

Unable to obtain because of the patient's status.

See The Spine for a much clearer view and a pictoral explanation of the Spine.
See Brain Trauma for a much clearer view and a pictoral explanation of Brain Trauma.

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Glossary of Terms for Above Report
Top of page
C2 lateral mass fracture: An isolated C2 lateral mass fracture is extremely rare and usually is found serendipitously when evaluating for other C2 traumatic pathology. If a C2 lateral mass fracture is found, other C-spine pathology must be sought. The mechanism of this fracture is axial compression with concomitant lateral bending. Signs and symptoms of concomitant C-spine pathology tend to dominate the clinical picture. The isolated fracture may present with high neck pain and a normal neurological examination.

Comminuted fracture: A fracture in which bone is broken, splintered or crushed into a number of pieces.

Contusion: Another name for a bruise. What is a bruise ? A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis. Cerebral contusion, Latin contusio cerebri, a form of traumatic brain injury, is a bruise of the brain tissue.

Diprivan (Propofol):
Is a short-acting intravenous sedative agent used for the induction of general anesthesia for adults and children, maintenance of general anesthesia, and sedation in medical contexts, such as intensive care unit (ICU) sedation for intubated, mechanically ventilated adults.

Displaced Fracture: A fracture in which the fragments are not perfectly aligned, but are not at an angle to one another. The fragments may be shifted sideways relative to each other, may override, or may be distracted from each other.

Foramen: An opening between vertebrae through which nerves leave the spine ... Also called a neural foramen.

Hematoma: An abnormal localized collection of blood in which the blood is usually clotted or partially clotted and is usually situated within an organ or a soft tissue space, such as within a muscle. A hematoma is caused by a break in the wall of a blood vessel. The break may be spontaneous, as in the case of an aneurysm, or caused by trauma. The treatment of a hematoma depends on its location and size. Treatment can involve draining the accumulated blood. A hematoma in or near the brain is particularly dangerous.

Parietal lobe:
(Top Rear of Brain) Damage to the right parietal lobe can result in neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosagnosia) and drawing ability.

Pneumothorax:
(Collapsed Lung) A pneumothorax is a collection of free air in the chest outside the lung that causes the lung to collapse.

Proximal humerus fracture: Fractures occuring near the shoulder joint. The shoulder joint is a ball-and-socket joint, with the ball being the top of the humerus bone. Fractures of this ball are considered proximal humerus fractures.

Pubic rami: A group of four bones in the front of the pelvis (inferior and superior bones for both the left and right sides).

Pulmonary Contusion: An injury to lung parenchyma, leading to edema and blood collecting in alveolar spaces and loss of normal lung structure & function. This blunt lung injury develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance and decreased lung compliance. There is also a significant inflammatory reaction to blood components in the lung, and 50-60% of patients with significant pulmonary contusions will develop bilateral Acute Respiratory Distress Syndrome (ARDS).

Respiratory failure: A syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. Furthermore, respiratory failure may be acute or chronic. While acute respiratory failure is characterized by life-threatening derangements in arterial blood gases and acid-base status, the manifestations of chronic respiratory failure are less dramatic and may not be as readily apparent.

Sacrum: A large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx (tailbone).

Spleen: The human spleen is an organ that creates lymphocytes for the destruction and recycling of old red-blood cells. The spleen is also a blood reservoir. It supplies the body with blood in emergencies such as a bad cut. The spleen is also the location where white blood cells trap organisms. The spleen is shaped like a loose fist and is tucked under the left side of the diaphragm.

Subarachnoid hemorrhage: Is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space. Injury-related subarachnoid hemorrhage is often seen in the elderly who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes.

Transverse fracture: A fracture in which the break is across the bone, at a right angle to the long axis of the bone.

Transverse process: A protrusion extending out from either side of a vertebral body. Each vertebra has a pair of transverse processes, one on either side. Spinal muscles attach to the transverse processes.

Temporal lobe:
(Brain) The temporal lobes are parts of the cerebrum that are involved in speech, memory, and hearing. They lie at the sides of the brain, beneath the lateral or Sylvian fissure. Seen in profile, the human brain looks something like a boxing glove. The temporal lobes are where the thumbs would be.

**Glossary of Terms for Above Report**
Top of page
C2 lateral mass fracture:	An isolated C2 lateral mass fracture is extremely rare and usually is found serendipitously when evaluating for other C2 traumatic pathology. If a C2 lateral mass fracture is found, other C-spine pathology must be sought. The mechanism of this fracture is axial compression with concomitant lateral bending. Signs and symptoms of concomitant C-spine pathology tend to dominate the clinical picture. The isolated fracture may present with high neck pain and a normal neurological examination.
Comminuted fracture:	A fracture in which bone is broken, splintered or crushed into a number of pieces.
Contusion:	Another name for a bruise. What is a bruise ? A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin (be it bumping against something or hitting yourself with a hammer). The raised area of a bump or bruise results from blood leaking from these injured blood vessels into the tissues as well as from the body's response to the injury. A purplish, flat bruise that occurs when blood leaks out into the top layers of skin is referred to as an ecchymosis. Cerebral contusion, Latin contusio cerebri, a form of traumatic brain injury, is a bruise of the brain tissue.
Diprivan (Propofol):	Is a short-acting intravenous sedative agent used for the induction of general anesthesia for adults and children, maintenance of general anesthesia, and sedation in medical contexts, such as intensive care unit (ICU) sedation for intubated, mechanically ventilated adults.
Displaced Fracture:	A fracture in which the fragments are not perfectly aligned, but are not at an angle to one another. The fragments may be shifted sideways relative to each other, may override, or may be distracted from each other.
Foramen:	An opening between vertebrae through which nerves leave the spine ... Also called a neural foramen.
Hematoma:	An abnormal localized collection of blood in which the blood is usually clotted or partially clotted and is usually situated within an organ or a soft tissue space, such as within a muscle. A hematoma is caused by a break in the wall of a blood vessel. The break may be spontaneous, as in the case of an aneurysm, or caused by trauma. The treatment of a hematoma depends on its location and size. Treatment can involve draining the accumulated blood. A hematoma in or near the brain is particularly dangerous.
Parietal lobe: (Top Rear of Brain)	Damage to the right parietal lobe can result in neglecting part of the body or space (contralateral neglect), which can impair many self-care skills such as dressing and washing. Right side damage can also cause difficulty in making things (constructional apraxia), denial of deficits (anosagnosia) and drawing ability.
Pneumothorax: (Collapsed Lung)	A pneumothorax is a collection of free air in the chest outside the lung that causes the lung to collapse.
Proximal humerus fracture:	Fractures occuring near the shoulder joint. The shoulder joint is a ball-and-socket joint, with the ball being the top of the humerus bone. Fractures of this ball are considered proximal humerus fractures.
Pubic rami:	A group of four bones in the front of the pelvis (inferior and superior bones for both the left and right sides).
Pulmonary Contusion:	An injury to lung parenchyma, leading to edema and blood collecting in alveolar spaces and loss of normal lung structure & function. This blunt lung injury develops over the course of 24 hours, leading to poor gas exchange, increased pulmonary vascular resistance and decreased lung compliance. There is also a significant inflammatory reaction to blood components in the lung, and 50-60% of patients with significant pulmonary contusions will develop bilateral Acute Respiratory Distress Syndrome (ARDS).
Respiratory failure:	A syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. Furthermore, respiratory failure may be acute or chronic. While acute respiratory failure is characterized by life-threatening derangements in arterial blood gases and acid-base status, the manifestations of chronic respiratory failure are less dramatic and may not be as readily apparent.
Sacrum:	A large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx (tailbone).
Spleen:	The human spleen is an organ that creates lymphocytes for the destruction and recycling of old red-blood cells. The spleen is also a blood reservoir. It supplies the body with blood in emergencies such as a bad cut. The spleen is also the location where white blood cells trap organisms. The spleen is shaped like a loose fist and is tucked under the left side of the diaphragm.
Subarachnoid hemorrhage:	Is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid space. Injury-related subarachnoid hemorrhage is often seen in the elderly who have fallen and hit their head. Among the young, the most common injury leading to subarachnoid hemorrhage is motor vehicle crashes.
Transverse fracture:	A fracture in which the break is across the bone, at a right angle to the long axis of the bone.
Transverse process:	A protrusion extending out from either side of a vertebral body. Each vertebra has a pair of transverse processes, one on either side. Spinal muscles attach to the transverse processes.
Temporal lobe: (Brain)	The temporal lobes are parts of the cerebrum that are involved in speech, memory, and hearing. They lie at the sides of the brain, beneath the lateral or Sylvian fissure. Seen in profile, the human brain looks something like a boxing glove. The temporal lobes are where the thumbs would be.

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