(a)Odontoid fractures occur when there is a fracture through the
odontoid process of the C2 vertebra. (b)A hangman fracture, or traumatic
spondylolysis of C2, occurs when the cervicocranium is thrown into
extreme hyperextension secondary to abrupt deceleration (eg, head-on,
high-speed motor vehicle collisions). (d)Clay-shoveler’s fracture occurs
secondary to cervical hyperextension or direct trauma to the posterior neck
resulting in an avulsion fracture of the spinous process (eg, assault with
blunt object to back of neck). (e)A teardrop fracture occurs from severe
hyperflexion of the cervical spine and is commonly seen after diving
accidents.This injury disrupts all of the cervical ligaments, facet joints,
and causes a triangular fracture of a portion of the vertebral body. It is asso-
ciated with anterior cord syndrome.
130.The answer is d.(Rosen, p 401.)The vignette describes a traumatic
arrest after penetrating chest trauma. The most likely cause is cardiac tam-
ponade, which occurs in approximately 2% of anterior penetrating chest
traumas. Clinically, patients present with hypotension, JVD, and muffled
heart sounds. These three signs are called Beck triad. In addition, tachy-
cardia is often present. JVD may not be present if there is marked hypov-
olemia. The most effective method for relieving acute pericardial tamponade
in the trauma setting is thoracotomyand incision of the pericardium with
removal of blood from the pericardial sac. The indications to perform an
ED thoracotomy generally include blunt or penetrating trauma patients
who lose their vital signs in transport to or in the ED. Patients with pene-
trating wounds have a significantly better chance of surviving with thora-
cotomy; also patients with stab wounds are more likely to do better than
GSWs.
(a and b)The role of advanced cardiac life support (ACLS) drugs in
traumatic arrest is unclear. However, patients in traumatic arrest typically
require surgical, rather than medical intervention. (c)Chest tube place-
ment will not treat pericardial tamponade. If the patient had evidence of a
tension PTX, chest tubes are the treatment of choice. (e)Pericardiocentesis
may or may not be effective in acute traumatic tamponade because the
pericardium is usually distended by clotted blood rather than by free
blood. Pericardiocentesis is indicated for patients with suspected cardiac
tamponade who have measurable vital signs that are stable.
131.The answer is d.(Rosen, pp 902-904.)The patient has an avulsed
tooth, which is a dental emergency.When a tooth is missing from a patient,
Trauma Answers 151