fall onto the face in an elderly person. Patients often have greater sensorimo-
tor neurologic deficits in the upper extremities compared to the lower
extremities. Cauda equina injury (d)causes peripheral nerve injury rather
than direct spinal cord damage. Its presentation may include variable motor
and sensory loss in the lower extremities, sciatica, bowel and bladder dys-
function, and saddle anesthesia. Brown-Séquard syndrome (e)results in ipsi-
lateral loss of motor strength, vibratory sensation, and proprioception, and
contralateral loss of pain and temperature sensation.
- The answer is b.(Tintinalli, pp 1596-1597.)The treatment of a
tensionPTX involves immediate reduction in the intrapleural pressure on
the affected side of the thoracic cavity. The simplest and quickest way to
establish this is by inserting a 14-gauge catheter into the thoracic cavity in the
second intercostal space in the midclavicular line. After this procedure, a
chest tube should be inserted as definitive management. Needle thoracos-
tomyis necessary when a patient’s vital signs are unstable; otherwise, direct
insertion of a chest tube is adequate for suspicion of a hemo- or pneumoth-
orax. A tension PTX is a life-threatening emergency caused by air entering
the pleural space that is not able to escape secondary to the creation of a one-
way valve. This increased pressure causes the ipsilateral lung to collapse,
shifting the mediastinum away from the injured lung, compromising vena caval
blood return to the heart. The severely altered preload results in reduced stroke
volume, increased cardiac output, and hypotension.
(a)Airway is the first component addressed in the ABCs; however, the
patient is breathing on his own and does not require intubation. (c and d)
If the BP does not elevate with insertion of a chest tube, then the next area
to focus on is an intra-abdominal injury, which can be assessed either by a
DPL or FAST examination. (e)A pericardiocentesis is indicated in the stable
trauma patient when there is suspicion for cardiac tamponade, which may
present with tachycardia and Beck triad: hypotension, JVD, and muffled
heart sounds. - The answer is e.(Tintinalli, pp 1549-1553.)The Canadian C-spine
rule for radiography in alert and stable patients following blunt head or
neck trauma identified age greater than 65 years as a high risk factor for
C-spine injury, evenamong those with stable vital signs and a GCS score
of 15. Therefore, C-spine imaging in all such elderly patients is warranted.
(a)It is thought that elderly patients experience a much lower inci-
dence of epidural hematomas than the general population because of a
Trauma Answers 165