injury
(in'jŭ-rē 
)
[L. injuria, injustice]
Blunt or penetrating trauma or damage to a part of the body.
SEE: transportation of the injured; table - Traumatic Injuries.
Symptoms and Signs: Various symptoms may occur depending on the nature, extent, and severity of the damage. Mild injury produces pain, tissue swelling, redness, and temporary disruption of tissue function. Severe injury may result in irretrievable loss of the function of an organ, massive hemorrhage, or shock.
acceleration i.An injury that occurs when the head, cervical spine, or other body part is hit by a rapidly moving object. SYN: impact-acceleration injury.
acceleration-deceleration i.An injury caused when a rapidly moving body comes to an abrupt halt, causing internal injuries such as whiplash, traumatic brain injury, or damage to the liver, spleen, kidney, bladder, aorta, or other tissues.
acquired brain i.Structural injury to the brain occurring after childbirth. It includes traumatic brain injury and insults to the brain resulting from strokes, tumors, or neurological diseases such as multiple sclerosis.
acute ischemic hepatocellular i.Ischemic hepatitis.
ABBR: AKI.
Acute renal failure.ABBR: ALI
A clinically severe, sudden decline in lung function, marked by infiltrates in both lung fields and significantly diminished arterial oxygen saturation. There is no evidence that the condition is caused by left-sided heart failure. The disease is similar to adult respiratory distress syndrome (ARDS). Like ARDS, ALI may be life threatening. ALI is distinguished from ARDS by the severity of hypoxemia. ALI = PaO2/FIO2 ratio of <300, ARDS = PaO2/FIO2 <200.Causes are similar to the causes of ARDS. The most frequently identified of these are sepsis, pneumonia, aspiration of gastric contents, repeated transfusions, shock, lung trauma, and multiple bony fractures.
acute spinal cord i.Acute traumatic injury of the spinal cord.
Signs and symptoms depend upon the vertebral level injured and degree of injury. Damage may be due to the initial injury and to any inflammatory response or swelling that occurs in the next 48 to 72 hr.
Diagnostic tests depend on the consciousness of the patient. If awake, the patient is inspected carefully, tested for sensory function and movement, and asked questions about the accident. If the patient is unable to respond, then tests may include x-rays, computerized tomography (CT) scans, or magnetic resonance imaging (MRI).
Therapy includes immobilization, high doses of corticosteroids, airway maintenance, cardiovascular resuscitation, and insertion of an indwelling catheter. The use of intravenous methylprednisolone given as a bolus dose of 30 mg/kg and then a maintenance dose of 5.4 mg/kg/hr for 24 to 48 hr during the acute phase improves neurological recovery and may reduce edema.
Cooling the patient or his or her spinal cord has theoretical advantages, but clinical benefit is difficult to document. Immediately after a spinal cord injury, the spine must be stabilized, adequate ventilation and circulation maintained, and problems with thermoregulation and urinary retention assessed and treated. After initial stabilization, all general patient care concerns apply. The patient is assessed for evidence of paralysis, loss of sensation or of reflexes, pneumonia, deep vein thrombosis, pulmonary embolism, decreased peristalsis, gastrointestinal bleeding, and problems associated with immobilization. Explanations of all procedures and support are provided to the patient and his or her supporters. Anxiolytics (if needed) should be administered as prescribed and their effects evaluated. The patient with serious trauma to the spinal cord may suddenly confront many challenges to body image and functional independence, including changes in mobility, urinary and fecal continence, erectile function, skin integrity, and mood. A sensitive and caring multidisciplinary approach to rehabilitation is needed to help the client.
birth i.Injury sustained by the neonate during birth.
blast i.An injury due to an explosion. The injury results from internal organ damage caused by a pressure wave extending outward from the explosion. It can also produce secondary shrapnel injuries and burns.
ABBR: BCI
Compression of the heart and /or great vessels, as during motor vehicle crashes when the patient's thorax suddenly strikes the steering wheel or instrument panel of a car or truck. BCI includes myocardial contusion (bruising of the heart muscle), aortic dissection, and myocardial rupture. SYN: blunt cardiac trauma.crush i.Injury to body tissues resulting from an applied force that compresses or squeezes tissues, causing damage such as compartment syndrome, dislocation, fracture, laceration, or nerve damage. If there is no bleeding, cold should be applied; if the wound is bleeding, application of the dressing should be followed by cold packs until the patient can be given definitive surgical treatment. If the bone is fractured, a splint should be applied. SYN: crushing wound.
deceleration i.An injury in which a moving body hits a stationary object, as when a patient falls and hits the ground.
defensive i.An injury to the fingers, hand s, wrists or extensor surfaces of the arms in an attempt to ward off an assault by another person. Such injuries include abrasions, bruises and other forms of blunt trauma, cuts, fractures, gun shot wounds, and lacerations.
ABBR: DAI
A very common, very severe form of traumatic brain injury, caused by acceleration/deceleration forces, as in automobile accidents, that disrupt the neurofilaments in the axon and lead to axonal degeneration. Coma is a frequent outcome. Approx. 90% of patients with severe DAI do not regain consciousness. Concussion is possibly a relatively mild kind of DAI.SEE: postconcussion syndrome; traumatic brain injury.
distracting i.An injury that presents with such significant symptoms or signs that other injuries are not recognized by the patient or by his or her health care providers.
ABBR: DILI
Hepatic inflammation, hepatocellular necrosis, or jaundice due to exposure to a medication or toxin. The most common cause of DILI is an overdose of acetaminophen, but many other medications can damage liver cells and produce signs, symptoms, and laboratory findings suggestive of cholestasis or hepatitis.glucopenic brain i.Neuroglycopenia.
immersion i.Drowning or near drowning.
impact-acceleration i.Acceleration injury
inhalation i.Injury to the oropharynx, nasopharynx, trachea, bronchi, or lungs from exposure to smoke or heated gas.
Inhalation injury is a potentially life-threatening complication of exposure to smoke and fire and is often present in those who have suffered facial burns. Firefighters are at special risk.
Patients who have suffered smoke inhalation injury may complain of dyspnea, cough, and black sputum. Stridor may be present if the upper airway is narrowed as a result of inflammation. Confusion may occur if carbon monoxide poisoning is also present.
Patients suspected of inhalation injury should be promptly and repeatedly assessed to make certain they have an open airway.
Emergent tracheal intubation is used to prevent respiratory failure.
Early complications of inhalation injury include bronchospasm, airway edema, airway obstruction, and respiratory failure. Late complications include hospital-acquired pneumonias and other respiratory illnesses.
SEE: carbon monoxide.
SYN: smoke inhalation injury.internal i.An injury to the organs occupying the thoracic, abdominal, or cranial cavities.
Symptoms vary depending on the structures involved. Shock is often present, manifested by hypotension and tachycardia. The patient may be pale, cold, and perspiring freely and have an altered state of consciousness. In some internal injuries, pain may not be felt.
The patient's vital signs should be monitored carefully and frequently. Changes in consciousness should be noted. If the patient is in shock, the shoulders should be lowered and the lower extremities elevated. Intravenous infusions, oxygen, airway management, cardiac monitoring, control of hemorrhage, and bony stabilization are quickly begun pending definitive surgical management.
ionizing radiation i.Damage to cells and intracellular molecules by x-rays, gamma rays, radionuclides, or other sources of radioactive energy. In sufficient doses, radioactive energy can damage the cytoplasm and the genetic material of the cell, leading to organ dysfunction (esp. in rapidly dividing tissues such as the skin and the lining of the gastrointestinal tract), mutations, inhibition of cell division, cell death, or carcinogenesis. When the developing fetus is exposed to radiation in the womb, developmental malformations may result.
SEE: low-level radiation; radiation syndrome.
SEE: under Lisfranc de St. Martin, Jacques.
local radiation i.Injury following acute radiation exposure to a limited part of the body, esp. the hand s, after picking up an unshielded radioactive element. The exposure usually results in delayed skin damage and frequently in underlying tissue injury. It may require local wound care, débridement, or, in some instances, amputation.
SEE: sharps; needlestick.
open head i.A head injury in which the integrity of the cranium is breached.
primary i.Cell death immediately associated with a traumatizing force and unrelated to subsequent hypoxic or enzymatic reactions.
primary brain i.Direct injury to the brain from blunt or penetrating force.
reperfusion i.Cellular injury that occurs after blood flow is restored to ischemic tissues.
repetitive motion i.Overuse syndrome.
repetitive strain i.Overuse syndrome.
secondary brain i.Brain injury due to cellular disruption, electrolyte disarray, inflammation, insufficient oxygen, or vasospasm after head trauma.
secondary enzymatic i.Cell death resulting from an enzymatic reaction occurring after trauma that decreases cell membrane potential and produces hydropic swelling. Secondary enzymatic injury does not include cell damage from the primary trauma.
secondary hypoxic i.Cell death caused by the lack of oxygen in tissues after trauma. It may sometimes be prevented by resting injured body parts and applying cold to them.SYN: post-traumatic hypoxia.
smoke inhalation i.Inhalation injury.
ABBR: SCI
Compression, contusion, or cutting of the spinal cord as a result of trauma. Depending on the type of lesion suffered, SCI may cause paralysis, loss of sensation, incontinence, or abnormal reflex activity.steering wheel i.Blunt injury to the chest sustained when an unrestrained driver hits the steering wheel or column. Typical injuries include rib fractures, inflamed cartilage, pneumothorax, hemothorax, or contusion of the heart. The trauma occasionally produces dissection of the thoracic aorta.
straddle i.Blunt trauma to the perineum, often with fractures of the pelvis and genital and internal injuries, e.g., to the vagina, penis, testes, bladder, or uterus. It may be due to falling and land ing astride a blunt object, such as bicycle hand lebars.
transfusion-related acute lung i.
ABBR: TRALI
A systemic immunological reaction to the transfusion of blood products, marked by breathlessness, fever, hypotension, inadequate oxygenation, and noncardiogenic pulmonary edema. It is caused by antibodies in the donor's plasma reacting against the white blood cells of the transfusion recipient. Ventilatory support is commonly needed. The reaction is life-threatening in about 10% of patients.ABBR: TBI
Any injury involving direct trauma to the head, accompanied by alterations in mental status or consciousness.SEE: diffuse axonal injury; postconcussion syndrome.
TBI is one of the most common causes of neurological dysfunction in the U.S. Each year about 50,000 people die from brain trauma, and an additional 70,000 to 90,000 sustain persistent neurological impairment because of it. About 1.7 million people suffer some form of head trauma annually, and 5.3 million Americans live with chronic TBI disabilities.
The most common causes of TBI are military injuries, motor vehicle or bicycle collisions, falls, gunshot wounds, assaults and abuse, and sports-related injuries.
Twice as many males as females suffer TBIs, with the incidence highest between ages 15 and 24. TBI is the most common cause of death in the U.S. until age 45. People over 75 are also frequently affected (because of falls).
Symptoms of TBI include acute problems with concentration, confusion, depressed mood, dizziness, headaches, impulsivity, irritability, memory, post-traumatic stress, or, in severe injuries, focal motor, sensory or verbal deficits. Late effects of severe or repeated injuries can include chronic traumatic encephalopathy (dementia caused by repeated concussions and other brain injuries); parkinsonism; or amyotrophic lateral sclerosis (motor neuron disease “Lou Gehrig disease”).
The initial assessment of the acutely injured patient includes use of stand ard trauma scales, such as the Glasgow Coma Scale or the Stand ardized Assessment of Concussion. A person with a brain injury who cannot identify his or her name, location, age, the date, or his or her recent activities should be triaged for further evaluation. Imaging studies of the brain should be performed when serious cranial or intracranial injuries are suspected, e.g., in the patient who has a seizure after TBI, or in the patient whose physical examination suggests skull fractures or intracerebral hemorrhage.
Many traumatic injuries to the head and brain are preventable if simple precautions are followed: motorists should never drive while intoxicated; cyclists and bicyclists should always wear helmets; frail, older people should wear supportive footwear and use sturdy devices to assist them while walking.
Treatments vary depending upon the type of injury that occurred. For example, mild athletic injuries are managed with rest, analgesics, and a period of exclusion from sports, while bleeding that occurs around the brain or within the brain may require neurosurgical drainage.
TBIs can produce intracranial hemorrhage (epidural hematoma [EDH]), subdural hematoma (SDH), intracerebral hemorrhage (ICH), and traumatic subarachnoid hemorrhage (SAH); cerebral contusions; concussion (with postconcussive syndrome); and diffuse axonal injury (DAI).
If an injury to the brain has occurred or is suspected, the victim should not be moved until spinal precautions are carefully implemented. Serial neurologic assessments are carried out to identify the severity of injury and any subsequent deterioration.SYN: cerebral concussion.
SEE: table - Mechanisms of Brain Injury.
ABBR: VILI
Injury to the alveoli or alveolar capillaries caused by high airway pressures, excessive tidal volumes, or repeated expansion and collapse of the alveoli during mechanical ventilation. It can produce local inflammatory lung destruction and the release of inflammatory molecules throughout the systemic circulation.whiplash i.An imprecise term for injury to the cervical vertebrae and adjacent soft tissues. It is produced by a sudden jerking or relative backward or forward acceleration of the head with respect to the vertebral column. This type of injury may occur in a vehicle that is suddenly and forcibly struck from the rear.