Symptoms of Injury

Research More About Injury

Do I have Injury?

• Injury: Introduction
• Injury: Diagnostic Testing to confirm diagnosis
• Alternative diagnoses and misdiagnosis for Injury
• Failure to Diagnose Injury
• How serious is it?
• Treatments for Injury
• More about Injury

Wrongly Diagnosed with Injury?

The list of other diseases or medical conditions that may be on the differential diagnosis list of alternative diagnoses for Injury includes:

• Arthritis
• Breast abscess
• Carpal Tunnel Syndrome
• Earache
• Exophthalmos

See the full list of 16 alternative diagnoses for Injury

More about symptoms of Injury:

More information about symptoms of Injury and related conditions:

• Other diseases with similar symptoms and common misdiagnoses
• Tests to determine if these are the symptoms of Injury
• Underlying causes of Injury
• Associated conditions for Injury
• Risk factors for Injury

Medical Books Online about Injury

Medical Books Excerpts Excerpts of published medical book chapters related to Injury are available from published medical books for more detailed information about Injury.

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

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Symptoms of Injury: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the symptoms of Injury.

Rape trauma syndrome: Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))

When a rape victim arrives in the emergency department, assess her physical injuries. If she isn’t seriously injured, allow her to remain clothed and take her to a private room where she can talk with you or a counselor before the necessary physical examination. (See If the rape victim is a child.) Remember, immediate reactions to rape differ and can include crying, laughing, hostility, confusion, withdrawal, or outward calm; anger and rage may not surface until later. During the attack, the victim may have felt demeaned, helpless, and afraid for her life; afterward, she may feel ashamed, guilty, shocked, and vulnerable and have a sense of disbelief and lowered self-esteem. Offer support and reassurance. Help her explore her feelings; listen, convey trust and respect, and remain nonjudgmental. Don’t leave her alone unless she asks you to do so.

Being careful to upset the victim as little as possible, obtain an accurate history of the rape, pertinent to physical assessment. (Remember, your notes may be used as evidence if the rapist is tried.) Record the victim’s statements in the first person, using quotation marks. Also, document objective information provided by others. Never speculate as to what may have happened or record subjective impressions or thoughts. Include in your notes the time the victim arrived at the facility, the date and time of the alleged rape, and the time that the victim was examined. Ask the victim if she’s allergic to penicillin or other drugs, if she has had recent illnesses (especially venereal disease), and if she was pregnant before the attack. Find out the date of her last menstrual period and details of her obstetric and gynecologic history.

Thoroughly explain the examination she’ll have, and tell her it’s necessary to rule out internal injuries and obtain a specimen for venereal disease testing. Obtain her informed consent for treatment and for the police report. Allow her some control if possible; for instance, ask her if she’s ready to be examined or if she would rather wait a bit.

Before the examination, ask the victim whether she douched, bathed, or washed before coming to the hospital. Note this on her chart. Have her change into a hospital gown, and place her clothing in paper bags. Label each bag and its contents.

Alert Never use plastic bags because secretions and seminal stains will mold, destroying valuable evidence.

Tell the victim she may urinate, but warn her not to wipe or otherwise clean the perineal area. Stay with her, or ask a counselor to stay with her, throughout the examination.

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Open trauma wounds: Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))

In all open wounds, assess the extent of injury, vital signs, level of consciousness (LOC), obvious skeletal damage, local neurologic deficits, and general patient condition. Obtain an accurate history of the injury from the patient or witnesses, including such details as the mechanism and time of injury and any treatment already provided. If the injury involved a weapon, notify the police.

Also assess for peripheral nerve damage — a common complication in lacerations and other open trauma wounds — as well as for fractures and dislocations. Signs of peripheral nerve damage vary with location:

❑ radial nerve — weak forearm dorsiflexion, inability to extend thumb in a hitchhiker’s sign

❑ median nerve — numbness in tip of index finger; inability to place forearm in prone position; weak forearm, thumb, and index finger flexion

❑ ulnar nerve — numbness in tip of little finger, clawing of hand

❑ peroneal nerve — footdrop, inability to extend the foot or big toe

❑ sciatic and tibial nerves — paralysis of ankles and toes, footdrop, leg weakness, numbness in sole.

Most open wounds require emergency treatment. In those with suspected nerve involvement, however, electromyography, nerve conduction, and electrical stimulation tests can provide more detailed information about possible peripheral nerve damage.

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Abdominal trauma: Signs and Symptoms
(Professional Guide to Diseases (Eighth Edition))

Pallor, cyanosis, pain, tachycardia, dyspnea, hypotension, bruising, abdominal distention and rigidity

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Blunt and penetrating abdominal injuries: Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))

Symptoms vary with the degree of injury and the organs damaged. Penetrating abdominal injuries cause obvious wounds (gunshots commonly produce both entrance and exit wounds) with variable blood loss, pain, and tenderness. They commonly result in pallor, cyanosis, tachycardia, shortness of breath, and hypotension. (See Projectile pathway.)Blunt abdominal injuries cause severe pain (which may radiate beyond the abdomen to the shoulders), bruises, abrasions, contusions, or distention. They may also result in tenderness, abdominal splinting or rigidity, nausea, vomiting, pallor, cyanosis, tachycardia, and shortness of breath. Rib fractures commonly accompany blunt injuries. (See Effects of blunt abdominal trauma, page 300.)

In both blunt and penetrating injuries, massive blood loss may cause hypovolemic shock. Damage to solid abdominal organs (liver, spleen, pancreas, and kidneys) generally causes hemorrhage. Damage to hollow organs (stomach, intestine, gallbladder, and bladder) causes rupture and release of the organs’ contents (including bacteria) into the abdomen, which in turn produces inflammation and, possibly, infection.

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Blunt chest injuries: Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))

Rib fractures produce tenderness, slight edema over the fracture site, and pain that worsens with deep breathing and movement; this painful breathing causes the patient to display shallow, splinted respirations that may lead to hypoventilation. Sternal fractures, which are usually transverse and located in the middle or upper sternum, produce persistent chest pains, even at rest. If a fractured rib tears the pleura and punctures a lung, it causes pneumothorax. This usually produces severe dyspnea, cyanosis, agitation, extreme pain and, when air escapes into chest tissue, subcutaneous emphysema.

Multiple rib fractures within two or more places may cause flail chest, in which a portion of the chest wall “caves in,” causing a loss of chest wall integrity and preventing adequate lung inflation. (See Flail chest: Paradoxical breathing.)

Signs and symptoms of flail chest include bruised skin, extreme pain caused by rib fracture and disfigurement, paradoxical chest movements, tachycardia, hypotension, respiratory acidosis, cyanosis, and rapid, shallow respirations. Flail chest can also cause tension pneumothorax, a condition in which air enters the chest but can’t be ejected during exhalation. This life-threatening thoracic pressure buildup causes lung collapse and subsequent mediastinal shift. The cardinal symptoms of tension pneumothorax include severe dyspnea, absent breath sounds (on the affected side), agitation, jugular vein distention, tracheal deviation (away from the affected side), cyanosis, and shock.

Hemothorax occurs when a rib lacerates lung tissue or an intercostal artery, causing blood to collect in the pleural cavity, thereby compressing the lung and limiting respiratory capacity. It can also result from rupture of large or small pulmonary vessels.

Massive hemothorax is the most common cause of shock after a chest injury. Although slight bleeding occurs even with mild pneumothorax, such bleeding resolves very quickly, usually without changing the patient’s condition. Rib fractures may also cause pulmonary contusion (resulting in hemoptysis, hypoxia, dyspnea, and possible obstruction), large myocardial tears (which can be rapidly fatal), and small myocardial tears (which can cause pericardial effusion).

Myocardial contusions — actual bruising of the heart muscle — produce electrocardiographic (ECG) abnormalities. Laceration or rupture of the aorta is almost always immediately fatal. Because aortic laceration may develop 24 hours after blunt injury, patient observation is critical. Diaphragmatic rupture (usually on the left side) causes severe respiratory distress. Unless treated early, abdominal viscera may herniate through the rupture into the thorax (with resulting bowel sounds in the chest), compromising both circulation and the lungs' vital capacity.

Other complications of blunt chest trauma may include cardiac tamponade, pulmonary artery tears, ventricular rupture, and bronchial, tracheal, or esophageal tears or rupture.

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Acceleration-deceleration cervical injuries: Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))

Although symptoms may develop immediately, they’re often delayed 12 to 24 hours if the injury is mild. Whiplash produces moderate to severe anterior and posterior neck pain. Within several days, the anterior pain diminishes, but the posterior pain persists or even intensifies, causing patients to seek medical attention if they didn’t do so before. Whiplash may also cause dizziness, gait disturbances, vomiting, headache, nuchal rigidity, neck muscle asymmetry, and rigidity or numbness in the arms.

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Cold injuries: Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))

Frostbite may be deep or superficial. Superficial frostbite affects skin and subcutaneous tissue, especially of the face, ears, extremities, and other exposed areas. Although it may go unnoticed at first, frostbite produces burning, tingling, numbness, swelling, and a mottled, blue-gray skin color when the person returns to a warm place.

Deep frostbite extends beyond subcutaneous tissue and usually affects the hands or feet. The skin becomes white until it’s thawed; then it turns purplish blue. Deep frostbite also produces pain, skin blisters, tissue necrosis, and gangrene. (See Recognizing frostbite.)

Indications of hypothermia (a core body temperature below 957 F [357 C]) vary with severity:

❑ mild hypothermia — temperature of 89.67 to 957 F (327 to 357 C), severe shivering, slurred speech, and amnesia

❑ moderate hypothermia — temperature of 867 to 89.67 F (307 to 327 C), unresponsiveness or confusion, muscle rigidity, peripheral cyanosis and, with improper rewarming, signs of shock

❑ severe hypothermia — temperature of 777 to 867 F (257 to 307 C), loss of deep tendon reflexes, and ventricular fibrillation. The patient may appear dead (in a state of rigor mortis), with no palpable pulse or audible heart sounds. His pupils may be dilated. A temperature drop below 777 F causes cardiopulmonary arrest and death.

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Spinal injuries: Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))

The most obvious symptoms of spinal injury are muscle spasm and back pain that worsen with movement. In cervical fractures, pain may produce point tenderness; in dorsal and lumbar fractures, it may radiate to other body areas such as the legs. After mild injuries, symptoms may be delayed for several days or weeks. If the injury damages the spinal cord, clinical effects range from mild paresthesia to quadriplegia and shock.

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Rape trauma syndrome: Signs and symptoms
(Handbook of Diseases)

A physical examination (including a pelvic examination by a gynecologist) will probably show signs of physical trauma, especially if the assault was prolonged. Depending on specific body areas attacked, a patient may have a sore throat, mouth irritation, difficulty swallowing, ecchymoses, or rectal pain and bleeding.

If additional physical violence accompanied the rape, the victim may have hematomas, lacerations, bleeding, severe internal injuries, or hemorrhage, and if the rape occurred outdoors, she may suffer from exposure. X-rays may reveal fractures. The patient may have injuries severe enough to require hospitalization.

Assessment

❑ When a rape victim arrives in the emergency department, assess her physical injuries. If she isn’t seriously injured, allow her to remain clothed and take her to a private room where she can talk with you or a counselor before the necessary physical examination.

❑ Immediate reactions to rape differ. The patient may experience crying, laughing, hostility, confusion, withdrawal, or outward calm; in many cases, anger and rage don’t surface until later. During the assault, the victim may have felt demeaned, helpless, and afraid for her life; afterward, she may feel ashamed, guilty, shocked, and vulnerable, and have a sense of disbelief and lowered self-esteem.

❑ Offer support and reassurance. Help her explore her feelings; listen, convey trust and respect, and remain nonjudgmental. Don’t leave her alone unless she asks you to.

❑ Being careful to upset the victim as little as possible, obtain an accurate history of the rape, pertinent to physical assessment.

CLINICAL TIP: Make sure your documentation is thorough. Your notes may be used as evidence if the rapist is tried.

❑ Record the victim’s statements in the first person, using quotation marks. Also, document objective information provided by others.

❑ Never speculate as to what may have happened or record subjective impressions or thoughts.

❑ Include in your notes the time the victim arrived at the hospital, the date and time of the alleged rape, and the time the victim was examined. Ask the victim whether she’s allergic to penicillin or other drugs, whether she has recently been ill (especially with venereal disease), or whether she was pregnant before the attack. Also ask the date of her last menstrual period and details of her obstetric-gynecologic history.

❑ Thoroughly explain the examination she’ll have, and tell her that it’s necessary to rule out internal injuries and obtain a specimen for venereal disease testing. Obtain her informed consent for treatment and for the police report. Allow her some control, if possible — for example, ask her whether she’s ready to be examined or if she’d rather wait a bit.

❑ Before the examination, ask the victim whether she douched, bathed, or washed before coming to the hospital. Note this on her chart. Have her change into a hospital gown, and place her clothing in paper bags. (Never use plastic bags, because secretions and seminal stains will mold, destroying valuable evidence.) Label each bag and its contents.

❑ Tell the victim she may urinate, but warn her not to wipe or otherwise clean the perineal area. If the patient wishes, ask a counselor to stay with her throughout the examination. This examination is typically very distressing for the rape victim. Reassure her and allow her as much control as possible.

❑ Throughout the examination, provide support and reassurance, and carefully label all possible evidence. Before the victim’s pelvic area is examined, take vital signs, and if the patient is wearing a tampon, remove it, wrap it, and label it as evidence.

❑ During the examination, make sure all specimens collected, including those for semen and gonorrhea, receive careful labeling. Include the patient’s name, the physician’s name, and the location from which the specimen was obtained. List all specimens in your notes.

❑ If the case comes to trial, specimens will be used for evidence, so accuracy is essential. Most emergency departments have “rape kits” with containers for specimens. Carefully collect and label fingernail scrapings and foreign material obtained by combing the victim’s pubic hair; these also provide valuable evidence. Note to whom these specimens are given.

GENDER INFLUENCE: For a male victim, be especially alert for injury to the mouth, perineum, and anus. Obtain a pharyngeal specimen for a gonorrhea culture and rectal aspirate for acid phospate or sperm analysis.

❑ Photographs of the patient’s injuries will also be taken. This may be delayed for a day or repeated when bruises and ecchymoses are more apparent.

❑ Most states require hospitals to report rape. The patient may not press charges and may not assist the police. If the patient doesn’t go to the hospital, she may not report the rape.

❑ If the police interview the patient in the hospital, be supportive and encourage her to recall details of the rape. Your kindness and empathy are in-valuable.

❑ The patient may also want you to call her family. Help her to verbalize anticipation of her family’s response.

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Wounds, open trauma: Signs and symptoms
(Handbook of Diseases)

In all open wounds, assess the extent of injury, vital signs, level of consciousness (LOC), obvious skeletal damage, local neurologic deficits, and general patient condition. Obtain an accurate history of the injury from the patient or witnesses, including such details as the mechanism and time of injury and any treatment already provided. If the injury involved a weapon, notify the police.

Also assess for peripheral nerve damage  —  a common complication in lacerations and other open trauma wounds, as well as for fractures and dislocations. Signs of peripheral nerve damage vary with location as follows:

❑ radial nerve — weak forearm dorsiflexion, inability to extend thumb in a hitchhiker’s sign

❑ median nerve — numbness in tip of index finger; inability to place forearm in prone position; weak forearm, thumb, and index finger flexion

❑ ulnar nerve — numbness in tip of little finger, clawing of hand

❑ peroneal nerve — footdrop, inability to extend the foot or big toe

❑ sciatic and tibial nerves — paralysis of ankles and toes, footdrop, weakness in leg, numbness in sole.

Most open wounds require emergency treatment. In those with suspected nerve involvement, however, electromyography, nerve conduction, and electrical stimulation tests can provide more detailed information about possible peripheral nerve damage.

READ BOOK EXCERPT ONLINE »

Chest injuries, blunt: Signs and symptoms
(Handbook of Diseases)

Rib fractures produce tenderness, slight edema over the fracture site, and pain that worsens with deep breathing and movement; this painful breathing causes the patient to display shallow, splinted respirations that may lead to hypoventilation.

Sternal fractures, which are usually transverse and located in the middle or upper sternum, produce persistent chest pain, even at rest. If a fractured rib tears the pleura and punctures a lung, it causes pneumothorax, which usually produces severe dyspnea, cyanosis, agitation, extreme pain and, when air escapes into chest tissue, subcutaneous emphysema.

Multiple rib fractures

Multiple rib fractures may cause flail chest: a portion of the chest wall “caves” in, which causes a loss of chest wall integrity and prevents adequate lung inflation. Bruised skin, extreme pain caused by rib fracture and disfigurement, paradoxical chest movements, and rapid, shallow respirations are all signs and symptoms of flail chest, as are tachycardia, hypotension, respiratory acidosis, and cyanosis.

Flail chest can also cause tension pneumothorax, a condition in which air enters the chest but can’t be ejected during exhalation; life-threatening thoracic pressure buildup causes lung collapse and subsequent mediastinal shift. The cardinal signs and symptoms of tension pneumothorax include tracheal deviation (away from the affected side), cyanosis, severe dyspnea, absent breath sounds (on the affected side), agitation, jugular vein distention, and shock.

Hemothorax

When a rib lacerates lung tissue or an intercostal artery, hemothorax occurs, causing blood to collect in the pleural cavity, thereby compressing the lung and limiting respiratory capacity. It can also result from rupture of large or small pulmonary vessels.

Massive hemothorax is the most common cause of shock following chest trauma. Although slight bleeding occurs even with mild pneumothorax, such bleeding resolves very quickly, usually without changing the patient’s condition.

Rib fractures may also cause pulmonary contusion (resulting in hemoptysis, hypoxia, dyspnea and, possibly, obstruction), large myocardial tears (which can be rapidly fatal), and small myocardial tears (which can cause pericardial effusion).

Further complications

Myocardial contusions produce electrocardiogram (ECG) abnormalities. Laceration or rupture of the aorta is nearly always immediately fatal. In rare cases, aortic laceration may develop 24 hours after blunt injury, so patient observation is critical.

Diaphragmatic rupture (usually on the left side) causes severe respiratory distress. Unless treated early, abdominal viscera may herniate through the rupture into the thorax, compromising both circulation and the vital capacity of the lungs.

Other complications of blunt chest trauma include cardiac tamponade, pulmonary artery tears, ventricular rupture, and bronchial, tracheal, or esophageal tears or rupture.

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Abdominal injuries: Signs and symptoms
(Handbook of Diseases)

Depending on the degree of injury and the organs involved, signs and symptoms vary as follows: