Chapter 25 Trauma Overview

the leading cause of death for people younger than age 44

traumatic injuries

traumatic injuries occur as a result of

physical forces applied to the body

medical emergencies occur from an

illness or condition not caused by an outside force

index of suspicion is

your awareness for potentially serious underlying and unseen injuries

traumatic injury occurs when

the body's tissues are exposed to energy levels beyond their tolerance

mechanism of injury (MOI) describes the

forces acting on the body that cause injury

understanding the MOI helps predict patterns and sharpens

the EMTS index of suspicion

three concepts of energy are typically associated with injury

- potential energy - kinetic injury - energy of work

defined as a force acting over a distance

energy of work

forces that bend, pull or compress tissues beyond their inherent limits results in

injury

....... energy comes from an object in motion

kinetic

remember that if the airbag did not deploy during the crash

it may deploy during extrication

....... energy is the product of mass, force of gravity and height

potential energy

when a person falls

potential energy is converted to kinetic energy; the kinetic injury is then converted into the work of bringing the body to a stop

nonsignificant Injuries

- injury to an isolated body part - fall without the loss of conciousness

significant MOIs include

- injury to more than one body system (multi system trauma)- falls from heights - motor vehicle and motorcycle crashes at higher speeds - car versus pedestrian or bicycle - gunshot wounds - stabbings

injury to more than one body system is

multisystem trauma

traumatic injuries can be divided into two separate categories

blunt trauma penetrating trauma

blunt trauma is

the result of force to the body that causes injury without penetrating the soft tissues

causes injury by objects that primarily pierce and penetrate the surface of the body

penetrating trauma

blunt trauma results from

an object making contact with the body

What are the most common MOIs

motor vehicle crashesfalls

a crash typically consist of three collisons

1) car against another car/tree/object2) passenger against the vehicles interior or safety restraint system, (SRS)3) passengers internal organs strike the internal structures of the body (ie brain hitting skull)

internal injuries from a car accident may not be as obvious as external injuries but they are

often the most life threntening injuries

coup injury

brain hits the side of skull that hits that is impacted by the object

contre-coup injury

brain hits skull on opposite of object impact

air bags decrease the severity of

deceleration injuries

seatbelts should be worn

below the anterior superior iliac spines of the pelvis and against the hips

seatbelts and airbags are effective in preventing

a second collision inside the motor vehicle

remember that if the air bag did not inflate during the accident,

it may deploy during extrication

occupant of a car can go up and ............. or down ..............

over the dashboard under the dashboard

SRS systems can cause harm whether they are used properly or not such as

- hip dislocation from seatbelt - internal injuries if seatbelt is worn to high - lumbar spine fractures (especially is children and geriatrics)

rapid deceleration of the head striking an object will cause,

compression injuries or bruising to the anterior portion of the brain stretching or tearing to the posterior part of the brain

rear end crashes are know to cause

whiplash type injuries especially in the absence of properly placed headrest

in whiplash type injury the ......... is at the most risk

cervical spine

explain how what happens to the body in whiplash

as the body is propelled forward, the head and neck are left behind causing hyperextension of cervical spine

acceleration type injury to the brain is possible in

rear end crashes

lateral or side impacts are a very

common cause of death associated with motor vehicle crashes

lateral crashes result in the passenger sustaining

a lateral whiplash injury

in a lateral crash if the passengers compartment is substantially intruded you should suspect

- lateral chest and abdomen injuries on side of crash - fractures to lower extremities, pelvis, ribs - organ damage from 3rd collison

the most common life threatening event in a rollover is

ejection or partial ejection from no seatbelt

injury patterns are hard to predict in

rollover crashes

in rotational crashes rotational forces increase the risk of

cervical spine injury

when a car hits a pedestrian injuries are often

graphic and apparent (but there can also be serious unseen injuries)

when a pedestrian gets hit by a car you should get some information that can help determine severity of injuries

- the vehicles speed- whether or not they were thrown in the air - what distanced they traveled - type of surface landed on

evaluate the car that struck the pedestrian for

structural damage that could indicate details about the crash

inspect ...... for damage when a bicycle rider is hit by a car

damage on the helmet

presume a patient that was hit by a car has a

injury to the spinal column, or spinal cord

when a pedestrian is hit by a car you will always use

spinal immobilization

helmets do not protect

against severe cervical injury

when assessing the scene of a car versus motorcycle crash

- deformity of motorcycle - side of the most damage - distance of skid in road -extent and location of deformity in the helmet - if there were multiple riders

there are four types of motorcycle impacts

head on crash angular crash ejection controlled crash

motorcycle strikes another object and stops its forward motion while the rider continues forward motion until stopped by outside force

head on crash

motorcycle strikes an object at an angle so that the rider sustains direct crushing injuries to the lower extremity between the object and the motorcycle

angular crash

in an ejection crash what will happen to the rider of the motorcycle

- rider will travel at high speed until stopped by stationary object, or road drag - severe abrasions injuries down to the bone can occur with drag

technique used by experienced motorcycle riders used to separate the rider from the body of the motorcycle and the object the motorcycle is about to hit

controlled crash (laying the bike down)

What are some significant MOIs

- rollovers, ejections - death of another occupant in vehicle - pedestrian or motorcyclist struck by vehicle - significant damage to vehicles exterior -damage intruding into the passenger compartment (more than 12 inches)- falls greater than 10 feet by pediatric patient, or any fall with loss of consciousness

injury potential for a fall depends on

the height from which the patient fell

more than a .... ft fall is considered significant for an adult

20 ft

In a fall .......... injuries pose the greatest threat

internal injuries

fall patients who landed on their feet may

have less severe internal injuries because their legs may have absorbed much of the energy

in falls take into account

- height of fall - type of surface struck - part of the body that hit/landed first

the second leading cause of trauma death in the untied states after blunt trauma

penetrating trauma

low energy penetrating trauma may be cause by

impalement

penetrating trauma may be caused intentionally by

knife, ice pick, pencil, rebar

with ................ penetrations, injuries are caused by the sharp edges of the object moving through the body. injuries reside along projectiles path

low energy penetrations

knives may have been

deliberately moved around internally, causing more damage than the external wound would suggest

in medium and high velocity penetrating trauma, the path of the projectile

may not be easy to predict

example of medium and high velocity penetrating trauma

handguns

a bullet may may flatten, tumble, or ricochet within the body before exiting, ...........

making injury pattern less predictable

path a projectile take is its

trajectory

fragmentation will

increase damage

example of a high velocity penetrating trauma

assault rifle

cavitation is

formation of a space within the body along the projectiles path

cavitation can result in

injury to the internal organs

......... cavitation injury results from stretching of the tissues that occurs with pressure changes

temporary

............. cavitation injury results closer to the bullet path and remains after the projectile has passed through the tissue

permanent

the relationship between distance and severity of injury varies

depending on the type of weapon involved

air resistance or drag slows a projectile decreasing the depth of penetration and energy of the projectile and thus

reducing damage to the tissues

area damaged by the projectile is typically

larger than the diameter of the projectile

energy available for a bullet to cause damage is more a function of

its speed than its mass

the three types of blast injuries

Primary - due to entire blast - damage caused by pressure wave Secondary - damage from being struck by flying debris Tertiary - Victim is hurled by the force of the explosion against a stationary object

Quaternary blast injuries are

miscellaneous blast injuries

most patient involved in an explosion will have some combination of

primary, secondary, tertiary and quaternary blast injuries

organs that contain air are the most susceptible to ........... during a blast

pressure changes

what are some organs with air

- middle ear - lung- gastrointestinal tract

the .... is the most sensitive to blast injuries

ear

pulmonary trauma that results from short-range exposure to the detonation of explosives

pulmonary blast injury

primary blast injuries are often characterized by

the lack of external visible injuries

one of the most concerning pulmonary blast injuries is ................., which occurs on the alveolar disruption with subsequent air embolization into the pulmonary vasculature.

arterial air embolism

arterial air embolism can produce

- disturbances in vison- changes in behavior LOC- variety of other neourlogic signs

......... are relatively protected from shock wave injury, but may be injured by secondary hurled objects

solid organs

the most common cause of death from blast injuries

neurologic injuries and head trauma

multisite trauma involves

more than one body system

if you encounter multisite trauma

alert medical control and transport immidialtly

when a person has experienced a nonsignificant MOI, focus on

chief complaint

bleeding or swelling inside the skull is often

life threatening

when an injury to the head occurs you should do frequent

neurologic examinations

some patient with a head injury will not head symptoms until

minutes or hours after the injury occurs

injuries to the neck and throat may result in ........... and quickly become a serious life threat

airway problems

survival of critically injured trauma patients is dependent on

time

limit on scene time of a severe trauma patient to

less then 10 minutes

facility that provides every aspect of trauma care 24/7

level 1

faculty that provides initial definitive care and capable of transferring to a level 1 trauma center

level II

facility that provides assessment, resuscitation, emergency car and stabilization

level III

facility provides advanced trauma life support

level IV

riverside traum centers

•Desert Regional Medical Center Lvl 3/No Peds•Inland Valley Medical Center Lvl 3/No Peds•Riverside Community Hospital Lvl 3/No Peds•The Riverside University Health System - Medical Center (Formely RCRMC) Lvl 2/Peds Lvl 2.

San Bernardino trauma centers

•Arrowhead Regional Medical Center Lvl 2/No Peds•Loma Linda Medical Center Lvl 1 for adult and Peds

kinetic energy is a calculation of

weight (mass) and speed (velocity)

energy cannot be destroyed only

converted

A 20-year-old man has major open facial injuries after his vehicle struck a tree head-on. Which of the following findings within the car would MOST likely explain his injury pattern?

non-intact windshield face injuries are usually a result of hitting the windshield

4.A young male experienced severe blunt chest trauma when his passenger car struck another vehicle head-on. During your inspection of the interior of his vehicle, you would MOST likely find:

steering wheel deformity chest trauma in a car accident tis most commonly occur when chest impacts steering wheel

5.An unrestrained driver collided with a bridge pillar. Upon inspection of the interior of his vehicle, you note that the lower dashboard is crushed. During your assessment of the patient, you will MOST likely encounter:

trauma to the pelvis

whiplash injuries a most common following a ........... accident

rear end

7.Death from a rollover motor vehicle crash is MOST often secondary to:

ejection of patient from mater vehicle

Severe abrasion injuries can occur when motorcycle riders are slowed after a collision by road drag. Road drag is most often associated with which type of motorcycle impact?

ejection

When assessing a stab wound, it is important for the EMT to remember that

more internal damage may be present than the external wound suggests.

A 40-year-old man was standing near a building when it exploded. He has multiple injuries, including a depressed skull fracture, severe burns, and an impaled object in his abdomen. His head injury was MOST likely caused by ___________ blast injuries.

tertiary