Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma...
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Transcript of Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma...
Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis
Sections
Most common cause of trauma death and disability
Energy exchange between an object and the human body, without intrusion through the skin
Introduction toBlunt Trauma
KinematicsKinematics
Process of examining the scene to determine potential injuries that result from the forces of motion
Windshield, steering wheel, dashboard Was the patient flying thru the air? Roll-over? Engine block on lap? (intrusion)
MOIMOI
Mechanism of injury description of the mechanical and
physiological changes that result in anatomical or functional damage of tissue
Translation: What hit the patient???, what did the patient hit???!
Index of SuspicionIndex of Suspicion
Based on the MOI and kinetics Predict expected injuries Experience counts here! Be obsessive and compulsive, its OK!!
Kinetics of Blunt Trauma Inertia
“A body in motion will remain in motion unless acted upon by an outside force.”
“A body at rest will remain at rest unless acted upon by an outside force.” (Newton)
Conservation of Energy “Energy can neither be created nor
destroyed. It is only changed from one form to another.” (Newton)
Force (Newton’s 2nd law of motion)
Emphasizes the importance of rate at which an object changes speed (acceleration or deceleration)
Kinetics of Blunt Trauma
onAcceleratiMassForce
SOOOO
The Force that puts an object in motion must be absorbed before the object will stop.
Guess what absorbs that force???? This absorption is what causes tissue
injury in the body.
Kinetic Energy Energy in Motion
Double Weight = Double Energy Double Speed = Quadruple Energy
SPEED IS THE GREATESTDETERMINANT
Kinetics of Blunt Trauma
2
)()( 2speedVelocityweightMassKE
Compression
Like laying an organ on a table and hitting it with a hammer, every time you hit it, cells are getting compressed and crushed.
Enough said…..
Shear
Occur when the organ and the organ’s attachment do not accelerate or decelerate at the same rate of speed, or two parts of an organ accelerate or decelerate at different rates.
Examples are arch of aorta, spleen, kidney.
Overpressure
Like hitting a closed paper bag with the
open hand….the bag pops. Examples are like steering column hitting
abdomen…pop! goes the diaphragm. Also can pop bladder, bowel, lungs……
Blunt Closed injury Indirect injury to underlying structures Transmission of energy into the body
Tearing of muscle, vessels and bone Rupture of solid organs Organ injury
Ligamentum teres in the chest for example
Types of Trauma
44,000 people die each year on US highways Events of Impact
Vehicle Collision Body Collision Organ Collision Secondary Collisions
Objects inside vehicle strike occupant
Additional Injuries Vehicle receives a second impact
Blunt Trauma: Car Crashes
Restraints Seatbelts
Occupant slows with the vehicle Shoulder and Lap belts MUST be worn together
Injuries if worn separately Airbags (SRS)
Reduce blunt chest trauma Cause: Hand, Forearm, & Facial Injury Check for steering wheel deformity Side Airbags
Child Safety Seats Infants and Small Children: Rear facing Older Child: Forward facing
Blunt Trauma: Car Crashes
Benefits of Air bags
700-1000 lives saved if all vehicles had head protecting SABs per year
In side impacts where someone died, 60% suffered brain injury.
Only 92 cases of SAB injury, 6 involving children, with no major injuries, only one minor injury (skin lac).
Bags and Belts
Burns, abrasions Do not protect when a second collision hits! Abdominal injuries (seat too close) Chest injuries (short, elderly) Seat belt abrasions above the pelvis account for
a 30-60% incidence of intra-abdominal injuries: intestinal rupture, mesenteric injury, vascular disruption
Types of Impact Frontal: 32% Lateral: 15% Rotational: 38%
Left & Right – Front & Rear Rear-end: 9% Rollover: 6%
Blunt Trauma: Automobile Crashes
Frontal Impact Down-and-Under (legs lead point)
Knee, femur, and hip fracture (dislocation of knee, fx acetabulum) Chest trauma-Steering Wheel
Up-and-Over (head lead point) Head, c-spine injuries Tenses legs = Bilateral femur fracture Hollow organ rupture and liver laceration Similar chest trauma Axial Loading
Ejection Due to up-and-over pathway Contact with the vehicle & external object
Blunt Trauma: Car Crashes
Lateral Impact (intersection race) 15% of MVC’s but 22% of deaths Upper extremity injury Rib, clavicle, humerus, pelvis, femur fracture, c-
spine dislocations, locked facets. Lateral compression
Ruptured diaphragm, Spleen fracture, Aortic injury
EVALUATE the unrestrained occupant
Blunt Trauma: Automobile Crashes
Rotational Vehicle struck at oblique angle Less serious injuries unless strike a
secondary object
Blunt Trauma:Car Crashes
Rear-end Seat propels the occupant forward Head is forced backwards
Stretching of neck muscles and ligaments Hyperextension & hyperflexion (think carotid)
Rollover Multiple points of impact Ejection or partial ejection (think: arm out of
window, then roll….) Less injury with restraints
Blunt Trauma:Car Crashes
Vehicle Crash Analysis Crumple Zones Intrusion (one inch for each mile per hour) Deformity of Vehicle Use of Restraints
Intoxication Fatal Accidents: >50% involved ETOH Recreational Accidents
Blunt Trauma: Automobile Crashes
Vehicular Mortality Head: 48% Internal (Torso): 37% Spinal & Chest fracture: 8% Extremity fracture: 2% All Other: 5%
Blunt Trauma: Automobile Crashes
Collision Questions How did collision
occur? Direction? Speed? Similar/Different
sized? Secondary
collisions?
Collision Questions How did collision
occur? Direction? Speed? Similar/Different
sized? Secondary
collisions?
Cause of CrashWeather & visibility?Alcohol involved?Skid marks?
Auto InteriorStarring of windshield?Steering wheel deformity?Dash deformity?Intrusion?
Cause of CrashWeather & visibility?Alcohol involved?Skid marks?
Auto InteriorStarring of windshield?Steering wheel deformity?Dash deformity?Intrusion?
Blunt Trauma: Automobile CrashesCrash Evaluation
The “Lucky Other Guy”
The passenger in the same car as the deceased driver for example.
BUT, this “lucky”person was in the same vehicle and the energy exchange on the body was the same.
So you’d better find that unrecognized injury!
Serious injuries can occur with high and low speed collision.
Types of Impact Frontal Angular Sliding (“laying the bike down”) Ejection
Initial Bike/Object Collision Rider/Object Rider/Ground
Blunt Trauma: Motorcycle Crashes
Motorcycle Injuries
No helmet use increases chance of head
injury by 300%. Does not protect c-spine, but does not
injure it either. Anti-helmet organizations such as
American Motorcycle Association may say different………
Adults Adults turn away and run (lat,post injuries) Bumper strikes lower legs first Victim rolls up and over and thrown
Children Children turn toward (ant injuries) Femurs, Pelvis often injured Thrown away or run over
Blunt Trauma:Pedestrian Struck
Lack structure and restraint system Types of Vehicles
Snowmobiles Personal watercraft ATV’s
Blunt Trauma: Recreational Vehicle Accidents
Falls Stairs, Force, Surface Landing Area
Surface Type Body Part
Height of Fall (3 times height of victim) Elderly Axial Loading…..
Other Types of Blunt Trauma
Crush Injuries Cause
Structural collapse, explosion, industrial; or agricultural Great force to soft tissue and bones
Tissue stretching and compression Extended pressure results in anaerobic metabolism
distal to compression Return of blood flow, toxins to entire body Severe hemorrhage due to severe damaged blood
vessels Care
Prolonged crush Medications Sodium Bicarbonate: Reduce Acidosis Morphine: Pain management
Other Types of Blunt Trauma
Blast Injuries Dust, Fumes, Explosive Compounds
Explosion Fuel + Oxidant combine instantaneously Heat & Pressure Wave
Blunt Trauma: Blast Injuries
Primary InjuriesPrimary Injuries rapid changes in atmospheric pressure from
movement of blast wave hollow organs more susceptible blast wave rapidly passes through tissue of
varying density; if lower density is adjacent to higher density surface tissue of denser tissue is disrupted- “spalling” as wave transverses the walls of the alveoli (high density), they rupture as the wave encounters the air within the alveoli (low density); massive destruction of alveoli and diffuse hemorrhage in lung
Implosion pressure wave passes through the lung, it
forces blood out of the vascular space and into the alveoli
wave of high pressure is followed by wave of low pressure allowing alveoli to expand rapidly with further tearing of the lung parenchyma, atelectasis, hemorrhage
Secondary InjurySecondary Injury
Results from flying debris created by the explosion and carried by blast winds
injuries are typically severe and penetrating due to high KE of projectiles
Tertiary InjuriesTertiary Injuries
Blast winds are sufficient force to cause victims to become human missiles
victim strikes the ground
Associated InjuriesAssociated Injuries
Injuries resulting from changes in the environment as a consequence of the explosion fire; burns combustion of toxic products; poisoning leaks of toxic chemicals; asphyxiation
Explosion
Pressure Wave Structural Collapse Blast Wind
Burns Projectiles Personnel Displacement Blast Injury Phases
Primary: Heat of the explosion Secondary: Trauma caused by projectiles Tertiary: Personnel displacement and structural
collapse
Blast Injury Assessment Be alert for secondary device Initial scene size-up important Establish Incident Command System (ICS) Evaluate for secondary hazards Injury Patterns
Rupture of Air or Fluid Filled Organs Lung: Late manifestation (heat & pressure) Hearing loss
Explosion
Blast Injury Care Lungs
Forceful compression and distortion of chest cavity
Compression and decompression Pulmonary Embolism, Dyspnea, Hemoptysis,
Pneumothorax Abdomen
Compression & Decompression Release of bowel contents Diaphragm rupture from pushing of organs up
into thorax area
Explosion
Blast Injury Care Ears
Initial Hearing Loss Injury improves over time
Penetrating Wounds Care as any serious open wound or impaled
object Burns
Treatment consistent with traditional management.
Explosion