Trauma Overview, Chapter 25, Emergency Care and Transport for the Sick and Injured: 12th edition

arterial air embolism

Air bubbles in the arterial blood vessels.

blunt trauma

An impact on the body by objects that cause injury without penetrating soft tissues or internal organs and cavities.

cavitation

A phenomenon in which speed causes a bullet to generate pressure waves, which cause damage distant from the bullet's path.

coup-contrecoup brain injury

A brain injury that occurs when force is applied to the head and energy transmission through brain tissue causes injury on the opposite side of original impact.

deceleration

The slowing of an object.

drag

Resistance that slows a projectile, such as air.

Glasgow Coma Scale (GCS) score

An evaluation tool used to determine level of consciousness, which evaluates and assigns point values (scores) for eye opening, verbal response, and motor response, which are then totaled; effective in helping predict patient outcomes.

index of suspicion

Awareness that unseen life-threatening injuries may exist when determining the mechanism of injury.

kinetic energy

the energy of a moving object

mechanism of injury (MOI)

The forces, or energy transmission, applied to the body that cause injury.

medical emergencies

Emergencies that require EMS attention because of illnesses or conditions not caused by an outside force.

multisystem trauma

Trauma that affects more than one body system.

penetrating trauma

Injury caused by objects, such as knives and bullets, that pierce the surface of the body and damage internal tissues and organs.

potential energy

The product of mass, gravity, and height, which is converted into kinetic energy and results in injury, such as from a fall.

projectile

Any object propelled by force, such as a bullet by a weapon.

pulmonary blast injuries

Pulmonary trauma resulting from short-range exposure to the detonation of explosives.

Revised Trauma Score (RTS)

A scoring system used for patients with head trauma.

trajectory

The path a projectile takes once it is propelled.

trauma emergencies

Emergencies that are the result of physical forces applied to a patient's body.

trauma score

A score calculated from 1 to 16, with 16 being the best possible score. It relates to the likelihood of patient survival with the exception of a severe head injury. It takes into account the Glasgow Coma Scale (GCS) score, respiratory rate, respiratory expansion, systolic blood pressure, and capillary refill.

tympanic membrane

The eardrum; a thin, semitransparent membrane in the middle ear that transmits sound vibrations to the internal ear by means of auditory ossicles.

work

The measure of force over distance.

The three collisions in a typical impact:

1. the collision of the car against another car or object

2. collision of the passenger against the interior of the vehicle

3. collision of the passenger's internal organs against the solid structures of the body

Significant MOIs are suggested by the following findings

—Death of an occupant in the vehicle

—Severe deformity of the vehicle or intrusion into the vehicle

—Severe deformities of the frontal part of the vehicle, with or without intrusion into the passenger compartment

—Moderate intrusions from a lateral (T-bone) type of accident

—Severe damage from the rear

—Crashes in which rotation is involved (rollover and spins)

—Ejection from the vehicle

Types of vehicle (car) crashes

—Frontal: (the car is impacted at the front)

—Rear-end: (the car is impacted in the back)

—Lateral: (the car is hit from the side, aka a T-bone)

—Rollover: (the car tumbles or "rolls over")

—Rotational: (the car spins out)

Types of motorcycle crashes

—Head-on crash: the motorcycle hits another object from the front, which usually flings the driver over the handlebars

—Angular crash: the motorcycle hits another object at an angle causing the driver to sustain crush injuries

—Ejection: the rider will travel at high speed until stopped by a stationary object, another vehicle, or road drag

—Controlled crash: a technique used to gradually stop the motorcycle. It involves the rider shifting the bike to its side to let friction take it to a stop

Types of blast injuries

—primary: caused by the blast itself

—secondary: caused by flying objects

—tertiary: occurs when the patient is thrown into a secondary object

—quaternary: occurs when the patient inhales hot and/or toxic gasses

Account for these factors when a patient has a fall:

—the height of the fall

—the type of surface struck

—the part of the body that hit first, followed by the path of energy displacement

The major components of patient assessment include the following:

—scene size-up

—primary assessment

—history taking

—secondary assessment

—reassessment

The following criteria will help you identify a critically injured patient

—Dangerous MOI

—Decreased level of consciousness

—Any threats to airway, breathing, or circulation

Types of trauma centers

—Level I: Capable of providing every aspect of trauma care from prevention through rehabilitation. Are university-based teaching hospitals.

—Level II: Can provide initial definitive care, regardless of injury severity. Can be academic institutions or a public/private community facility.

—Level III: Provides assessment, resuscitation, emergency care, and stabilization. Can transfer patients to higher-level facilities.

—Level IV: Can provide ATLS prior to transfer to a higher-level trauma center. these facilities can be an urgent care or clinic without a physician.

GCS (Glasgow Coma Scale): eyes

Eye Opening:

4 = spontaneous

3 = To sound

2 = To pressure

1 = None

GCS (Glasgow Coma Scale): Verbal

5 = Oriented Conversation

4 = Confused Conversation

3 = Inappropriate Words

2 = Incomprehensible sounds

1 = None

GCS (Glasgow Coma Scale): Motor

6 = Obeys Commands

5 = Localizes Pressure

4 = Withdraws from Pressure

3 = Abnormal Flexion (decorticate)

2 = Abnormal Extension (decerebrate)

1 = None