Chapter 24: Trauma Overview

Trauma emergencies

occur as a result of physical forces applied to the body

Medical emergencies

include illnesses or conditions not caused by an outside force

Index of suspicion

your awareness and concern for potentially serious underlying and unseen injuries

Mechanism of injury (MOI)

the way in which traumatic injuries occur; it describes the forces (or energy transmission) acting on the body that cause injury

Three concepts of energy are typically associated with injury

* Potential energy
* Kinetic energy
* The energy of work

Work

defined as force acting over a distance

Kinetic energy

the energy of a moving object

\
KE = 1⁄2 m × v2

Potential energy

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

Newton’s 1st Law

objects at rest tend to stay at rest and objects in motion tend to stay in motion unless acted on by some force

Newton’s 2nd Law

force equals mass times acceleration

\
F = (m)(a)

Newton’s 3rd Law

for every action, there is an equal and opposite reaction.

Multisystem trauma

trauma that affects more than one body system

Blunt trauma

the result of force to the body that causes injury without anything penetrating the soft tissues or internal organs and cavities

Penetrating trauma

results in injury by objects that pierce and penetrate the surface of the body and injure the underlying soft tissues, internal organs, and body cavities

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; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds

Deceleration

the slowing of an object

Frontal crashes

Rear-end crashes

Lateral crashes

Rollover crashes

Rotational crashes

Car versus pedestrian

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Car versus bicycle

Car versus motorcycle

Falls

Projectiles

any object propelled by force, such as a bullet by a weapon

Trajectory

the path a projectile takes once it is propelled

Cavitation

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

Drag

resistance that slows a projectile, such as air

Primary blast injuries

Secondary blast injuries

Secondary blast injuries

Tertiary blast injuries

Quaternary blast injuries

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

Pulmonary blast injuries

pulmonary trauma resulting from short-range exposure to the detonation of high-energy explosives

Arterial air embolism

air bubbles in the arterial blood vessels

Solid organs

* Liver
* Spleen
* Pancreas
* Kidneys

Hollow organs

* Stomach
* Large and small intestines
* Urinary bladder

Decision scheme for field triage of injured patients

Measure vital signs and LOC

Assess anatomy of injury

Assess MOI and evidence of high-energy impact

Transport

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

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

Revised Trauma Score (RTS)

a scoring system used for patients with head trauma

ACS-COT/CDC