Chapter 25: Trauma Overview

traumatic emergencies =

injury = capacity of tissue < forces upon that tissue

mechanism of injury (MOI)

describes the forces acting on the body that cause injury

index of suspicion

your awareness for potentially serious underlying and unseen injuries

• MOI + age + sex + medical history + physical condition + etc

concepts of energy typically associated with injury

potential energy = mgh

kinetic energy = ½ mass x velocity²

energy of work = F x D

nonsignificant injury

injury to an isolated body part, nonsignificant —> general hospital

What would you ask when someone falls to determine whether they need to go to a trauma center

did you hit your head

did you go unconscious

are you on blood thinners

significant MOIs ex

rollovers or ejection from the vehicle

death of another occupant in the same vehicle

pedestrians, cyclist, or motorcyclist struck by vehicle

damage intruding into passenger compartment (above 12 inches)

falls greater than 2 times the height of the pt or any fall with loss of consciousness

penetrating trauma

how it occurs (with what)

pierces into and penetrates into soft tissue

knife, GSW

blunt trauma

how it occurs (with what)

doesn’t penetrate into soft tissue

baseball bat, fall

blunt trauma signs of internal damage

where does force travel and need to have what suspicion

contusion, tenderness, crepitus, deformity, distention (abdomen), swelling

force travels into the body, have a high index of suspicion

3 classes of collisions

what causes the damage

primary collision

secondary collision

tertiary collision

the deceleration of the force

primary collision

vehicle collides with another object

(car hits tree)

secondary collision

occupant collides with interior of vehicle

(body hits steering wheel)

tertiary collision

organs of occupant collide within the body

(brain hits skull)

frontal crash evaluation (questions to ask)

ask or see if the patient was wearing a seatbelt? properly? seatbelt marks?

• should be worn just under anterior superior iliac spine

did the airbags go off? if not, they are in potential danger

what do supplemental restraints help prevent

secondary collision

lower dash damage

lower extremity and hip injuries

seat belt damage

hip or abdominal injuries (if worn improperly)

steering wheel damage

chest or abdominal injuries

windshield damage

face or head injuries

coup-contrecoup injury

example of what type of crash

what type of collision

brain smashes around inside of skull from a direct blow

frontal crash

tertiary collision

rear-end crashes

what happens

whiplash occurs, suspect c spine injury

whiplash

rapid hyperextension then hyper flexion of neck

acceleration-type injury to the brain is possible

lateral crashes

what kind of injuries suspected

what kind of collision

injuries on side of impact

organ damage from the third collision (ex: aortic rupture)

how to tell if there is internal abdominal bleeding

distention, rigidity, bruising

rollover crashes

75% of ejected patients die

• partial ejection around 60%

unpredictable injury pattern if unrestrained

rollover and rotational crashes

have centrifugal forces (spinning)

might hit other objects, introducing new force vectors

car v.s pedestrian questions to determine

vehicle’s speed

whether the patient was thrown through the air

what distance the patient traveled

type of surface he/she landed on

what landed first

loss of consciousness

evaluate the vehicle that struck the patient for strutural changes

vehicle v.s bicycle evaluation

evaluate like car vs pedestrian collision

• evaluate bike and helmet for damage

• ask who hit who

car vs motorcycle

protection is from

what to look for when assessing the scene

helmet (does not protect from c-spine injury)

abrasion resistance clothing (doesn’t protect from blunt trauma)

deformity of the motorcycle, side of most damage, distance of skid in the road, extent and location of deformity in the helmet

4 types of car vs motorcycle crashes

head on

controlled

ejection

angular

head on motorcycle crashes

almost half of fatal motorcycle crashes are cars pulling in front of motorcycles

angular motorcycle crashes

type of injuries

crushing injuries

ejection

rider will travel at high speed until stopped

• severe abrasion

controlled crash

rider low-sides then sometimes separates from bike (to avoid getting flung over)

falls

significant MOI and why

2x height of patient, as we fall we increase in speed

what to take into account when there is a fall

height

surface

part of body that hit first/landed on

what happens if someone falls on their calcaneus

force goes up the body, lower back injuries

penetrating trauma

survivability rate

1-3% survivability rate from cardiac arrest, higher in younger than geriatrics

knives may have been deliberately moved around internally, causing more damage than the external wound suggests

where does damage reside in low velocity penetrating trauma

along the projectile path

where does the damage reside in medium to high velocity penetrating trauma

ex

force and damage spreads

handguns

when can cavitation occur

in serious injuries to internal organs

what do pressure changes cause tissues to do

causes tissues to stretch creating a temporary cavitation (open space or stretches body tissues past its normal limits)

primary blast injury

what is most susceptible and s&s

due entirely to the shockwave

ears susceptible —> ringing (tinnitus), hearing loss, pain, blood

lungs susceptible —> pulmonary edema, tightness in chest, pneumothorax, air embolism

• can hear crackles and trouble breathing

air embolism in blast injury

what happens to the heart

what happens to the brain

can travel to heart and cause myocardial injury

can travel to brain and cause visual disturbances, ALOC, behavioral changes, neurological deficits

secondary blast injuries

damage from an object striking the pt causing penetrating injuries

tertiary injuries

damage from pt striking an object causing brain injuries

• head trauma

quaternary (miscellaneous) blast injuries

burns

toxic gasses

crush injury from the collapse of the buildings

suffocation

poisoning

other medical emergencies

contamination of wounds from environmental chemical or toxic substances

most common blast injuries that result in death

neurologic injuries and head trauma

extremity injuries such as traumatic amputations

how long to stay on scene before rapid transport

less than 10 mins, rapid transport is essential

revised trauma score

when a patient’s GCS drops, they have a lower trauma score and a lower survival rate

• lower score indicates a higher severity of injury

variables

• glasgow coma scale

• systolic blood pressure

• respiratory rate

posterior hip dislocation

result of dashboard injury