EMT Basic Chapter 25,26

what is the leading cause of death in the US among people from 1-44 years old

traumatic and unintentional injuries

how to reduce suffering and risk of death from trauma

proper prehospital evaluation and care

when does traumatic injury occur

body's tissues are exposed to energy levels beyond tolerance

three concepts of injury

potential energy, kinetic energy, and energy of work

what to remember for effects of energy on human

conservation of energy

conservation of energy

energy can be neither created nor destroyed: only converted or transformed

what to do at trauma assessments

have sense of effects of event and see how event relates to energy

work

force * distance force acting over a distance

kinetic energy

energy of a moving object relationship between mass of object and velocity it is traveling

kinetic energy formula

1/2mv2

things to notice with kinetic energy equation

energy that is available to cause injury 2x → mass 2x

energy that is available to cause injury 4x → speed 2x

what is something important to report for shooting

what type of firearm used

potential energy

mass * gravity * height

mostly associated with falling objects

anything that is not ground level

nonsignificant injuries

injury to an isolated body part or a fall without the loss of consciousness

multisystem trauma

injury to more than one body system

examples of significant MOIs

falls from heights, motor vehicle and motorcycle crashes, gunshot wounds, stabbings

what are the two most common MOIs for blunt trauma

motor vehicle crashes and fall

what to be alert for blunt trauma

internal bleeding, skin discoloration, reports of pain

classifications of motor vehicle crashes

frontal (head-on), rear-end, lateral (T-bone), roll oevr, and rotation(spins)

what is the principal difference between crash types

direction of the force of impact

in spins and rollovers -> possibility of multiple impacts

how many collisions are in a motor vehicle crashes

three collisions

three collisions in a motor vehicle crash

1. collision of car against another car, tree, or some other object 2. collision of passenger to interior of car 3. collision of passenger's internal organs against the solid structures of the body

what does the way the collision happened tell us

severity of collision

greater the damage to the car

greater the energy that was involve and greater potential to cause patient injry

how to determine the MOI in crashes

look at how the vehicle crashed

allows us to predict what injuries may have happened to the passengers at time of incident

what to do when arrive at car collision

scene size up

inspect the severity of damage to vehicle or vehicles

look for mechanism of injury

common passenger injuries in car crash

lower extremity fractures, rib fractures, head trauma

coup-countrecoup brain injury

force is applied ot the head and energy transmission through brain tissue causes injury on the opposite side of original impact

traumatic aortic transection or rupture

sudden and rapid deceleration of the heart and aorta within thoracic cavity

can rupture the aorta and cause fatal bleeding

signs of brain injury in car injury

contusion on patient's forehead and spidering on windshield

if you see head injury what should you also suspect

spinal injury and take cervical spine precautions

significant MOIs in motor vehicle crashes

death of person

ejection, rotation of crash

severe deformity of the vehicle or intrusion into vehicle

taking photos for crash scene

may provide valuable information to staff and treating health care providers

never post on social media and only show to appropiate personnel

may need to be deleted after review from health care providers

can become part of medical record

what to examine for frontal crashes

evaluation of supplemental restraint system -> seat belts and airbags

wearing seatbelt and if airbag was destroyed

seat belts

restrain passengers in a vehicle

prevent a second collision

decrease third collision

airbags

final capture point of passengers and decrease the severity of deceleration injuries

cushion the occupant as body slows

deceleration

slowing of an object

other injuries that can happen in frontal crashes

extremities or internal organs

why are seatbelts and airbags important

enhance safety and survival of forward-facing occupants inside the vehicle during a crash

what should you do in cars for children < 4' 9"

back seat and airbag should be turned off

what to remember when providing care in vehicle

if airbag did not inflate, it may deploy during extrication and can be seriously injured be very careful

what happens if you don't buckle lap portion of seat belt

lower extremities and pelvis crash into dashboard and cause injury

seatbelt injuries

unseen abdominal injuries in pediatric patients

lumbar spine fractures

what happens if seat belts are worn too low

hip dislocations

what happens if seatbelts are worn too high

internal injuries and damage to abdominal organs

how are seatblets designed to be worn

iliac crests of the pelvis to distribute the force over the bony surface

modern motor vehicles

multiple airbags and side curtains to protect occupants of vehicle

can alter injury patterns

what happens if you push or use tools in areas with airbags

might cause airbags to unexpectedly deploy and cause injury

what to do when see passengers pass out before impact

look for abrasions and/or traction type injuries on face, neck, and chest

contact points

1. passenger came into contact with dashboard at knees which puts force onto femur, pelvis, and hip joint

2. chest or abdomen may hit the steering wheel

3. passenger may hit the windshield or visor/roof areax

rear end impacts

cause whiplash injuries

what happens during rear-end crashes

• passenger's body and torso move forward on impact

• head and neck are whipped back as body is propelled due to weight

• as vehicle goes into rest, unrestrained passenger moves forward and hits the fashboard

• if head and neck is not restrained by headrest, can cause whiplash

• cervical spine, surrounding area, pelvis, brain can be injured

headrests

decrease extension ofthe head and neck during a crash and reduce injury

what collision can happen from rear end

third collision

brain to skull

who might have a higher incident of thoracic and lumbar spine injuries in car accidents

peoplen in back of the car

lateral or side impacts

commmon cause of death associated with motor vehicle crashes

what happens during lateral crashes

• passenger gets lateral whiplash injury toward the intruding vehicle

• typically struck above center of gravity and begins to rock away from side of impact

what injuries can happen from lateral injuries

shoulder, thorax, upper extremities, skul, cervical spine

what to assume if substantial intrusion in passenger compartment for lateral crashes

lateral chest and abdomen injuries on side of impact

possible fractures of loewr extremities, pelvis, and ribs

what collision can happen from lateral crashes

3rd collisoin

approximately 25% of severe injuries to the aorta occur during:

lateral crashes

what percent of lateral crashes are all fatalities that occur in motor vehicle crashes

30%

what vehicles are more likely to be susceptible to roll over crashes

large trucks and sport utility vehicles

why are large trucks and sport utility vehicles more susceptible to roll over crashes

high center of gravity

most unpredictable types of rollover crashes

unrestrained passenger may have sustained multiple strikes within interior of vehicle as it rolled one or more times

most common life threatening event in rollover crashes

ejection or partial ejection of passenger

what could happen to passenger during rollover crash

• struck interior or exterior many times before ejection

• struck several objects before landing

• struck both interior and exterior of vehicle

• sandwiched between environment and exterior of vehicle

• roof of vehicle hits the ground during the rollover

• restrained passenger can still move toward roof for spinal injury during crash

what is lateral impacts associated with

motor vehicle crashes

rotational crashes

vehicle can strike objects such as utility poles, similar to rollovers

car versus pedestrian crashes

graphic and apparent injuries such as broken bones

also cause serious unseen injuries under body

how to deal with car versus pedestrian injuries

1. estimate speed

2. 2. determine whether patient was thrown, what surface the patient landed on

3. 3. what distance or whether the patient was struck and pulled under the vehicles

4. 4. evulate vehicle for structural damage for contact points and potential injuries in patient

5. 5. if needed get ALS if more severe

difference between car vs bicycle and car vs pedestrian

additional evaluation of damage to and the postion of bicycle is warranted

what to do if patient was wearing a helmet in car versus bicycle crash

inspect helmet for damage and suspect potential injury to the head

presume spinal injury and immobilize

if the patient's helmet is off during car vs bicycle crash

bring it to the hospital

what do helmets not protect you from

cervical spinal injury

what is motorcycle crash protection to victim (might reword), pg 911

protective devices: helmet, leather or abrasion resistant clothing, boots

leather and synthetic gear

protect professional riders in competition

falls tend to be controlled and result in long sliding mechanisms on hard surfaces rather than multiple collisions against road objects and other vehicles

what to do if patient experienced motorcycle crash

undergo cervical spine assessment and have collar on if needed

what does leather clothing protect against

road abrasion

what does leather clothing not protect

blunt trauma from secondary impacts

strreet crash

collisions usually occur against other larger vehicles or stationary objects

what to do when assessing scene of a motorcycle crash

• deformity of the motorcycle

• side of most damage

• distance of skid in road

• deformity of stationary objects or other vehicles

• extent and location of deformity in the helmet

four types of motorcycle impacts

head on angular ejection controlled

head on crash

motorcycle strikes another object -> motorcycle stops forward motion while rider and pqarts of motorcycle that are broken off continue motion until stopped by an outside force

angular carsh

motorcycle strikes an object or another vehicle at angle -> rider gets crushing injuries in lower extremity between object and motorcycle -> leads to severe nerovascular compromise

ejection motorcycle crash

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

what injuries can happen from drag

abrasion (road rashes) to bone

controlled crash

separate rider from body of motorcycle and object to be hit

what is controlled crash also known as

laying the bike down

who created controlled crash

motorcycle racers and street bikers

how does controlled crash happen

as crash approaches, motorcycle tipped sideways at 90 degrees to direction of travel so one leg is on ground

occupant is slower than motorcycle and can separate if wearing the proper gear

injuries from controlled crash

anything from rolling over pavenet or secondary collision

what is considered a significant fall

>20 feet

syncope

fainting or passing out

falling onto feet

less severe internal injuries because legs absorbed energy from fall

serious injuries to lower extrenities, pelvic and spinal injuries

factors when observing fall

height of fall

type of surface struck

which part of body that hit first followed by path of energy displacement

osteoporosis

bones can fail under relatively low strss because weak structurally

how many deaths from firearms in 2017

38,000

what is the second leading cause of trauma death

penetrating trauma

low energy trauma

accidentally by impalement or intentionally be a knife, ice pick, or other weapon caused by the sharp edges of objects through the body