exam 3 (ch 27)

transport decision priorities

1.)physiological indicators

GCS

Systolic BP

RR

2.) Location of injury

3.) MOI

3 impacts in vehicle collisions

1.) vehicle collision

2.) Body collision (pt comes to quick stop on interior part of vehicle)

3.) organ collision (pt organs come to quick stop striking inside surface of body)

high index of suspicion for serious injury in these situations

-death of another occupant in vehicle

-unresponsive or altered mental status

-intrusion of more than 12 inches for occupant site , 18 inches anywhere else on car

-ejection

-vehicle telemetry data consistent with high risk of injury

up and over injuries

unrestrained person goes up and over airbag/steering wheel

• head, neck, abdomen, chest, possible windshield ejection

down and under injuries

knees, femur, hips, pelvis, spine

what happens in frontal MVC

driver continues moving forward at the same speed vehicle was traveling

• up and over or down and under injuries possible

adults vs children differences in injury for pedestrian/vehicle collisions

children often have injuries on front part of body, low center of gravity, usually thrown forward and ran over

adults usually turn away from the vehicle, side impact more common

most common MOI

falls

colles/silver fork fracture

wrist fracture common from trying to break fall with arms

falls more than 20 feet

internal organ damage from deceleration forces

greatest damage indicator for penetrating injuries

amount of kinetic energy

low velocity

knife

exerts damage to immediate area of impact and underlying structures

medium/high velocity

pellets , bullets

high velocity

rifles

medium velocity

shotguns/handguns

damage from medium/high velocity projectiles depend on what

trajectory and dissipation of energy

trajectory

path/motion of projectile during its travel

the faster the bullet, the straighter its path

dissipation of energy

the way energy is transferred to the body from force acting on it

dissipation of energy is affected by

drag

profile

cavitation

fragmentation

drag

factor that slows bullet (wind resistance)

profile

impact point,

greater the size of impact point, the more energy is transferred

cavitation

cavity in body tissue formed by pressure wave

90% of fatal gunshot wounds involve …

head, thorax, abdomen

why are facial GSWs so concerning?

threat to airway

can make it very difficult to get a seal when ventilating