Chapter 25 Trauma Overview (EMT B)

Trauma Emergencies

Occur as a result of physical forces applied to the body

• Example: A patient has a stroke and veers off the road, striking a tree

Medical Emergencies

Include illnesses or conditions

• Example: Pneumonia develops in a patient a few days after a fall that fractured the patient’s ribs

Mechanism of Injury (MOI)

How the traumatic injuries occur

• Describes the forces acting on the body that cause injury

The three concepts of energy

1. Potential energy- Product of mass, force of gravity, and height and is mostly associated with the energy of falling objects

(Example: A scaffold has potential energy because he or she is some height above the ground. If the worker falls, potential energy is converted into kinetic energy.)

2. Kinetic energy- The energy of a moving object

(Kinetic energy is expressed as: KE= ½ m X v²)

3. The energy of work- Force acting over a distance (Example: Force needed to bend metal multiplied by the distance over which the metal is bent is the work that crushes the front end of a vehicle that is involved in a frontal impact) →Forces that bend, pull, or compress tissues beyond their inherent limits result in the work that causes injury

Blunt Trauma

Non penetrating trauma that causes injury without breaching the skin

• Usually by impact of a firm surface or object

Penetrating Trauma

Trauma that breaches the skin causing injury

Significant MOIs

• Injury to more than one body system (multisystem trauma)

• Falls from heights

• Motor vehicle and motorcycle crashes

• Car versus pedestrian or bicycle

• Gunshot wounds

• Stabbings

Significant vehicle MOIs

• Death of an occupant in the vehicle

• Severe deformity of the vehicle or intrusion into the vehicle

• Moderate intrusion from a lateral accident

• Severe damage from the rear

• Crashes in which rotation is involved

• Ejection from the vehicle

Despite airbags, suspect injuries to?

Extremities and Internal organs

Safety restraint systems can cause harm how?

• Hip dislocation may result if seat belts are worn too low

• Internal injuries can occur when belt is worn too high

• Lumbar spine fractures are also possible, particularly in children and older patients

Whiplash-type injuries are a result of what?

Rear-end crashes

• Acceleration-type injury to the brain is possible

What type of motor vehicle crash is common cause of death?

Lateral crashes

If there is substantial intrusion into the passenger compartment, suspect what? (lateral crashes)

• Lateral chest and abdomen injuries on the side of the impact

• Possible fractures of the lower extremities, pelvis, ribs

• Organ damage from the third collision

Most common life-threatening event in a rollover

Ejection or partial ejection of the passenger from the vehicle

When rotation of the vehicle as it spins provides?

Opportunities for the vehicle to strike objects, such as utility poles

When someone is struck by a vehicle, you should determine what?

• Speed of the vehicle

• Whether the patient was thrown through the air and at what distance

• Surface the patient landed on

• Whether the patient was stuck and pulled under the vehicle

When a person is struck by a vehicle on a bicycle presume what?

That the patient has sustained an injury to the spinal column, or spinal cord

• Spinal stabilization must be initiated and maintained during the encounter

Four types of motorcycle impacts

• Head-on crash

• Angular crash

• Ejection

• Controlled crash

Injury potential related to a fall is related to?

The height from which the patient fell

• The greater the height of the fall, the greater the potential for injury

→A fall from more than 20 ft (6m) is considered significant

→ May have very serious injuries to the lower extremities, pelvis, and spine

When it comes to falls what should you take into account?

• The hight of the fall

• The type of surface struck

• The part of the body that hit first, followed by path of energy

Low-energy penetrating trauma

Caused by the sharp edges of a object moving through the body (knife, pencil, rebar, other weapon)

Medium velocity penetrating trauma

Cause direct tissue damage (usually from handguns)

→injury pattern can be unpredictable due to ricochet, shrapnel

The path a projectile takes is called what?

Trajectory

High velocity penetrating trauma

Causes a shock wave through the body also damaging the bodys tissue (from rifles, explosives, and so on)

• Cavitation→ shock through the body

The four different blast mechanisms

1. Primary blast injuries: Caused by pressure wave of the blast

→Blast caused by the pressure wave generated by the explosion

2. Secondary blast injuries: Caused by flying debris

3. Tertiary blast injuries: Caused by being thrown against a stationary object

4. Quaternary (miscellaneous) blast injuries:

• burns from hot gases or fires started by the blast

• Respiratory injury from inhaling toxic gases

• Crush injury from the collapse of buildings

• Suffocation, poisoning, other medical emergencies

• Contamination of wounds from environmental, chemical, or toxic substances

Pulmonary Blast injuries

defined as pulmonary trauma, results from short range exposure to the detonation of explosives

• Pneumothorax is a common injury

• MOST concerning injury is arterial air embolism

→Air bubbles get into the arteries and block blood flow to the brain, lungs, and heart

Can produce

• Disturbances in vision

• Changes in behavior

• Altered LOC

Common injury of blasts?

Pneumothorax

Most concerning pulmonary blast injury?

Arterial air embolism: occurs on alveolar disruption with subsequent air embolization into the pulmonary vasculature

Can Cause

• Disturbances in vision

• Changes in behavior

• Changes in state of consciousness

• Variety of other neurologic signs

Multisystem Trauma

Involves more than one body system or patient has serious injuries to two or more body systems at the same time

1. Head and spinal trauma

2. Chest and abdominal trauma

3. Chest and multiple extremity trauma

4. Alert medical control and transport rapidly

5. Multisystem trauma patients have a high level of morbidity (illness) and mortality (death)

What do patients with multisystem trauma require?

Surgical intervention

What will help identify a critically injured patient?

• Dangerous MOI

• Decreased level of conciseness

• Threats to airway, breathing, circulation

Trauma centers classification and what they provide

• Level 1 facility: Provides every aspect of trauma care

• Level 2 facility: Capable of stabilizing trauma patients and transferring them to a level 1 trauma center

• Level 3 facility:Limited services and ability to stabilize trauma patients

→assessment, resuscitation, emergency care, stabilization

• Level 4 facility: Facility provides advanced trauma life support

Index of suspicion

Awareness and concern for potential injury

Kinetic Energy

Energy from motion

SRS

Safety restraint system

→ Seat belts, shoulder harness, or air bags

TBI

Traumatic brain injury

5 types of MVC’s

1. Head-on collisions

2. Rear-impact collisions

3. Lateral-impact collisions (T-bone)

4. Rollovers

5. Rotational Spins

The three collisions of an MVC

1. First Collision: Vehicle strikes an object

2. Second Collision: Occupants strike the interior of the interior of the vehicle or the safety restraint system

3. Third Collision: Internal organs strike the internal structures of the body

List at least 3 high-risk MVCs

1. Rollover accidents

2. Any MVC with occupant ejection

3. Death of another occupant in the same vehicle

Most pediatric trauma-related deaths are due to?

Motor vehicle collisions

→Then drowning is the leading cause of injury-related deaths in children 1-4 years old

Solid organs include?

Liver, spleen, pancreas, kidneys

→ May tear, lacerate, or fracture

*Which may cause serious bleeding into the abdomen

Hollow organs include?

Stomach, large and small intestines, and urinary bladder

→ May rupture and leak toxic digestive chemicals causing possible life-threatening infection

*Can cause possible life-threatening infection

Pneumothorax

Air accumulates In the chest and lung tissue becomes compressed interfering with the body’s ability to exchange oxygen

Tension Pneumothorax

When air enters the body (left or right side) and causes a lung to compress against the other lung

→ leading to hypotension, tachycardia, and dyspnea

Hemothoarx

Blood collects and causes interference with breathing

→leads to dypnea, hypotension, diaphoretic

Coup-Contra-Coup

Brain bouncing in your skull when head hits something hard

List the organs that contain air and are most susceptible to to pressure changes (blast injuries)

• Middle ear

• Lung

• Gastrointestinal tract

→ The ear is most sensitive to blast injuries