(27) Trauma Overview: The trauma patient and the trauma system

Chapter 27

trauma

• the leading cause of death for individuals up to the age of 45 years old

• the fourth leading cause of death overall

Mechanism of injury (MOI)

refers to how a person was injured

• e.g., motor vehicle collision, a fall, gunshot, other

Kinetics of trauma

the science of analyzing the mechanism of injury

• help you predict the kind and extent of injuries as a basis for your priority decisions regarding continuing assessment, care, and transport

kinetics

the branch of mechanics dealing with the movements of bodies

• helpful in understanding MOI and trauma

T

T or F?

MOI is the third consideration in making a transport decision.

Kinetic energy

The energy contained in a moving body

kinetic energy

__________ = mass×velocity²/ 2

Law of intertia

A body at rest will remain at rest, and a body in motion will remain in motion, unless acted upon by an outside force

chest; abdomen

Organs strike the interior of ______ and ______ causing additional damage.

F

T or F?

MOI provides an accurate indicator of injury.

falls

The most common MOI

• not the most lethal

High

High or low index of suspicion?

• Death of another occupant of the vehicle

  • Death of one will almost certainly cause severe injuries to other passengers

• An unresponsive patient or a patient with an AMS

• Intrusion of greater than 12 inches for the occupant site, including the roof or greater than 18 inches anywhere to the vehicle

• Ejection from the motor vehicle

abdominal and chest injury

A damaged dashboard or steering wheel should cause you to suspect which two types of injury?

Compression

Compression or shear force?

occurs when the heart is caught between the sternum and the spine, which can bruise the heart muscle

Shear

Compression or shear force?

tends to pull the aorta at the ligament, which can tear or transect the aorta

whiplash; rear-end

If the vehicle does not have headrests or they are improperly positioned, the neck is hyperextended and the anterior spinal ligaments are often stretched or torn. You would suspect which type of injury?

Colles (silver fork) fracture

A fracture of the wrist bones

Trajectory

the path or motion of a projectile during its travel

Dissipation of energy

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

Drag

The factors that slow a bullet down, such as wind resistance, constitute drag

Profile

The impact point of the bullet is its profile. The greater the size of the impact point, the more energy is transferred.

Cavitation

the cavity in the body tissues formed by a pressure wave resulting from the kinetic energy of the bullet

• greatly extends the tissue damage beyond the initial bullet pathway

T

T or F?

It is not important for an EMT to determine what penetrating injury is the entrance or exit; however, it is imperative to locate and manage all open wounds

Fragmentation

A bullet that breaks up into small pieces or releases small pieces upon impact increases the body damage

Pneumothorax

air trapped in the pleural cavity causing the lung to collapse

Primary

Which phase of blast injuries?

Due to the pressure wave of the blast

• Severe damage and death can occur from this phase without any external sign of injury

Secondary

Which phase of blast injuries?
Due to flying debris propelled by the force of the blast, or blask wind

• obvious injuries

Tertiary

Which phase of blast injuries?

occur when the patient is thrown away from the source of the blast.

Quaternary

Which phase of blast injuries?

result from structural collapse and exposure to chemicals, toxins, bacteria, metals, and radiation

multi system trauma

capable of injuring multiple body systems

golden hour

parameter for emergency care because severely injured patients have the best chance for survival if intervention takes place as quickly as possible from the time of injury

T

T or F?

As an EMT, it is better to maintain a high index of suspicion than a low index of suspicion.

Level I (Regional Trauma Center)

Which level of trauma center?

Can manage the full range of traumatic injuries 24 hours a day, 7 days a week.

Level IV (Trauma Facility)

Which level of trauma center?

Is typically a small community hospital in a remote area capable of stabilizing seriously injured trauma patients and then transferring them to a higher-level trauma center