Chapter 25, Trauma Overview

Chapter 25: Trauma Overview

Introduction

• Understanding trauma in emergency care involves examining the various forms of energy and their impact on the human body.

• Goals include grasping the mechanisms of injury, recognizing common injury patterns, and applying principles of physics in trauma assessment.

• Emphasis on critical thinking and maintaining an index of suspicion when evaluating injury potential is essential for effective emergency response.

Trauma as Leading Cause of Death

• Traumatic injuries rank as the leading cause of death among individuals under 44 years of age in the United States.

• It's crucial to differentiate between trauma emergencies (resulting from physical forces) and medical emergencies (stemming from illnesses unrelated to external forces).

• A comprehensive evaluation of the mechanism of injury is vital for identifying potential underlying injuries that may not be immediately apparent.

Energy and Trauma Basics

• Traumatic Injury: Arises when the energy applied to body tissues exceeds their tolerance, leading to damage.

• Mechanism of Injury: Refers to the variety of forces that act on the body resulting in injury, which can be influenced by multiple factors including speed, weight, and height.

Key Energy Concepts:

• Potential Energy: This type of energy is related to an object’s mass and height, such as an object falling from a significant height.

• Kinetic Energy: Associated with the mass and velocity of moving objects, contributing to the severity of injuries in high-velocity traumas.

• Energy of Work: Defined as the force exerted over a distance, influencing how energy transfers in collision scenarios.

Mechanism of Injury Profiles

Types of Mechanisms:

• Non-Significant Mechanisms: Involve isolated injuries, typically lower in risk (e.g., a fall without loss of consciousness).

• Significant Mechanisms: Involve complex multi-system trauma scenarios, seen in cases such as falls from considerable heights, vehicular accidents, or assaults.

Blunt Trauma vs. Penetrating Trauma:

• Blunt Trauma: Characterized by injuries that do not involve penetration of the skin, frequently observed in motor vehicle accidents.

• Penetrating Trauma: Results from objects that pierce the skin, such as gunshot or stab wounds, posing different clinical challenges.

Motor Vehicle Crashes

Three Collisions Occurring in a Crash:

1. Vehicle vs. Object Collision: For example, the vehicle colliding with a tree or barrier.

2. Passenger vs. Vehicle Interior: Often leading to injuries such as fractures and head trauma when the passenger impacts the internal structure of the vehicle.

3. Internal Organs vs. Internal Structures: These injuries occur when the body’s internal organs collide with each other or the surrounding structures during a crash.

Frontal Crashes:

• The importance of seat belts and airbags cannot be overstated; these safety devices play a key role in mitigating injuries.

• Assess for injuries associated with both the second (passenger impact) and third collisions (internal organ impact).

Rear-End Crashes:

• Frequently lead to whiplash-type injuries due to inadequate headrest support, which requires special attention during the assessment.

Lateral Crashes:

• Characterized by a high risk of severe whiplash and injuries to the chest and abdomen due to vehicle structure intrusion from the side.

Rollover Crashes:

• Present a significant risk of ejection from the vehicle; the types of injuries sustained can vary greatly depending on seatbelt usage.

Rotational Crashes:

• Similar to rollovers, these accidents can yield secondary collisions that may further complicate injuries.

Collision with Pedestrians, Bicyclists, and Motorcyclists:

• Car vs. Pedestrian: It’s imperative to assess the vehicle's speed and the distance the pedestrian was projected after the impact, as there may be unseen injuries.

• Car vs. Bicycle: Evaluating bicycle damage and helmet usage is critical; spinal immobilization is paramount in cases of significant impact.

• Car vs. Motorcycle: Helmets can provide some level of protection but do not eliminate all risks; it is essential to assess the motorcycle for damage and collect evidence from the scene.

  • Types of motorcycle impacts such as head-on, angular, ejection, and controlled crashes carry different injury probabilities.

Falls

• The height of a fall directly correlates with the potential severity of injury; falls greater than 20 feet are considered significant and warrant thorough evaluation for possible internal injuries.

• Factors such as the impact surface and body position during landing significantly affect injury outcomes.

Penetrating Trauma

• This type of trauma represents the second leading cause of death; mechanisms can range from low-energy (e.g., knife wounds) to high-energy (e.g., gunshot wounds).

• Cavitation: Describes the effects of pressure changes causing both temporary and permanent tissue damage surrounding the wound channel.

• Distance and Severity: The relationship between projectile characteristics, distance, and resulting wound severity is crucial in assessment and treatment.

Blast Injuries

• Commonly encountered in both military and civilian contexts, blast injuries can be categorized into primary, secondary, tertiary, and quaternary injuries.

• The most vulnerable organs include air-containing structures such as ears and lungs; pulmonary blast injuries warrant careful monitoring.

• Neurologic injuries frequently emerge as the leading causes of death in blast-related incidents.

Multi-System Trauma

• Involves simultaneous injuries across multiple body systems; such cases necessitate prompt advanced medical intervention.

• Key focus areas include ensuring scene safety, evaluating the mechanism of injury, managing life-threatening conditions, and facilitating rapid transport to appropriate medical facilities.

• Controlling hemorrhage is the utmost priority when dealing with multi-system trauma patients.

Patient Assessment

• Conduct a thorough physical examination for critically injured patients; ongoing assessments are essential for monitoring changes in condition.

Specific Injuries:

• Head Injuries: Be vigilant for signs of bleeding or swelling; frequent neurologic evaluations are crucial for detecting deterioration.

• Neck Injuries: Assess for airway compromise and look for jugular distention or tracheal deviation as signs of serious injury.

• Chest Injuries: Thoroughly evaluate for rib fractures, pneumothorax, or hemothorax, all of which can compromise respiratory function.

• Abdominal Injuries: Key assessments should focus on identifying potential internal bleeding, discerning between injuries to solid organs (like the liver and spleen) versus hollow organs (such as the intestines).

Transport Decisions

• Trauma centers are classified into levels ranging from 1 to 4 based on the resources available and the level of care they can provide.

• Criteria for air medical transportation include distance to definitive care, patient condition, and scenarios involving multiple casualties.

• Modes of transport include ground EMS (typically staffed by EMTs) and air EMS (staffed by trained nurses and paramedics), both play critical roles in emergency response logistics.

Conclusion

• A thorough understanding of the key principles governing trauma, particularly the role of energy in causing injuries and the various mechanisms involved, is essential for effective management.

• Practical application of these principles should be demonstrated through realistic case examples.

• The importance of continuous education and practice in trauma management cannot be overstated; ongoing training is vital to keep skills current and improve patient outcomes.