CH 25 Emergency Care and Transportation of the Sick and Injured - Trauma Overview

National EMS Education Standard Competencies

Trauma: Applies fundamental knowledge to provide basic emergency care and transportation based on assessment findings for an acutely injured patient.

Trauma Overview:

• Pathophysiology, assessment, and management of the trauma patient

• Trauma scoring

• Rapid transport and destination issues

• Transport mode

Multisystem Trauma:

• Recognition and management of multisystem trauma

• Pathophysiology, assessment, and management of multisystem trauma

• Blast injuries

Introduction

For people younger than age 44, traumatic injuries are the leading cause of death in the United States.
Traumatic emergencies result from physical forces applied to the body.
Medical emergencies occur from an illness or condition not caused by an outside force.
Index of suspicion: Awareness and concern for potentially serious underlying and unseen injuries.

Energy and Trauma

Traumatic injury occurs when the body’s tissues are exposed to energy levels beyond their tolerance.
Mechanism of injury (MOI) describes how traumatic injuries occur and the forces acting on the body that cause injury.

Three concepts of energy:

• Potential energy

• Kinetic energy

• Energy of work

Energy can neither be created nor destroyed; it can only be converted or transformed.
Work is force acting over a distance.
Forces that bend, pull, or compress tissues beyond their inherent limits result in the work that causes injury.
Kinetic energy is the energy of a moving object.
$KE = \frac{1}{2} \text{mass} \cdot \text{velocity}^2$

Potential energy is the product of mass, force of gravity, and height.
Mostly associated with the energy of falling objects.

Mechanism of Injury Profiles

Different MOIs produce many types of injuries.
Nonsignificant injuries:

• Injury to an isolated body part

• Fall without the loss of consciousness

Significant injuries:

• 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

Blunt and Penetrating Trauma

Blunt trauma is the result of force to the body that causes injury without penetrating the soft tissues.
Penetrating trauma causes injury by objects that pierce and penetrate the surface of the body.
Either type may occur from a variety of MOIs.

Blunt Trauma

Results from an object making contact with the body.
Motor vehicle crashes and falls are the most common MOIs.
Be alert to skin discoloration and pain.
Maintain a high index of suspicion for hidden injuries.

Vehicular Crashes

A crash consists of three collisions:

• Car against another car, tree, or object

• Assessing the vehicle can often determine the MOI.

• Passenger against the interior of the car

  • Common passenger injuries include lower extremity fractures, flail chest, and head trauma.

• Passenger’s internal organs against solid structures of the body

  • Internal injuries may not be as obvious as external injuries but are often the most life threatening.

• Coup-contrecoup injury: The brain continues its forward motion and strikes the inside of the skull.

Significant MOIs include the following findings:

• Death of an occupant in the vehicle

• Severe deformity of vehicle or intrusion into vehicle

• Severe damage from the rear

• Crashes in which rotation is involved

• Ejection from the vehicle

Frontal Crashes

Evaluate supplemental restraint system.
Determine whether the passenger was restrained and whether the airbags deployed.
Seat belts and airbags are effective in preventing a second collision inside the motor vehicle.
Airbags decrease the severity of deceleration injuries and decrease injury to the chest, face, and head.
Despite airbags, suspect injuries to:

• Extremities (resulting from the second collision)

• Internal organs (resulting from the third collision)

• Children shorter than 4’9