Transcript Blunt trauma

Blunt Trauma
Sections
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Introduction to Blunt Trauma
Kinetics of Blunt Trauma
Types of Trauma
Blunt Trauma
Explosion
Other Blunt Trauma
Examination, Diagnosis
Introduction to
Blunt Trauma
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Most common cause of trauma death
and disability
Energy exchange between an object
and the human body, without intrusion
through the skin
Kinematics
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Process of examining the scene to
determine potential injuries that result from
the forces of motion
Windshield, steering wheel, dashboard
Was the patient flying thru the air?
Roll-over?
Engine block on lap? (intrusion)
MOI
 Mechanism
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of injury
description of the mechanical and
physiological changes that result in
anatomical or functional damage of tissue
Translation: What hit the patient???, what
did the patient hit???!
Index of Suspicion
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Based on the MOI and kinetics
Predict expected injuries
Experience counts here!
Be obsessive and compulsive, its OK!!
Kinetics of Blunt Trauma
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Inertia
“A body in motion will remain in motion
unless acted upon by an outside force.”
 “A body at rest will remain at rest unless
acted upon by an outside force.” (Newton)
Conservation of Energy
 “Energy can neither be created nor
destroyed. It is only changed from one
form to another.” (Newton)
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Kinetics of Blunt Trauma
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Force (Newton’s 2nd law of motion)
Force  Mass  Acceleration
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Emphasizes the importance of rate at
which an object changes speed
(acceleration or deceleration)
SOOOO
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The Force that puts an object in motion
must be absorbed before the object will
stop.
Guess what absorbs that force????
This absorption is what causes tissue
injury in the body.
Kinetics of Blunt Trauma
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Kinetic Energy
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Energy in Motion
Mass ( weight )  Velocity ( speed )
KE 
2
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Double Weight = Double Energy
Double Speed = Quadruple Energy
SPEED IS THE GREATEST
DETERMINANT
2
Physics (UGH!)
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Three types of forces in blunt trauma
Compression
Shear
Overpressure
Compression
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Like laying an organ on a table and hitting
it with a hammer, every time you hit it,
cells are getting compressed and crushed.
Enough said…..
Shear
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Occur when the organ and the organ’s
attachment do not accelerate or
decelerate at the same rate of speed, or
two parts of an organ accelerate or
decelerate at different rates.
Examples are arch of aorta, spleen,
kidney.
Overpressure
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Like hitting a closed paper bag with the
open hand….the bag pops.
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Examples are like steering column hitting
abdomen…pop! goes the diaphragm. Also
can pop bladder, bowel, lungs……
Types of Trauma
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Blunt
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Closed injury
Indirect injury to underlying structures
Transmission of energy into the body
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Tearing of muscle, vessels and bone
Rupture of solid organs
Organ injury
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Ligamentum teres in the chest for example
Blunt Trauma: Car Crashes
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44,000 people die each year on US highways
Events of Impact
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Vehicle Collision
Body Collision
Organ Collision
Secondary Collisions
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Objects inside vehicle strike occupant
Additional Injuries
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Vehicle receives a second impact
Inertia and MVC’s
Protections (think Volvo!)
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Steel frame
Belts
Bags
Seat construction
Roof
Crumple Zones
Blunt Trauma: Car Crashes
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Restraints
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Seatbelts
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Occupant slows with the vehicle
Shoulder and Lap belts MUST be worn together
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Airbags (SRS)
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Injuries if worn separately
Reduce blunt chest trauma
Cause: Hand, Forearm, & Facial Injury
Check for steering wheel deformity
Side Airbags
Child Safety Seats
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Infants and Small Children: Rear facing
Older Child: Forward facing
Benefits of Air bags
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700-1000 lives saved if all vehicles had
head protecting SABs per year
In side impacts where someone died, 60%
suffered brain injury.
Only 92 cases of SAB injury, 6 involving
children, with no major injuries, only one
minor injury (skin lac).
Bags and Belts
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Burns, abrasions
Do not protect when a second collision hits!
Abdominal injuries (seat too close)
Chest injuries (short, elderly)
Seat belt abrasions above the pelvis account for
a 30-60% incidence of intra-abdominal injuries:
intestinal rupture, mesenteric injury, vascular
disruption
Blunt Trauma:
Automobile Crashes
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Types of Impact
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Frontal: 32%
Lateral: 15%
Rotational: 38%
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Left & Right – Front & Rear
Rear-end: 9%
Rollover: 6%
Blunt Trauma: Car Crashes
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Frontal Impact
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Down-and-Under (legs lead point)
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Up-and-Over (head lead point)
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Knee, femur, and hip fracture (dislocation of knee, fx
acetabulum)
Chest trauma-Steering Wheel
Head, c-spine injuries
Tenses legs = Bilateral femur fracture
Hollow organ rupture and liver laceration
Similar chest trauma
Axial Loading
Ejection
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Due to up-and-over pathway
Contact with the vehicle & external object
Blunt Trauma:
Automobile Crashes
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Lateral Impact (intersection race)
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15% of MVC’s but 22% of deaths
Upper extremity injury
Rib, clavicle, humerus, pelvis, femur fracture, cspine dislocations, locked facets.
Lateral compression
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Ruptured diaphragm, Spleen fracture, Aortic injury
EVALUATE the unrestrained occupant
Blunt Trauma:Car Crashes
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Rotational
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Vehicle struck at oblique angle
Less serious injuries unless strike a
secondary object
Blunt Trauma:Car Crashes
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Rear-end
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Seat propels the occupant forward
Head is forced backwards
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Stretching of neck muscles and ligaments
Hyperextension & hyperflexion (think carotid)
Rollover
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Multiple points of impact
Ejection or partial ejection (think: arm out of
window, then roll….)
Less injury with restraints
Blunt Trauma:
Automobile Crashes
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Vehicle Crash Analysis
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Crumple Zones
Intrusion (one inch for each mile per hour)
Deformity of Vehicle
Use of Restraints
Intoxication
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Fatal Accidents: >50% involved ETOH
Recreational Accidents
Blunt Trauma:
Automobile Crashes
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Vehicular Mortality
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Head: 48%
Internal (Torso): 37%
Spinal & Chest fracture: 8%
Extremity fracture: 2%
All Other: 5%
Blunt Trauma:
Automobile Crashes
Crash Evaluation
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Collision Questions
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How did collision
occur?
Direction?
Speed?
Similar/Different
sized?
Secondary
collisions?
Cause of Crash
Weather & visibility?
Alcohol involved?
Skid marks?
Auto Interior
Starring of windshield?
Steering wheel deformity?
Dash deformity?
Intrusion?
The “Lucky Other Guy”
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The passenger in the same car as the
deceased driver for example.
BUT, this “lucky”person was in the same
vehicle and the energy exchange on the
body was the same.
So you’d better find that unrecognized
injury!
Blunt Trauma:
Motorcycle Crashes
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Serious injuries can occur with high and low
speed collision.
Types of Impact
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Frontal
Angular
Sliding (“laying the bike down”)
Ejection
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Initial Bike/Object Collision
Rider/Object
Rider/Ground
Motorcycle Injuries
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No helmet use increases chance of head
injury by 300%.
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Does not protect c-spine, but does not
injure it either.
Anti-helmet organizations such as
American Motorcycle Association may say
different………
Blunt Trauma:Pedestrian Struck
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Adults
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Adults turn away and run (lat,post injuries)
Bumper strikes lower legs first
Victim rolls up and over and thrown
Children
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Children turn toward (ant injuries)
Femurs, Pelvis often injured
Thrown away or run over
Blunt Trauma:
Recreational Vehicle
Accidents
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Lack structure and restraint system
Types of Vehicles
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Snowmobiles
Personal watercraft
ATV’s
Other Types of
Blunt Trauma
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Falls
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Stairs, Force, Surface
Landing Area
Surface Type
 Body Part
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Height of Fall (3 times height of victim)
Elderly
Axial Loading…..
Maam, you aren’t on
Coumadin, are you??????
Other Types of Blunt Trauma
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Crush Injuries
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Cause
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Great force to soft tissue and bones
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Structural collapse, explosion, industrial; or agricultural
Tissue stretching and compression
Extended pressure results in anaerobic metabolism distal
to compression
Return of blood flow, toxins to entire body
Severe hemorrhage due to severe damaged blood
vessels
Care
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Prolonged crush Medications
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Sodium Bicarbonate: Reduce Acidosis
Morphine: Pain management
Blunt Trauma:
Blast Injuries
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Blast Injuries
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Dust, Fumes, Explosive Compounds
Explosion
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Fuel + Oxidant combine instantaneously
Heat & Pressure Wave
Primary Injuries
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rapid changes in atmospheric pressure from
movement of blast wave
hollow organs more susceptible
blast wave rapidly passes through tissue of
varying density; if lower density is adjacent to
higher density surface tissue of denser tissue is
disrupted- “spalling” as wave transverses the walls
of the alveoli (high density), they rupture as the
wave encounters the air within the alveoli (low
density); massive destruction of alveoli and diffuse
hemorrhage in lung
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Implosion
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pressure wave passes through the lung, it
forces blood out of the vascular space and
into the alveoli
wave of high pressure is followed by wave
of low pressure allowing alveoli to expand
rapidly with further tearing of the lung
parenchyma, atelectasis, hemorrhage
Secondary Injury
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Results from flying debris created by the
explosion and carried by blast winds
injuries are typically severe and
penetrating due to high KE of projectiles
Tertiary Injuries
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Blast winds are sufficient force to cause
victims to become human missiles
victim strikes the ground
Associated Injuries
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Injuries resulting from changes in the
environment as a consequence of the
explosion
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fire; burns
combustion of toxic products; poisoning
leaks of toxic chemicals; asphyxiation
Explosion
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Pressure Wave
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Structural Collapse
Blast Wind
Burns
Projectiles
Personnel Displacement
Blast Injury Phases
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Primary: Heat of the explosion
Secondary: Trauma caused by projectiles
Tertiary: Personnel displacement and structural
collapse
Explosion
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Blast Injury Assessment
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Be alert for secondary device
Initial scene size-up important
Establish Incident Command System (ICS)
Evaluate for secondary hazards
Injury Patterns
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Rupture of Air or Fluid Filled Organs
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Lung: Late manifestation (heat & pressure)
Hearing loss
Explosion
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Blast Injury Care
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Lungs
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Forceful compression and distortion of chest
cavity
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Compression and decompression
Pulmonary Embolism, Dyspnea, Hemoptysis,
Pneumothorax
Abdomen
Compression & Decompression
 Release of bowel contents
 Diaphragm rupture from pushing of organs up
into thorax area
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Explosion
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Blast Injury Care
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Ears
Initial Hearing Loss
 Injury improves over time
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Penetrating Wounds
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Care as any serious open wound or impaled
object
Burns
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Treatment consistent with traditional
management.