Chapter 24 trauma overview

Traumatic injury occurs when the body's tissues are exposed to

energy levels beyond their tolerance. •The mechanism of injury is the way traumatic injuries occur. -Describes the forces acting on the body that cause injury

Multisystem Trauma •Involves

more than one body system -Head and spinal trauma -Chest and abdominal trauma -Chest and multiple extremity trauma •Alert medical control and transport rapidly.

Penetrating Trauma (4 of 6) •Cavitation results from

rapid changes in tissue and fluid pressure that occur with the passage of the projectile. •Can result in serious injury to internal organs

Injuries to the Abdomen (1 of 2) •Abdomen contains

vital organs that require a very high amount of blood flow •Solid organs include the liver, spleen, pancreas, and kidneys. •Hollow organs include the stomach, large and small intestines, and urinary bladder. •Solid organs may tear, lacerate, or fracture. •Hollow organs may rupture and leak toxic digestive chemicals. •The rupture of large blood vessels can cause serious unseen bleeding.

Rear-End Crashes (1 of 2) •Known to cause

whiplash-type injuries -Particularly in absence of a headrest

Injuries to the Neck and Throat (1 of 2)

•Area of serious or deadly injuries. •Airway problems may result. •Look for DCAP-BTLS in the neck region. •Swelling may prevent blood flow to the brain.

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.

Injuries to the Head

•Disability and unseen injury to the brain may occur. •Bleeding or swelling inside the skull is often life threatening. •Include frequent neurologic examinations in your assessment. •Some patients will not have obvious signs or symptoms.

Frontal Crashes (1 of 5)

•Evaluate supplemental restraint system -Determine whether the passenger was restrained and whether the air bags deployed. -Seatbelts and air bags are effective in preventing a second collision inside the motor vehicle. -Air bags decrease the severity of deceleration injuries and decrease injury to the chest, face, and head.

Blast Injuries (3 of 7)

•Primary blast injuries -Due entirely to the blast itself -Damage to the body by pressure wave •Secondary blast injuries -Damage to the body results from being struck by flying debris. •Tertiary blast injuries -Victim is hurled by the force of the explosion. •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 •Most patients will have some combination of the four types of injury.

For people younger than age 44, traumatic injuries are the leading cause of death in the United States. .

-Traumatic emergencies occur as result of physical forces applied to the body. -Medical emergencies occur from an illness or condition not caused by an outside force

Golden Principles of Prehospital Trauma Care (2 of 3) •Identify and manage life threats. •Then focus on patient care.

-ABCs -Shock therapy -Spinal immobilization •Transport immediately to the appropriate facility.

Injuries to the Chest (1 of 2) •Chest contains heart, lungs, and large blood vessels. •Many life-threatening injuries may occur.

-Broken ribs may hinder breathing. -Heart may be bruised. -Large vessels may be torn.

Vehicular Crashes (3 of 5) •Passenger against the interior of the car

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

Vehicular Crashes (5 of 5) •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

Vehicular Crashes (1 of 5) •Motor vehicle crashes are classified as:

-Frontal -Rear-end -Lateral -Rollovers -Rotational •The principal difference is the direction of the force of impact.

Injuries to the Chest (2 of 2) •A penetration or perforation of the integrity of the chest is called an open chest wound.

-If untreated, shock and/or death will result. -Assess the chest region every 5 minutes. -Assessment should include DCAP-BTLS, lung sounds, and chest rise and fall.

Mechanism of Injury Profiles (1 of 2) •Different MOIs produce many types of injuries. •Nonsignificant injuries

-Injury to an isolated body part -Fall without the loss of consciousness

Mechanism of Injury Profiles (2 of 2) •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

Vehicular Crashes (4 of 5) •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.

Lateral Crashes (3 of 3) •If substantial intrusion into the passenger compartment, suspect:

-Lateral chest and abdomen injuries on the side of the impact -Possible fractures of the lower extremities, pelvis, and ribs -Organ damage from the third collision

Management: Transport and Destination (4 of 8) •Destination selection

-Level I facility •Serves large cities or heavily populated areas •Provides every aspect of trauma care •Usually university-based hospitals -Level II facility •Located in less population-dense areas •Provides initial definitive care

•Destination selection (cont'd)

-Level III facility •Provides assessment, resuscitation, emergency care, and stabilization •Transfers patients to Level I or Level II facility when necessary -Level IV facility •Found in remote outlying areas •Provides advanced trauma life support

Falls (1 of 3) •Injury potential depends on the height from which the patient fell.

-More than 20 ft (6m) is considered significant. •Internal injuries pose the greatest threat to life.

Review 1.An unrestrained driver collided with a bridge pillar. Upon inspection of the interior of his vehicle, you note that the lower dashboard is crushed. During your assessment of the patient, you will MOST likely encounter: A.trauma to the pelvis. B.blunt abdominal trauma. C.a severe closed head injury. D.penetrating thoracic trauma.

Answer: A Rationale: Impact points are often obvious from a quick inspection of the vehicle's interior. During a frontal collision, the unrestrained occupant's knees often impact the lower dashboard. With this type of impact, energy is transferred from the knees to the femurs, and then to the pelvis or hip.

Review 1.Whiplash injuries are MOST common following _________ impacts. A.rear-end B.rollover C.frontal D.lateral

Answer: A Rationale: Whiplash injuries of the neck are a common occurrence following rear-end collisions. As the vehicle is suddenly thrust forward, the occupant's head is thrust backward. Properly positioned headrests can minimize the severity of whiplash injuries.

Review 1.A young male experienced severe blunt chest trauma when his passenger car struck another vehicle head-on. During your inspection of the interior of his vehicle, you would MOST likely find: A.deployed airbags. B.steering wheel deformity. C.starring of the windshield. D.a crushed instrument panel.

Answer: B Rationale: Blunt chest injuries during a motor vehicle crash typically occur when the chest impacts the steering wheel. Therefore, your inspection of the vehicle's interior will most likely reveal a deformed steering wheel.

Review 1.Severe abrasion injuries can occur when motorcycle riders are slowed after a collision by road drag. Road drag is most often associated with which type of motorcycle impact? A.Head-on collision B.Angular collision C.Ejection D.Controlled crash

Answer: C Rationale: During an ejection, the rider will travel at high speed until stopped by a stationary object, another vehicle, or road drag. Severe abrasion injuries (road rash) down to bone can occur with drag.

Review 1.A 40-year-old man was standing near a building when it exploded. He has multiple injuries, including a depressed skull fracture, severe burns, and an impaled object in his abdomen. His head injury was MOST likely caused by ___________ blast injuries. A.primary B.secondary C.tertiary D.quaternary

Answer: C Rationale: Primary blast injuries are caused by the pressure wave and include ruptured eardrums and hollow organ rupture. Secondary blast injuries are caused by flying debris and include impaled objects and shrapnel injuries. Tertiary blast injuries occur when the victim is thrown into a solid object, resulting in blunt trauma to virtually any part of the body. Quaternary blast injuries include other miscellaneous injuries.

Review 1.A 20-year-old man has major open facial injuries after his vehicle struck a tree head-on. Which of the following findings within the car would MOST likely explain his injury pattern? A.Deployed airbag B.Bent steering wheel C.Nonintact windshield D.Crushed instrument panel

Answer: C Rationale: The mechanism of injury and condition of the vehicle's interior suggest likely areas of injury. Head and neck injuries are likely to result when the head and face impact the windshield.

Review 1.Which of the following would MOST likely result from the third collision in the "three-collision" effect that occurs during a high-speed, frontal impact motor vehicle crash? A.Extensive damage to the automobile B.Flail chest and lower extremity fractures C.Massive external trauma with severe bleeding D.Aortic rupture or compression injury to the brain

Answer: D Rationale: During the third collision, the body's internal organs collide with the inside of the body. These injuries are usually not as obvious, but are often the most life-threatening. Injuries that may result from this include internal injuries of the brain (compression injuries) and aortic tears, resulting in massive internal bleeding.

Review 1.Death from a rollover motor vehicle crash is MOST often secondary to: A.crushing injuries. B.airbag-related trauma. C.multiple collisions to the interior of the car. D.ejection of the patient from the motor vehicle.

Answer: D Rationale: Rollover crashes are the most unpredictable with regard to injuries sustained by the patient. An unrestrained passenger may have struck multiple points within the vehicle. However, the most life-threatening event in a rollover is ejection or partial ejection of the patient from the vehicle.

Review 1.When assessing a stab wound, it is important for the EMT to remember that: A.stabbings to an extremity are rarely associated with an exit wound. B.the majority of the internal trauma will be near the path of the knife. C.most stabbings are unintentional and cause less severe internal injury. D.more internal damage may be present than the external wound suggests.

Answer: D Rationale: With low-velocity penetrations, injuries are caused by sharp edges of the object moving through the body and are therefore close to the object's path. Weapons such as knives, however, may have been deliberately moved around internally, causing more internal damage than the external wound suggests.