Chapter 27: Trauma Overview

Children Vehicle-Pedestrian Collision

A child who is about to be hit by a vehicle-whether the child is walking or riding a bicycle-generally turns toward the oncoming vehicle, so injuries frkm the impact are generally to the front of the body -common injuries ti the femur, chest, abdomen, and head

Frontal Impact (Abdomen)

A damaged dashboard or steering wheel shpuld cause a suspected abdominal injury

Feet-First Falls

A feet-first landing causes energy to trvel up the skeletal system. Fractures of the heels and fractures or dislocations of the ankles are common

Law of inertia

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

All-Terrain Vehicles

ATVs are Easily tipped over

Trauma Level 2

Area Trauma Center

Frontal Impact (Chest)

As the chest hits the dashboard or steering wherl, bones and soft tissues are both affected

Vehicle Collision (Index of Suspicion Situations)

Death of another occupant of the vehicle An unresponsive patient or a patient with an altered mental status Intrusion if greater than 12 inches for the occupant site or greater than 18 inches anywhere to the vehicle Ejection from the motor vehicle

Medium-and high-velocity Dissipation of energy

Drag Profile Cavitation Fragmentation

Secondary phase injuries

Due to flying debris propelled by the force if the blast, or blast wind

Blast Injuries (Primary phase injuries)

Due to the pressure wave of the blast, affect the gas containing organs

Motorcycle Collisions (Ejection)

Ejection continues until a body part impacts with the object if the collision, the ground, or both

Energy (change in form)

Energy is forced to change form if it can no longer travel in a straight line

Energy (direction)

Energy travels in a straight line unless it meets and is deflected by some kind of interference

Golden Principles of Prehospital Trauma Care

Ensure safety, determine need for additional resources, determine MOI and kinetics involved, provide a primary assessment, establish and maintail spinal stabilization, establish and maintain an airway, establish and maintain adequate oxygenation, provide positive pressure ventilation, control external hemmorrhage, treat for shock, consider application of the pneumatjc antishock garment, maintain spical stabilization, transport critically injured or multisystem trauma patients, obtain a history, perform a secondary assessment

MVC Classifications

Frontal Rear-end Lateral Rotational Rollover

(Restraints) Air Bags

Frontal air bags are triggered to inflate from the steering wheel or glove compartment when a collision occurs

Gunshot wounds

Head Chest Abdomen Extremities

Velocity

Higher the velocity, greater the injury

Vehicle collision

If a vehicle is stopped suddenly and gets bent out of shape

Body collision

If an individual comes to a quick stop on some part or parts of the inside of the vehicle (steering wheel), causing injury to the chest

Golden period

Parameter for emergency care because severely injured patients have the best chance for survival if intervention takes place as quickly as possibly from the time of injury - "golden hour"

Multisystem Trauma

Patient has multiple injuries or involvement of more than one body system, manage life-threatening injuries

Special considerations

Personal safety is of utmost importance, airway management and adequate ventilation and oxygenation are key elements, stop sognificant bleeding, assessment if the trauma patient is conducted in a sequence that promotes a systematic approach, rapid transport of the severely injured patient is essential, a backboard can serve to secure suspected fractures in an unstable patient who requires rapid transport, do not develop tunnel vision and become focused in dramatic injuries or dramatic patients

Frontal Impact (Face, Head, Neck)

These parts of the body will impact the dashboard, windshield, or window. Always check for the "spiderweb" windshield cracking or other impact marks to the windshield, which are usually caused by a head striking the glass

Lateral Impact (Chest and Abdomen)

This occurs when the door strike the side if the chest and abdomen

Trauma Level 4

Trauma Facility

Common MOIs

Vehicular collisions, falls, penetrating gunshots or stabbings, explosions

Vehicle-Pedestrian Collision

When a vehicle hits a pedestrian, the extent of injury depends on how fast the vehicle was going, what part of the pedestrian's body was hit, how far the pedestrian was thrown, the surface the pedestrian landed on, and the body part thag first struck the ground

Lateral Impact

When a vehicle is struck laterally, or directly on the side, it can be crushed inward, impinging upon the occupants

Tertiary phase injuries

Occurs when the patient is thrown away from the source of the blast

Kinetics of Trauma

The science of analyzing mechanisms of injury - helps you predict the kind and extent of injuries as a basis for your priority decisions regarding continuing assessment, care, and transport

Dissipation of energy

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

Trauma Level 3

Community Trauma Center

MOI

(Mechanism of Injury) - refers to how a person was injured

Platinum 10

In cases of severe trauma 10 minutes is the maximhm time the EMS team should devote to on-scene activities

Organ collision

Individual's internal organs come to a quick stop and strike the inside surface of the body

Rotational/Rollover Crash

Injuries from rotational crashes are not as easy to predict as those from other crashes

Kinetic Energy Equation

Kinetic energy = (mass x velocity^2)/2

Low-Velocity Injuries

Knife injuries with slash marks from defense, the length of the object used in the stabbing also provides valuable clues, the injuries may include lacerated pulmonary veins, lacerated aorra, and even laceration to the heart itself

Restraints

Lap belts, when worn properly, distribute force across the iliac crests if the pelvis Lap and shoulder belts that are properly positioned may reduce the force of the impact in any one point and, consequently, reduce the severity of the injuries

Trauma Level 1

Regional Trauma Center

"Laying the Bike down"

The bike is turned sideways and "laid down" with the driver's inside leg dragging on the oavement or ground

Lateral Impact (Head and Neck)

The body is pushed laterally out from under the head, causing the head to move in the opposite direction.

Kinetics

The branch of mechanisms dealing with the movements of bodies

Frontal Impact

The driver will continue to move forward at the same soeed the vehicle is traveling, then he will proceed to go either up and over the steering wheel (causing injuries to the head, neck, chest, and abdomen and possible ejection through the windshield) OR he will go down and under the steering wheel (causing injuries to the knees, femurs, hips, acetabulum and spine)

Kinetic energy

The energy contained in a moving body

Vehicle Collisions (Velocity)

The greater the speed at collision, the greater the change of life-threatening injury

Head-First Falls

The head may be forcibly hyperextended, hyperflexed, or compressed, all of ehich can cause extensive damage to the crrvical soine. Chest, lower spine, and pelvic injuries are also common.

Lateral Impact (Pelvis)

The impact of the vehicle door to the chest wall also causes a lateral impact to the pelvis

Falls more than 20 feet

The internal organs are likely to be injured from decceleration forces: the liver, spleen, kidney, aorta, and heart may be affected

Motorcycle Collisions (Head-On)

The motorcycle tends to tip forward and causes the rider to travek nto the handlebars at the same soeed the bike was traveling

Trajectory

The path or motion of a projectile during its travel

Rear-End Impact

The patient's head and neck are immediately whipped back. This leads to "whiplash" where the neck is hyperextended and the anterior spinal ligaments are often stretched or torn.

(Restraints) Considerations for Infants and Children

The properly secured car seaf restrains a child and three points or at five points. The result can be a spinal cord i jury suthout injury to the vertebrae, which are pliable in children. To completely avoid injury from ajr bag deployment, children should always be restrained in the back seat of the vehicle and not in the front passneger seat

Deceleration

The rate at which a body in motion decreases its speed

Acceleration

The rate at which a body in motion increases its speed

Motorcycle Collisions (Angular Impact)

The rider strikes an object, usually a protruding object, at an angle