Ch. 22 Trauma
|Death||Traumatic death is the #1 cause of death in people under 40 years of age.|
|Work|| Force acting over a distance.|
Work of a moving object is called kinetic energy.
|Potential Energy|| The product of mass, force of gravity, and height.|
Mostly associated with the energy of falling objects.
|Blunt Trauma|| 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 Collisions||Common passenger injuries include lower extremity fractures(Knees into the dashboard), flail chest (ribcage into the steering wheel), and head trauma(head into the windshield).|
|Children|| Children shorter than 4' 9" should ride in the rear seat.|
In a pickup truck or single-seated vehicle, the air bag should be turned off.
|Frontal Collisions|| Despite air bags, suspect injuries to:|
Extremities (resulting from the second collision)
Internal organs (resulting from the third collision)
|Rear-End Collisions|| Known to cause whiplash-type injuries. (Particularly in absence of a headrest)|
Acceleration-type injury to the brain is possible. (Third collision of the brain within the skull.)
|Lateral Collisions|| Side impacts. (Commonly called T-bone collisions)|
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 (Lateral whiplash)
|Rollover Crashes||Injuries depend on whether the passenger was restrained. Most common life-threatening event is ejection or partial ejection of the passenger from the vehicle.|
|Rotational Collisions|| Spins are conceptually similar to rollovers.|
Opportunities for the vehicle to strike objects such as utility poles.
|Car Versus Pedestrian||Injuries are often graphic and apparent, but there can also be serious unseen injuries|
You should determine:
Speed of the vehicle
Whether the patient was thrown through the air
Whether the patient was struck and pulled under the vehicle.
Evaluate the vehicle that struck the patient for structural damage.
ALS backup should be summoned for any patients who have sustained a significant MOI.
|Car Versus Bicycle||Evaluate the damage to and position of the bicycle.|
If the patient was wearing a helmet, inspect it for damage. Presume that the patient has sustained an injury to the spinal column, or spinal cord, until proven otherwise at the hospital.
Spinal stabilization must be initiated and maintained during the encounter.
|Car Versus Motorcycle|| When you are assessing the scene, attention should be given to the:|
Deformity of the motorcycle
Side of most damage
Distance of skid in the road
Extent and location of deformity in the helmet
|Car Versus Motorcycle Collision Types||Head-on collision|
Motorcycle strikes another object and stops its forward motion while the rider continues.
Motorcycle strikes an object at an angle so that the rider sustains direct crushing injuries to the lower extremity.
Rider will travel at high speed until stopped by a stationary object, another vehicle, or road drag.
Technique used to separate the rider from the body of the motorcycle.
|Falls|| Injury potential depends on the height from which the patient fell. More than 15' or 3 times the patient's height is considered significant.|
Internal injuries pose the greatest threat to life.
|Landing|| Patients who fall and land on their feet may have less severe internal injuries.|
Their legs may have absorbed much of the energy of the fall.
|Assessing a Fall|| Take the following factors into account:|
The height of the fall
The type of surface struck
The part of the body that hit first, followed by the path of energy displacement
|Penetrating Trauma||Second leading cause of trauma death after blunt trauma.|
|Predicting Projectile Path|| Bullet may ricochet within the body before exiting.|
Path the projectile takes is its trajectory.
Fragmentation will increase damage.
|Cavitation|| Temporary cavitation is caused by the acceleration of the bullet.|
Permanent cavitation is caused by the bullet path.
|Blast Injuries||Most common in war|
Also seen in:
Mines, Shipyards, Chemical plants, and Terrorist attacks.
Solid organs are relatively protected from shock wave injury.
May be injured by secondary missiles or a hurled body
Neurologic injuries and head trauma are the most common causes of death.
Traumatic amputations are common.
|Primary Blast Injury||Due entirely to the blast itself. Damage is caused by the pressure wave generated by the explosion. blast waves cause organs to rupture, disruption of major blood vessels, and damage to hollow organs.|
|Secondary Blast Injury||Damage to the body results from being struck by flying debris.|
|Tertiary Blast Injury||Victim is hurled by the force of the explosion.|
|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.
|Pressure Changes|| Organs that contain air are most susceptible to pressure changes.|
Middle ear, Lung, and Gastrointestinal tract
The ear is most sensitive to blast injuries. The tympanic membrane will detect minor changes in pressure and will rupture at pressures 5-7lbs per square inch above atmospheric pressure.
|Pulmonary Blast Injuries|| Results from short-range exposure to the detonation of explosives.|
Arterial air embolisms can produce:
disturbances in vision, changes in behavior and state of consciousness,and a variety of other neurologic signs
|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.
|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.
|Injuries to the Neck and Throat|| 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.
Penetrating injury may result in air embolism.
Crushing injury may cause the cartilages of the upper airway and larynx to fracture.
|Injuries to the Chest||Many life-threatening injuries may occur to the chest.|
Broken ribs may hinder breathing.
Heart may be bruised.
Large vessels may be torn.
A penetration or perforation of the integrity of the chest is called an open chest wound.
Assess the chest region every 5 minutes.
Assessment should include DCAP-BTLS, lung sounds, and chest rise and fall.
|Injuries to the Abdomen|| Abdomen contains vital organs that require a very high amount of blood flow|
Solid organs may tear, lacerate, or fracture.
Hollow organs may rupture and leak acidlike digestive chemicals.
The rupture of large blood vessels can cause serious unseen bleeding.
|Abdominal Solid Organs||liver, spleen, pancreas, and kidneys.|
|Abdominal Hollow Organs||stomach, large and small intestines, and urinary bladder.|
|Management: Transport and Destination Time Dependency|| Critically injured patient:|
Decreased level of consciousness
Threats to airway, breathing, or circulation
|Type of Transport|| Ground EMS units are staffed by EMTs and paramedics.|
Air EMS units or critical care transport units are staffed by critical care nurses and paramedics.
|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
|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
|Significant MOI of Injury||death of occupant in the vechile, severe deformity of vehicle or intrusion into vehicle, altered mental status, ejection from the vehicle.|