Blunt Trauma.ppt

Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Most common cause of trauma death and disability Energy exchange between an object and the human body,without intrusion through the skin Process of examining the scene to determine potential injuries that result from the forces of motion Mechanism of injury description of the mechanical and physiological changes that result in anatomical or functional damage of tissue Based on the MOI and kinetics predict expected injuries 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.”Conservation of Energy“Energy can neither be created nor destroyed.It is only changed from one form to another.”Kinetic versus Potential Energy Kinetic Energy Energy in Motion Double Weight=Double Energy Double Speed=Quadruple EnergySPEED IS THE GREATESTDETERMINANT2)()(2speedVelocityweightMassKE Force Emphasizes the importance of rate at which an object changes speed(acceleration or deceleration)onAcceleratiMassForce Blunt Closed injury Indirect injury to underlying structures Transmission of energy into the body Tearing of muscle,vessels and bone Rupture of solid organs Organ injury Ligamentum teres Penetrating Open injury Direct injury to underlying structures 44,000 people die each year on US highways Events of Impact Vehicle Collision Body Collision Organ Collision Secondary Collisions Objects inside vehicle strike occupant Additional Injuries Vehicle receives a second impact Restraints Seatbelts Occupant slows with the vehicle Shoulder and Lap belts MUST be worn together Injuries if worn separately Airbags(SRS)Reduce blunt chest trauma Cause:Hand,Forearm,&Facial Injury Check for steering wheel deformity Side Airbags Child Safety Seats Infants and Small Children:Rear facing Older Child:Forward facing Types of Impact Frontal:32%Lateral:15%Rotational:38%Left&Right Front&Rear Rear-end:9%Rollover:6%Frontal Impact Down-and-Under Knee,femur,and hip fracture Chest trauma-Steering Wheel Paper Bag Syndrome Up-and-Over Tenses legs=Bilateral femur fracture Hollow organ rupture and liver laceration Similar chest trauma Axial Loading Ejection Due to up-and-over pathway Contact with the vehicle&external object Lateral Impact 15%of MVCs but 22%of deaths Upper extremity injury Rib,clavicle,humerus,pelvis,femur fracture Lateral compression Ruptured diaphragm,Spleen fracture,Aortic injuryEVALUATE the unrestrained occupant Rotational Vehicle struck at oblique angle Less serious injuries unless strike a secondary object Rear-end Seat propels the occupant forward Head is forced backwards Stretching of neck muscles and ligaments Hyperextension&hyperflexion Rollover Multiple points of impact Ejection or partial ejection Less injury with restraints Vehicle Crash Analysis Hazards Crumple Zones Intrusion Deformity of Vehicle Use of Restraints Intoxication Fatal Accidents:50%involved ETOH Recreational Accidents Vehicular Mortality Head:48%Internal(Torso):37%Spinal&Chest fracture:8%Extremity fracture:2%All Other:5%Collision Questions 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?Serious injuries can occur with high and low speed collision.Types of Impact Frontal Angular Sliding Ejection Initial Bike/Object Collision Rider/Object Rider/Ground Adults Adults turn away Bumper strikes lower legs first Victim rolls up and over and thrown Children Children turn toward Femurs,Pelvis often injured Thrown away or run over Lack structure and restraint system Types of Vehicles Snowmobiles Personal watercraft ATVs Blast Injuries Dust,Fumes,Explosive Compounds Explosion Fuel+Oxidant combine instantaneously Heat&Pressure Wave 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 Implosion 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,atelecasis,hemorrhage 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 Blast winds are sufficient force to cause victims to become human missiles victim strikes the ground Injuries resulting from changes in the environment as a consequence of the explosion f