Determining the Usual Suspects : Clues to Injury Patterns in Trauma

Transcription

1 Caffeine is my shepherd; I shall not doze. It maketh me to wake in the lecture hall; it leadeth me beyond the sleeping masses. It restoreth my buzz. It leadeth me in the paths of consciousness for its name s sake. Yea, though I walk through the valley of addiction, I will fear no decaf. For thou art with me; thy cream and thy sugar, they comfort me. Thou preparest a tall latte before me in the presence of fatigue. Thou anointest my day with pep; my mug runneth over. Surely richness and taste shall follow me all the days of my life; and I will dwell in the House of Java forever. Anonymous

2 Determining the Usual Suspects : Clues to Injury Patterns in Trauma Mark Forgues, M.Ed., EMT-P EMS Technical Liaison Massachusetts Institute of Technology

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8 EMT Training 2005

9 Acute Care in the United States Est. 40 million injury-related ED visits in 2000 Most common causes traffic crashes, falls, and violence. Only ¼ of U.S. lives in areas served by trauma care system. Studies of conventional trauma care show that as many as 35% of trauma patient deaths could have been prevented if optimal acute care had been available. Up to 25% of injuries treated in emergency departments are alcohol related.

10 10 Leading Causes of Death, United States 2001, All Races, Both Sexes Age < Rank 1 Congenital Anomalies 5,513 Unintent. Injury 1,714 Unintent. Injury 1,283 Unintent. Injury 1,553 Unintent. Injury 14,411 Unintent. Injury 11,839 2 Short Gestation 4,410 Congenital Anomalies 557 Malignant Neoplasms 493 Malignant Neoplasms 515 Homicide 5,297 Homicide 5,204 3 SIDS 2,234 Malignant Neoplasms 420 Congenital Anomalies 182 Suicide 272 Suicide 3,971 Suicide 5,070 4 Maternal Pregnancy Comp. 1,499 Homicide 415 Homicide 137 Congenital Anomalies 194 Malignant Neoplasms 1,704 Malignant Neoplasms 3,994 5 Placenta Cord Membranes 1,018 Heart Disease 225 Heart Disease 98 Homicide 189 Heart Disease 999 Heart Disease 3,160 Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC Data Source: National Center for Health Statistics (NCHS) Vital Statistics System.

11 10 Leading Causes of Death, United States 2001, All Races, Both Sexes Age < Rank Congenital Anomalies 5,513 Short Gestation 4,410 SIDS 2,234 Maternal Pregnancy Comp. 1,499 Placenta Cord Membranes 1,018 Unintent. Injury 1,714 Congenital Anomalies 557 Malignant Neoplasms 420 Homicide 415 Heart Disease 225 Unintent. Injury 1,283 Malignant Neoplasms 493 Congenital Anomalies 182 Homicide 137 Heart Disease 98 Unintent. Injury 1,553 Malignant Neoplasms 515 Suicide 272 Congenital Anomalies 194 Homicide 189 Unintent. Injury 14,411 Homicide 5,297 Suicide 3,971 Malignant Neoplasms 1,704 Heart Disease 999 Unintent. Injury 11,839 Homicide 5,204 Suicide 5,070 Malignant Neoplasms 3,994 Heart Disease 3,160 Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC Data Source: National Center for Health Statistics (NCHS) Vital Statistics System.

12 Unintentional Injuries One of the top 9 causes of death in all age groups Ranks #5 overall in all age groups 101,537 in % of pedi deaths result from injury, MVAs

13 Introduction-Easy Stuff Pt. is transported after being hit in the head with a beer bottle during a bar fight in which the patient wasn t directly involved. Is complaining of a terrible headache Injury? Cause?

14 More Easy Stuff Patient is brought in with a single knife wound to the leg. EMS report is sketchy and breathless stating that the patient is shocky and lost a lot of blood. Where is he stabbed? What is the treatment? What stuff do you need to do to prepare?

15 Fantasy Stories Does the patient s presentation add up to the story told to you? 5-YOM presents with a sore shoulder after falling down the stairs. It is his only complaint.

16 Kinematics 101 Energy is not lost or gained but converted (car brakes) Anytime force is applied to the body, potential damage occurs (energy converted) By looking at how force was applied, we can predict injury patterns

17 Kinematics 101 cont. Extent of injury is directly related to how fast the force is applied force over time You are tossed a.45 bullet, vs having it shot at you

18 The Formula KE = mass (weight) x velocity (speed) 2 2 KE = mv 2 2

19 Blunt Trauma MVC s Pedv MV Falls Impacts Bicycle Motorcycle Explosions

20 Motor Vehicle Crashes

21 Relationship of Bent Metal to Patient Injury Unpublished study of ±100 MVCs Pictures taken of each car Compared to damage to the patient Negative correlation However Positive correlation with damage to the interior of the car.

22 Rear End- Bent Metal

23 Australian Offset Frontal

24 Frontal Crash

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28 How Do Seatbelts Work?

29 Car v Pedestrian

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31 Where is the Contact? Questions to be asked Height of the bumper v height of the person struck Adult v child struck (side v frontal impact) Shape of the vehicle front end

32 Knock Down

33 Windshield Strike

34 Low-Profile Vehicles Corvette Intrepid Saturn Grand Prix

35 Where Are the Injuries Here?

36 Subtle Findings

37 Car V Kid Adults turn away Children tend to face

38 Car v. Bicycle

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40 What Does This Tell You? What Do You Need To Know?

41 Roll Over Crashes

42 Stay in the Car

43 Ejection

44 Two-wheel wheel Transportation

45 Frontal Number of Impacts?

46 Side Scuff Injuries

47 Explosions Laboratories Shipyards Chemical plants Tank trucks Refineries Fireworks firms Silos LP gas tanks

48 Primary Phase Injuries Cause: pressure from the blast Affected areas: gas containing organs Injuries: Pulmonary bleeding Pneumothorax Air emboli Perforation of the GI tract Burns Death may occur in absence of outward signs

49 Secondary Phase Injuries Cause: flying debris Affected area: Body surface Skeletal system Injuries: Lacerations Fractures Burns

50 Tertiary Phase Injuries Cause: victim thrown against an object Affected area: area of impact or referred energy. Injuries: similar to those sustained in a vehicle ejection.

51 Falls Height Surface Intermediate strikes Position on contact Protection Mortality in the elderly

52 Don Juan Syndrome

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54 Don Juan The Original

55 Forces in Don Juan L 2 -L 3

56 Pump Staging Classic Don Juan

57 Lover s Leap Syndrome Lands on feet, fractures ankles, L2-L3 injuries, falls backwards and lands on hands Add fractured wrists to Don Juan Syndrome

58 Regular Falls

59 LOMFDGB

60 Stairs

61 Bleachers

62 Bleachers See any problems with these???

63 Head Injuries

64 Skull Fracture

65 Epidural Hematoma

66 Subdural Hematoma

67 C-Spine

68 Sports Injuries

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70 Spinal Immobilization

71 Applying a Cervical Spine Immobilization Device

72 Stabilize and measure.

73 Choose correct collar size.

74 Slide collar under chin.

75 Use of Long Spine Board: Standing Patient

76 Maintain stabilization; apply collar.

77 Position board and EMT-Bs.

78 Grasp board after reaching under patient s shoulders.

79 Carefully lower patient; then secure board.

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81 Questions? Mark Forgues Massachusetts Institute of Technology

82 Burns

83 Electrical Burns

84 Electrical Burns Entrance and exit wounds:

85 Electrical Burns

86 Road Rash = 2 o -3 o Burns

87 Penetrating Trauma Injury depends on: Physics Direction Anatomy Weapon velocity Bullet design

88 Low-Velocity (Fixed Devices) Usually hand-driven weapons Knives Forks Ice picks Machete Victim impaled on objects

89 Commonalities If you follow the trajectory of the implement, you usually will find the injuries Infrequent secondary injuries

90 Questions How deep is the penetration? What is the direction? What is in the way? How does length of the weapon correlate to the cone of damage?

91 Injury Site Any wound between the umbilicus and the 5 th rib can be either an abdominal or thoracic wound or both. Depends on position of the patient, inhalation v exhalation or combination

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97 Medium-Energy

98 Examples Hand Guns Shotguns Powder actuated tools.22 &.38 caliber ram set

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100 Others Pellet gun BB gun Pneumatic nail guns

101 Construction 101

102 So Whaddaya know about.22-caliber bullets? Small Unpredictable They bounce Lethal Range of 1-mile

103 Penetrating Trauma Physics, pt.2

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106 High Velocity

107 High Velocity Injuries How do these weapons differ from handguns and shotguns? How do the wounds differ internally and externally?

108 Projectile Characteristics The larger the frontal area of the projectile, the greater the damage The larger the cavitation and the greater the damage, the greater the exit wound.

109 GSW Cavitation Reformation by elastic tissue Temporary cavity Direction of travel Bullet Permanent cavity Compression and crush

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111 Caveat: Watch your documentation Never characterize wounds as entrance or exit wounds Just penetrating with jagged edges, stippling, burns, etc. Large wound may result from gun muzzle being pressed into the skin

112 Entrance wounds may be larger than exit wounds Skin

113 Caveats of Penetrating Trauma Where the bullet exits has nothing to do with its path What s supposed to happen doesn t What you see on X-ray may not exist Reassess, reassess, reassess

114 Bad Indicators in Trauma Having had 2 beers (1, 3, 4, 5, etc. appear to be OK) Being approached by some dude Trauma Recidivism Standing on the corner not doing nothin Lots of tattoos, esp. with skulls and naked women