Chapter 24 Introduction Kinematics of Trauma Energy and Trauma Kinetic Energy Newton s First Law Newton s Second Law

Transcription

1 Chapter 24 Trauma Overview Introduction Traumatic emergencies occur as resut of physica appied to the body. Medica emergencies occur from an iness or condition not caused by an outside force. Index of suspicion: your awareness for serious unseen injuries Kinematics of Trauma Injuries are the eading cause of among chidren and young aduts. Kinematics introduces the basic physica concepts that dictate how injuries occur and affect the human body. Energy and Trauma Work Force acting over distance Kinetic energy Energy of object Potentia energy Product of weight, gravity, and height Kinetic Energy KE =Mass/2 X Veocity² Doube the speed = the KE Energy cannot be created or destroyed, ony converted Potentia energy is the product of mass, force of gravity, and height. Mosty associated with the energy of faing objects Newton s First Law Objects at rest tend to stay at rest, and objects in motion tend to stay in, uness they are acted upon by some force. Newton s Second Law Force (F) equas Mass (M) times Acceeration (A) 1

2 Force (F) equas Mass (M) times Acceeration (A) F=MA Newton s Third Law For every action, there is an equa and opposite reaction Mechanism of Injury Profies Different MOIs produce many types of injuries. Nonsignificant injuries Injury to an body part Fa without the oss of consciousness Significant injuries Injury to more than one body system Fas from heights Vehice crashes Traumatic Injuries Bunt trauma Caused by a force to the body Injuries do not soft tissue or organs Penetrating trauma Caused by objects such as knives and buets Injuries pierce and penetrate the surface of the body Mechanism of Injury (MOI) MOI is the way in which injuries occur. Different MOIs produce many types of injuries. Isoated to one body system Injuries to many body systems Vehicuar Crashes and Mechanisms of Injury (MOI) By assessing the crash, the may be determined. By determining the MOI, you may be abe to predict the types of injuries that may have happened at the time of impact. Vehicuar Coisions Three types of crashes: 1) Coision of against another car or object 2

3 Three types of crashes: 1) Coision of against another car or object Vehicuar Coisions Three types of crashes: 2) Coision of passenger(s) against of car Vehicuar Coisions Three types of crashes: 3) Coision of passenger s interna against the soid structures of the body Significant Mechanisms of Injury (MOI) Severe deformities to the fronta part of the vehice Moderate from a T-bone accident Severe damage from the rear Coisions in which rotation is invoved Types of Motor Vehice Coisions Fronta Latera Rear-end Spins Roovers Fronta Coisions (1 of 2) Evauate seat bets and s. Remember that suppementa restraint systems cannot prevent a injuries. You shoud sti suspect serious injuries to extremities and interna organs Fronta Coisions (2 of 2) Check for contact points. Steering whees can aso cause chest injuries, especiay if no air bag is present. Knee strikes dash and knee is injured: Injury Knee strikes dash resuting in pevic injury: Indirect Injury Fronta Coisions Nondepoyed airbags may depoy during extrication. 3

4 Nondepoyed airbags may depoy during extrication. Suppementa restraint systems can cause harm whether used propery or impropery. Rear-End Coisions Commony cause whipash-type injuries Unrestrained passengers wi be thrust f into the dashboard. Back seat passengers wearing ony ap bets might have a higher incidence of umbar and thoracic spine injury. Latera Coisions Responsibe for the incidence of deaths. Latera whipash injury is the resut. There may be intrusion into the passenger compartment. Latera Coisions If substantia intrusion into the passenger compartment, suspect: Latera chest and abdomen injuries on the side of the impact Possibe fractures of the ower extremities, pevis, and ribs damage from the third coision Roover Crashes Injury patterns differ if patients are unrestrained. Large trucks and are prone The most unpredictabe injuries are to unrestrained passengers. Ejection is the most common ife-threatening injury. Spins Vehice is put into rotationa motion. Vehice often strikes a fixed object, combining forces of rotation with atera impact. Car Versus Pedestrian Coisions Injuries are often and apparent. Can aso be serious unseen injuries Evauate MOI to determine: Whether patient was and how far. Whether patient was struck and pued under car. 4

5 Whether patient was and how far. Whether patient was struck and pued under car. Vehice speed Presume injury to the spina cord and maintain immobiization Car Versus Bicyce Evauate ike a car-versus-pedestrian coision. Evauate damage to and position of the bicyce. Inspect for damage. Spina stabiization must be initiated and maintained. Car Versus Motorcyce Protection is from: Hemet Leather or abrasion-resistant cothing and boots When assessing the scene, ook for: Deformity of the motorcyce Side of most damage Distance of in the road Extent and ocation of deformity in the hemet Car Versus Motorcyce Head-on crash Motorcyce strikes another object and stops its forward motion whie the rider continues motion Anguar crash Motorcyce strikes an object at an ange so that the rider sustains direct crushing injuries to the ower extremity Car Versus Motorcyce Ejection Rider wi trave at high speed unti stopped by a stationary object, another vehice, or road drag. Severe abrasions can occur. Controed crash Technique used to separate the rider from the 5

6 Controed crash Technique used to separate the rider from the of the motorcyce Fas Injury potentia is reated to the height of the fa. More than 20 or times the person s height is considered significant. Suspect interna injuries from a significant fa. Patients who and on their feet may have ess-severe interna injuries. Their egs may absorb much of the energy of the fa. Considerations for Fas The height of the fa The surface struck The part of the body that hit first, foowed by the path of energy Penetrating Trauma Second argest cause of death in the United States after bunt trauma Penetration can be ow-energy, or medium- or high-veocity The greater the of penetration, the greater the injuries Low-Energy Penetrating Trauma Caused accidentay by an object or i with a weapon Injury caused by the sharp edges of the object moving through the body Knives may have been deiberatey moved around internay, causing more damage. Medium-Veocity and High-Veocity Penetrating Trauma Usuay caused by buets Buets can change shape and within the body. Fragmentation wi increase damage 6

7 body. Fragmentation wi increase damage Pressure waves cause cavitation. If possibe, identify weapon caiber and shooting distance. Cavitation Temporary cavitation is caused by the acceeration of the buet. Permanent cavitation is caused by the buet path. Bast Injuries Primary bast injuries Due entirey to the bast itsef Secondary bast injuries Damage to the body resuts from being struck by fying. Tertiary bast injuries Victim is hured by the force of the exposion. Bast Injuries Quaternary (misceaneous) bast injuries Burns from hot gases or fires started by the bast Respiratory injury from inhaing gases Crush injury from the coapse of buidings Most patients wi have some combination of the four types of injury. Bast Injuries Organs Most Affected Organs that contain air are most susceptibe to pressure changes. Midde ear Lung Gastrointestina tract The ear is most to bast injuries. Pumonary Bast Injuries Pumonary bast injuries resut from short-range exposure to the detonation of exposives. Arteria air emboisms can produce: 7

8 42 43 detonation of exposives. Arteria air emboisms can produce: Disturbances in vision Changes in behavior and state of consciousness Variety of other signs Bast Injuries Soid organs are reativey from shock wave injury. May be injured by secondary missies or a hured body Neuroogic injuries and head trauma are the most common causes of death. Traumatic amputations are common Mutisystem Trauma Invoves more than body system Head and spina trauma Chest and abdomina trauma Chest and mutipe extremity trauma Aert medica contro and transport rapidy. 8