1. Trauma and Shock

2. Trauma Leading cause of death for people under 40
Occurs as a result of physical forces applied to the body
Blunt forces
Penetrating forces

3. Mechanism of Injury
The way in which forces act on the body to cause an injury
Kinetic energy- the energy of a moving object, and is the relationship of mass (weight) and velocity (speed)
Kinetic Energy = mass/2 x velocity2
If weight doubles energy doubles
If speed doubles energy quadruples

4. Mechanism of Injury
Knowledge of different types of MOIs allow us to predict injuries
A high index of suspicion for multisystem trauma and unseen injuries in the following situations
Falls from heights
Motor vehicle and motorcycle crashes
Car vs pedestrian / bicycle / motorcycle
Gunshot wounds / stabbings

5. Blunt Trauma Vehicle collisions 3 impacts Vehicle strikes something
Passenger impacts interior of vehicle
Passengers organs impact solid structures in body

6. Vehicular Crashes Frontal Collisions Rear end Collisions
Deceleration injuries
Rear end Collisions
Whiplash injuries
Lateral Collisions (T Bone)
Rollover Crashes
Injuries unpredictable due to multiple impacts
Restrained vs Unrestrained
Partial or full ejection

7. Vehicular Crashes Car vs Pedestrian Car vs Bicycle Car vs Motorcycle
Usually presents with graphic injuries but be alert for unseen injuries
Car vs Bicycle
Similar findings as pedestrian
May be wearing a helmet
Car vs Motorcycle
Lay down vs impact with larger object
Protective equipment (helmet, leather clothing)

8. Situations that Indicate Trauma
Death of other vehicle occupant
Severe damage to the vehicle
Severe damage to front or rear
Moderate damage to laterally
Rotational or rollover
Patient with altered mental status
Ejection

9. Concerns with MVC’s Speed Safety equipment
Seat belts
SRS systems
Did safety systems deploy or were they used.

10. Falls How far did they fall?
15 feet or 3 x persons height considered significant
What part of body impacted ground? (head vs feet)
What was ground surface? (cement, grass)

11. Penetrating Trauma Low velocity/ knife or ice pick
Medium / High velocity
Hand gun
Rifle
Shot gun
Military weapons
Try to get as much info as possible about weapon for hospital.

12. Blast Injuries Primary blast injuries – pressure wave from blast
Disruption of blood vessels
Rupture of major organs (especially hollow organs)
Secondary blast injuries – injuries caused by being struck by flying debris
Tertiary blast injuries – occurs when persons body is thrown back
Miscellaneous injuries – burns, inhalation injuries

13. Multisystem Trauma Injuries to head Bleeding or bruising to the brain
Swelling in the brain causes pressure against skull
All signs may not be evident early in assessment conditions may deteriorate with time
Frequent reassessment is crucial

14. Multisystem Trauma Injuries to neck and throat
Life threatening injuries possible
Trachea
Major blood vessels
Cervical spine

15. Multisystem Trauma Injuries to chest Lungs Pneumothorax
Tension Pneumothorax
Heart
Contusion
Tamponade
Great Vessels
Rib Fractures

16. Multisystem Trauma Abdomen Solid organs
Liver, Spleen, Pancreas, Kidneys
Hollow Organs
Stomach, Large and Small intestine, urinary bladder
Organs very vascular risk for internal bleeding high

17. Main Priorities of Trauma Care
Scene Safety/ appropriate resources
MOI / high degree of suspicion
Identify and manage life threats
Try to limit on scene time to 10 minutes “the platinum 10 minutes”
Give receiving facility a “heads up”
Transport considerations (ground vs air)
Secondary assessment and non life threatening treatments enroute
Reassess every 5 min

18. SHOCK
Shock (hypoperfusion) means a state of collapse and failure of the cardiovascular system.
In the early stages, the body attempts to maintain homeostasis.
As shock progresses, blood circulation slows and eventually ceases.

19. Shock
As an EMT, you cannot go wrong assuming that every patient is in shock or may go into shock.
Shock can occur because of medical or traumatic events.
Heart attack
Severe allergic reaction
Automobile crash
Gunshot wound

20. Shock
Shock refers to a state of collapse and failure of the cardiovascular system that leads to inadequate circulation.
Shock is an unseen life threat caused by a medical disorder or traumatic injury.
If the symptoms of shock are not promptly addressed, the patient will soon die.

21. Cardiovascular System
Cardiovascular system has three parts:
Pump (heart)
Set of pipes (blood vessels and arteries)
Contents (the blood)

22. Causes of Shock

23. Cardiogenic Shock Caused by inadequate function of the heart
A major effect is the backup of blood into the lungs.
Resulting buildup of pulmonary fluid is called pulmonary edema
Edema is the presence of abnormally large amounts of fluid between cells in body tissues, causing swelling.

24. Obstructive Shock
Obstructive shock occurs when conditions that cause mechanical obstruction of the cardiac muscle also affect the pump function
Common examples include cardiac tamponade and tension pneumothorax.
Tension pneumothorax
Caused by damage to lung tissue
The air normally held within the lung escapes into the chest cavity.
This air applies pressure to the organs, including the heart.

25. Distributive Shock
Results from widespread dilation of small arterioles, venules, or both
The circulating blood volume pools in the expanded vascular beds.
Tissue perfusion decreases.
Septic shock
Occurs as a result of severe infections in which toxins are generated by bacteria or by infected body tissues
Toxins damage vessel walls, causing increased cellular permeability.
Vessel walls leak and are unable to contract well.

26. Distributive Shock Neurogenic shock
Usually a result of injury to the part of the nervous system that controls the size and muscle tone of the blood vessels
Causes include damage to the spinal cord, brain conditions, tumors, pressure on the spinal cord, and spina bifida.
Muscles in the blood vessel walls are cut off from nerve impulses that cause them to contract.

27. Distributive Shock Anaphylactic shock
Occurs when a person reacts violently to a substance to which he or she has been sensitized
Sensitization means becoming sensitive to a substance that did not initially cause a reaction.
Each subsequent exposure tends to produce a more severe reaction.

28. Distributive Shock

29. Distributive Shock Psychogenic shock
Caused by a sudden reaction of the nervous system
Produces temporary vascular dilation
Results in fainting (syncope)
Serious causes include irregular heartbeat and brain aneurysm.

30. Hypovolemic Shock
Result of an inadequate amount of fluid or volume in the system
Hemorrhagic causes and non-hemorrhagic causes
Loss of 20% of circulating blood volume is considered severe.
Occurs with severe thermal burns
Intravascular plasma is lost.
Dehydration, the loss of water or fluid from body tissues, can cause or aggravate shock.
Fluid loss may be a result of severe vomiting and/or diarrhea.

31. Progression of Shock Three stages in the progression of shock:
Compensated shock: early stage when the body can still compensate for blood loss
Decompensated shock: late stage when blood pressure falls
Irreversible shock: terminal stage when transfusion is not enough to save patient

32. Progression of Shock Use caution when caring for elderly patients.
Treating a pediatric or geriatric patient in shock is no different than treating other shock patients.
Expect shock in many emergency medical situations.
Also expect shock if a patient has any one of the following conditions:
Multiple severe fractures, abdominal or chest injury, spinal injury, severe infection, major heart attack or anaphylaxis

33. Summary of Shock
Perfusion requires an intact cardiovascular system and a functioning respiratory system.
Most types of shock are caused by dysfunction in the heart, blood vessels, or volume of blood.
Shock is the collapse and failure of the cardiovascular system, when blood circulation slows and eventually stops.
Blood is the vehicle for carrying oxygen and nutrients through the vessels to the capillary beds to tissue cells, where these supplies are exchanged for waste products.

34. Summary of Shock
Blood contains red blood cells, white blood cells, platelets, and a liquid called plasma.
The systolic pressure is the peak arterial pressure.
The diastolic pressure is the pressure maintained within the arteries while the heart rests between heartbeats.
Remember, by the time a drop in blood pressure is detected, shock is usually in an advanced stage.
Treating a pediatric or geriatric patient in shock is no different than treating any other shock patient.