Presentation on theme: "Kinematics of Trauma Kimberly Ann Holmes Kenney RN, CNS-Rx, MS(N), MS"— Presentation transcript:
1Kinematics of Trauma Kimberly Ann Holmes Kenney RN, CNS-Rx, MS(N), MS CCRN, CEN, CFRN, NREMT-P
2Objectives Discuss the laws of energy and motion. Discuss trauma associated with blunt impact and penetrating injury.Overview of the effects of energy distribution in MVCs.Review the kinematics of blast and violent injuries.Use kinematics to predict injury patterns.
3Kinetic Energy KE = or KE = Kinetic energy is the energy of motion. mass (weight) x velocity (speed)22KE =ormv22KE =Kinetic energy is the energy of motion.
4Example of Kinetic Energy The KE of a 150-lb. person traveling at 30 mph would be:= 67,500 KE units150 x 30 x 302
5Velocity vs. Mass What is more important: velocity or mass? 150 lb. person traveling at 30 mph = 67,500 KE units180 lb. person traveling at 30 mph = 81,000 KE units150 lb. person traveling at 40 mph = 120,000 KE unitsWhat is more important: velocity or mass?
7Newton’s First Law of Motion A body at rest will stay at rest.A body in motion will remain in motion.Unless what?
8Newton’s First Law and Blunt Trauma Car strikes pole.Driver continues moving forward.Anterior surface of body strikes steering wheel.Posterior body continues moving forward.Organs compressed within body.
9Law of Conservation of Energy Energy cannot be created.Energy cannot be destroyed.But, energy can change forms and can be transferred.Can you give an example?
10How does the Law of Conservation of Energy pertain to trauma? Can you give some examples?
11Deceleration and Acceleration Compression Injury
17Types of Motor Vehicle Collisions Frontal impact.Lateral impact.Rotational impact.Rear impact.Rollover.
18What type of injury patterns might you see in a frontal impact?
19Frontal Impact - Occupant Pathways What injuries would you expect with an up and over pathway?
20Injuries with Up & Over Pathway continued...Head injuries.Spine injuries.Chest injuries.Fractures.Pneumothorax.Hemothorax.Contusions.Great vessel injury.
21Injuries with Up & Over Pathway continued...Abdominal injuries.Solid organs.Hollow organs.Diaphragm.Fractured pelvis.
22Frontal Impact - Occupant Pathways What injuries would you expect with a down and under pathway?
23Injuries with Down & Under Pathway Posterior knee/hip dislocations.Femur fractures.Lower extremity fractures.Pelvic/acetabular fractures.
24What types of injuries would you expect? Rear ImpactWhat types of injuries would you expect?
25What types of injuries would you expect? Lateral ImpactWhat types of injuries would you expect?
26Body Motion during Lateral Impacts NeckChestPelvis
27What types of injuries would you expect? Rotational ImpactWhat types of injuries would you expect?
28RolloverWhat injury patterns might you see following this collision?
29Lap Restraint Device Properly positioned lap restraint. Improperly positioned lap restraint.What types of injuries should you anticipate?
30Lap & Shoulder Restraint System Shoulder harness only; lap belt not used. (Victim moves down and under).Lap restraint only; shoulder harness not used. (Victim moves up and over)What types of injuries should you anticipate?
31Airbag Deployment What types of injuries would you expect to see? What injuries would occur in a second collision?
32Airbag Deployment What concerns would you have about a: Small patient? Child in a car seat?
33Motorcycle Collisions Mandatory helmet laws have been associated with up to 300% fewer head injuries and deaths.
34Types of Impact: Frontal/Ejection How many impacts did this collision involve?What types of injuries would you expect to see?
35Types of Impact: Lateral How many impacts did this collision involve? What types of injuries would you expect to see?
36Pedestrian vs. Motor Vehicle How would the injury patterns differ between the adult and the child?
37Falls Impact surface. Height. (Harder surface = greater injury.)Height.(Greater height = greater injury.)Falls from a distance of more than three times the patient’s height produce critical injuries.
42Sports & Recreational Activity Mechanisms AccelerationDecelerationHyperextensionHyperflexionTwistingFallingWhat types of sporting or recreational injuries are common to your area?
43Predicting Sports-Related Injuries Kinematics & forces involved.Equipment contributing to injury.Involvement of protective equipment.Nature of the sport.
44Blast Injuries Warfare. Civilian areas. Mines. Shipyards. Chemical plants.Tank trucks.Refineries.Fireworks firms.Silos.LP gas tanks.Do you have any of these in your area?
45Blast-Related Injuries Three mechanisms of injury:Primary.Secondary.Tertiary.
46Primary Phase Injuries Cause: pressure wave from blast.Affected area: gas-containing organs.Injuries:Pulmonary bleeding.Pneumothorax.Air emboli.Perforation of the GI tract.Burns.Death may occur in absence of outward signs.
50Penetrating Trauma Newton’s First Law and ballistics: Bullet in brass cartridge is at rest.Bullet propelled by rapid combustion of powder.Bullet leaves barrel of gun.Bullet strikes a body.Bullet transfers energy to victim.
51Low-Energy Injuries Low velocity. Usually hand-driven weapons. Less secondary trauma.Multiple wounds from a single weapon.
52Low-Energy Penetrating Wounds How does the length of the weapon relate to the cone of damage?
53Assessment of Low-Energy Injuries Type of weapon involved.Path of weapon.Depth of penetration.Number of wounds.Underlying anatomy.
55High-Energy Penetrating Injuries How do these weapons differ from handguns and shotguns?How do the wounds differ internally and externally?
56Projectile - Frontal Area 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.
57Gunshot Wounds - Cavitation Reformation by elastic tissueTemporarycavityDirection of travelBulletPermanentcavityCompressionand crush
58Gunshot Wounds Describe the difference between entrance and exit wounds.
59Tumbling Projectiles Some projectiles are designed to tumble. Tumbling creates greater tissue damage and more tissue destruction.
60FragmentationThe shotgun round is the ultimate in fragmentation.
61Considerations for Penetrating Trauma Scene safety.Patient care is the priority!Weapon type.Range at which weapon was fired.Number of entrance and exit wounds.Underlying anatomy and track.Crime scene preservation.
62Kinematics SummaryThe cornerstone of assessment is early consideration of kinematics to predict hidden injury.