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Kinematics of Trauma Kimberly Ann Holmes Kenney RN, CNS-Rx, MS(N), MS CCRN, CEN, CFRN, NREMT-P.

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Presentation on theme: "Kinematics of Trauma Kimberly Ann Holmes Kenney RN, CNS-Rx, MS(N), MS CCRN, CEN, CFRN, NREMT-P."— Presentation transcript:

1 Kinematics of Trauma Kimberly Ann Holmes Kenney RN, CNS-Rx, MS(N), MS CCRN, CEN, CFRN, NREMT-P

2 Objectives 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. 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.

3 mv 2 2 mass (weight) x velocity (speed) 2 2 Kinetic Energy or Kinetic energy is the energy of motion. KE =

4 Example of Kinetic Energy The KE of a 150-lb. person traveling at 30 mph would be: = 67,500 KE units 150 x 30 x 30 2

5 150 lb. person traveling at 30 mph = 67,500 KE units 180 lb. person traveling at 30 mph = 81,000 KE units 150 lb. person traveling at 40 mph = 120,000 KE units 150 lb. person traveling at 30 mph = 67,500 KE units 180 lb. person traveling at 30 mph = 81,000 KE units 150 lb. person traveling at 40 mph = 120,000 KE units Velocity vs. Mass What is more important: velocity or mass?

6 Velocity

7 A body at rest will stay at rest. A body in motion will remain in motion. Unless what? A body at rest will stay at rest. A body in motion will remain in motion. Unless what? Newtons First Law of Motion

8 Car strikes pole. Driver continues moving forward. Anterior surface of body strikes steering wheel. Posterior body continues moving forward. Organs compressed within body. Car strikes pole. Driver continues moving forward. Anterior surface of body strikes steering wheel. Posterior body continues moving forward. Organs compressed within body. Newtons First Law and Blunt Trauma

9 0 But, energy can change forms and can be transferred. Energy cannot be created. Energy cannot be destroyed. Energy cannot be created. Energy cannot be destroyed. Law of Conservation of Energy Can you give an example?

10 How does the Law of Conservation of Energy pertain to trauma? Can you give some examples?

11 Compression Injury Deceleration and Acceleration

12 Shear Injury Deceleration and Acceleration

13 Organ Injury In a 50 mph MVC, what types injuries would occur if the patient were to strike the windshield?

14 Head Injury Fractures. Ligamentous injuries. Soft tissue injury. Brain injury. Cord damage. Fractures. Ligamentous injuries. Soft tissue injury. Brain injury. Cord damage.

15 Torso Injury Rib fractures. Heart & lung damage. Abdominal organ damage. Major vessel damage. Rib fractures. Heart & lung damage. Abdominal organ damage. Major vessel damage.

16 Extremity Injury Fractures. Ligamentous injury. Soft tissue injury. Fractures. Ligamentous injury. Soft tissue injury.

17 Frontal impact. Lateral impact. Rotational impact. Rear impact. Rollover. Frontal impact. Lateral impact. Rotational impact. Rear impact. Rollover. Types of Motor Vehicle Collisions

18 What type of injury patterns might you see in a frontal impact?

19 Frontal Impact - Occupant Pathways What injuries would you expect with an up and over pathway?

20 Injuries with Up & Over Pathway Head injuries. Spine injuries. Chest injuries. 4 Fractures. 4 Pneumothorax. 4 Hemothorax. 4 Contusions. 4 Great vessel injury. Head injuries. Spine injuries. Chest injuries. 4 Fractures. 4 Pneumothorax. 4 Hemothorax. 4 Contusions. 4 Great vessel injury. continued...

21 Abdominal injuries. 4 Solid organs. 4 Hollow organs. 4 Diaphragm. Fractured pelvis. Abdominal injuries. 4 Solid organs. 4 Hollow organs. 4 Diaphragm. Fractured pelvis. Injuries with Up & Over Pathway continued...

22 Frontal Impact - Occupant Pathways What injuries would you expect with a down and under pathway?

23 Injuries with Down & Under Pathway Posterior knee/hip dislocations. Femur fractures. Lower extremity fractures. Pelvic/acetabular fractures. Posterior knee/hip dislocations. Femur fractures. Lower extremity fractures. Pelvic/acetabular fractures.

24 Rear Impact What types of injuries would you expect?

25 Lateral Impact What types of injuries would you expect?

26 Body Motion during Lateral Impacts Neck Chest Pelvis Neck Chest Pelvis

27 Rotational Impact What types of injuries would you expect?

28 Rollover What injury patterns might you see following this collision?

29 Properly positioned lap restraint. Improperly positioned lap restraint. Properly positioned lap restraint. Improperly positioned lap restraint. Lap Restraint Device What types of injuries should you anticipate?

30 Lap & Shoulder Restraint System What types of injuries should you anticipate? Shoulder harness only; lap belt not used. (Victim moves down and under). Lap restraint only; shoulder harness not used. (Victim moves up and over) Shoulder harness only; lap belt not used. (Victim moves down and under). Lap restraint only; shoulder harness not used. (Victim moves up and over)

31 What types of injuries would you expect to see? What injuries would occur in a second collision? What types of injuries would you expect to see? What injuries would occur in a second collision? Airbag Deployment

32 What concerns would you have about a: 4 Small patient? 4 Child in a car seat? What concerns would you have about a: 4 Small patient? 4 Child in a car seat? Airbag Deployment

33 Motorcycle Collisions Mandatory helmet laws have been associated with up to 300% fewer head injuries and deaths.

34 Types of Impact: Frontal/Ejection How many impacts did this collision involve? What types of injuries would you expect to see? How many impacts did this collision involve? What types of injuries would you expect to see?

35 Types of Impact: Lateral How many impacts did this collision involve? What types of injuries would you expect to see?

36 Pedestrian vs. Motor Vehicle How would the injury patterns differ between the adult and the child?

37 Falls Impact surface. (Harder surface = greater injury.) Height. (Greater height = greater injury.) Falls from a distance of more than three times the patients height produce critical injuries. Impact surface. (Harder surface = greater injury.) Height. (Greater height = greater injury.) Falls from a distance of more than three times the patients height produce critical injuries.

38 Falls Deceleration injuries. 4 Liver. 4 Aorta. 4 Spleen. 4 Kidney. Deceleration injuries. 4 Liver. 4 Aorta. 4 Spleen. 4 Kidney.

39 Landing Feet First (Don Juan Syndrome) Injuries seen in patients landing feet first: 4 Bilateral heel fractures. 4 Ankle fractures. 4 Distal tibia/fibula fractures. 4 Knee dislocations. 4 Femur fractures. 4 Hip injuries. 4 Spine compression fractures. Injuries seen in patients landing feet first: 4 Bilateral heel fractures. 4 Ankle fractures. 4 Distal tibia/fibula fractures. 4 Knee dislocations. 4 Femur fractures. 4 Hip injuries. 4 Spine compression fractures.

40 Landing Arms/Hands First Physical findings: 4 Colles fractures of wrists. 4 Shoulder dislocations. 4 Fractures of the clavicles. Physical findings: 4 Colles fractures of wrists. 4 Shoulder dislocations. 4 Fractures of the clavicles.

41 Landing Head-First Physical findings: 4 C-spine injuries. 4 Facial injuries. 4 CNS damage. Physical findings: 4 C-spine injuries. 4 Facial injuries. 4 CNS damage.

42 Acceleration Deceleration Hyperextension Hyperflexion Twisting Falling Acceleration Deceleration Hyperextension Hyperflexion Twisting Falling Sports & Recreational Activity Mechanisms What types of sporting or recreational injuries are common to your area?

43 Kinematics & forces involved. Equipment contributing to injury. Involvement of protective equipment. Nature of the sport. Kinematics & forces involved. Equipment contributing to injury. Involvement of protective equipment. Nature of the sport. Predicting Sports-Related Injuries

44 Blast Injuries Warfare. Civilian areas. 4 Mines. 4 Shipyards. 4 Chemical plants. 4 Tank trucks. 4 Refineries. 4 Fireworks firms. 4 Silos. 4 LP gas tanks. Warfare. Civilian areas. 4 Mines. 4 Shipyards. 4 Chemical plants. 4 Tank trucks. 4 Refineries. 4 Fireworks firms. 4 Silos. 4 LP gas tanks. Do you have any of these in your area?

45 Blast-Related Injuries Three mechanisms of injury: 4 Primary. 4 Secondary. 4 Tertiary. Three mechanisms of injury: 4 Primary. 4 Secondary. 4 Tertiary.

46 Primary Phase Injuries Cause: pressure wave from blast. Affected area: gas-containing organs. Injuries: 4 Pulmonary bleeding. 4 Pneumothorax. 4 Air emboli. 4 Perforation of the GI tract. 4 Burns. Death may occur in absence of outward signs. Cause: pressure wave from blast. Affected area: gas-containing organs. Injuries: 4 Pulmonary bleeding. 4 Pneumothorax. 4 Air emboli. 4 Perforation of the GI tract. 4 Burns. Death may occur in absence of outward signs.

47 Secondary Phase Injuries Cause: flying debris. Affected area: 4 Body surface. 4 Skeletal system. Injuries: 4 Lacerations. 4 Fractures. 4 Burns. Cause: flying debris. Affected area: 4 Body surface. 4 Skeletal system. Injuries: 4 Lacerations. 4 Fractures. 4 Burns.

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

49 Physics. Weapon velocity. Bullet design. Physics. Weapon velocity. Bullet design. Penetrating Trauma

50 Newtons First Law and ballistics: 4 Bullet in brass cartridge is at rest. 4 Bullet propelled by rapid combustion of powder. 4 Bullet leaves barrel of gun. 4 Bullet strikes a body. 4 Bullet transfers energy to victim. Newtons First Law and ballistics: 4 Bullet in brass cartridge is at rest. 4 Bullet propelled by rapid combustion of powder. 4 Bullet leaves barrel of gun. 4 Bullet strikes a body. 4 Bullet transfers energy to victim.

51 Low-Energy Injuries Low velocity. Usually hand-driven weapons. Less secondary trauma. Multiple wounds from a single weapon. Low velocity. Usually hand-driven weapons. Less secondary trauma. Multiple wounds from a single weapon.

52 Low-Energy Penetrating Wounds How does the length of the weapon relate to the cone of damage?

53 Type of weapon involved. Path of weapon. Depth of penetration. Number of wounds. Underlying anatomy. Type of weapon involved. Path of weapon. Depth of penetration. Number of wounds. Underlying anatomy. Assessment of Low-Energy Injuries

54 Medium-Energy Penetrating Injuries

55 High-Energy Penetrating Injuries How do these weapons differ from handguns and shotguns? How do the wounds differ internally and externally?

56 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. 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. Projectile - Frontal Area

57 Gunshot Wounds - Cavitation Reformation by elastic tissue Temporary cavity Compression and crush Permanent cavity Direction of travelBullet

58 Gunshot Wounds Describe the difference between entrance and exit wounds. Describe the difference between entrance and exit wounds.

59 Tumbling Projectiles Some projectiles are designed to tumble. Tumbling creates greater tissue damage and more tissue destruction. Some projectiles are designed to tumble. Tumbling creates greater tissue damage and more tissue destruction.

60 Fragmentation The shotgun round is the ultimate in fragmentation.

61 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. 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. Considerations for Penetrating Trauma

62 Kinematics Summary The cornerstone of assessment is early consideration of kinematics to predict hidden injury.


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