Presentation on theme: "Trauma Comprehensive Review. Time vs. Survival Relationship of time to survival The “golden hour” Importance of an organized approach to trauma."— Presentation transcript:
Trauma Comprehensive Review
Time vs. Survival Relationship of time to survival The “golden hour” Importance of an organized approach to trauma
Scene Size-up Body substance isolation review Scene safety Total number of patients Essential equipment and resources needed on-scene Mechanisms of injury
It is important to be aware of mechanisms of injury because…
Basic Mechanisms of Motion Injury Blunt injuries Rapid forward deceleration (collisions) Rapid vertical deceleration (falls) Energy transfer from blunt objects (bat, stick) Penetrating injuries Projectiles Knives Falls upon fixed objects
Clues to Injury Motor Vehicle Collision Vehicle damage What forces were involved in the collision? Intrusion > 12 in occupant compartment Intrusion > 18 in anywhere else Damage to interior structures What did the patient hit? Injury patterns on the patient What anatomic areas were hit?
Newtons Law Says what……….? Link
3 “Impacts” in each Accident 1. Car vs Slower or stopped object 2. Person vs Car (e.g wheel) 3. Organs vs Boney cage (e.g brain vs inside of cranium)
History taking Scene survey (use your knowledge of trauma kinetics to extract information from the scene) Ask bystanders what they saw, heard and their initial assessment Ask first responders their initial impressions Ask patient some questions? Keep in mind what the trauma team wants to know. 4 main questions 1 2 3 4 Time frame – actual vs perceived History taking and “recreation” of the crash is the only thing that separates the real medic from the layperson who looks at the destruction and crash scene What also does it do re: patient injuries and expectations?
Rapid forward deceleration Rapid vertical deceleration Energy transfer from blunt instruments
ITLS See table 1-3 Mechanism of injury and potential injury patterns Read Chapter 1
Different Kinds of MVC’s Fontal (head on) T boned 0 side impact Rollover Rear ended
Patient Trapped “down and under” Forces on upper legs to force them under the dashboard Specific injuries occur
Head on Crash Link
Lateral-impact Collision- T bone Machine collision Body collision Organ collision Courtesy of Bonnie Meneely, EMT-P
Rear-impact Collision Machine collision Body collision Organ collision Courtesy of Bonnie Meneely, EMT-P
Occupant Restraint Systems Lap belts Cross-chest lap belt Air bags Passive restraint system. No hazardous materials are released. Always “lift and look” under the air bag. Deformity of wheel suggests impact.
Small Vehicle Crashes Motorcycles Mopeds E Bikes All-terrain vehicles Personal watercraft Snowmobiles
Car Vs Pedestrian
Pedestrian Injuries Patient sustains high-energy transfer. Even with low- speed collision Patient may have “second impact” injuries. Courtesy of Bonnie Meneely, EMT-P
Helmet Ensure you review helmet removal technique Look at it carefully Inspect for damage Bring to ER with you Helmet tells a story too!
Patients may not look as injured
Explosions Need to know the force involved Patient thrown? How far? Contact surface? Heat or fire involved? Assume trauma and full c- spine support Hazmat? Three phases…
Blast Injuries Scene Size-up Scene safety! May involve multiple patients Mechanism Primary Secondary Tertiary Courtesy of Bonnie Meneely, EMT-P
FALLS Injuries depend upon 3 factors: Distance of fall Elderly may fracture hip from “trivial” fall. Anatomic area impacted Patients landing on their feet may have injury to knees, hips, or lumbar spine. Patients landing on their heads may have cervical spine injury. Surface hit
Forcesin falls Something called Axial loading Along the long axis of the body
Case Study Classic 21 yr old dating A 14 year old. Parents Come home and “Don” jumps out 3 rd story balcony! Fractures ankles and wrist ? Lumbar #
Tractor Accidents Rear overturns (15%) More likely to crush the driver Side overturns (85%) Mechanism Crush injuries Thermal & chemical burns sy of Roy Alson, M.D. Courtesy of Roy Alson, M.D.
Penetrating Injuries Knives & Other Objects Severity depends upon: Site Length of object Angle of penetration Below 4th intercostal space may involve chest and abdomen. Do not remove impaled object. Courtesy of Bonnie Meneely, EMT-P
Penetrating Injuries Gunshot Wounds Remember scene safety! Severity depends upon: Anatomic area struck & tissue density Missile velocity & size Type of bullet (hollow point, shot shell, jacketed) Preserve evidence if possible. Courtesy of Bonnie Meneely, EMT-P
Collision Summary Note type of collision. Note evidence of high-energy transfer. Maintain high index of suspicion. Keep scene time to a minimum. Relay observations to receiving physician.
More to come Ensure you do the readings of ITLS and Bledsoe for trauma Tomorrow TTG