Presentation on theme: "Trauma Overview: The Trauma Patient and the Trauma System"— Presentation transcript:
1 Trauma Overview: The Trauma Patient and the Trauma System Chapter 27
2 Objectives Discuss Kinetics of Trauma Discuss Mechanism of Injury Discuss the Multi-system Trauma PatientDiscuss The Golden PeriodDiscuss the Trauma SystemDiscuss Special Considerations in Trauma Care
3 The Kinetics of Trauma – Mass and Velocity Mechanism of Injury (MOI)- How a person was injuredKinetics of Trauma – Science of analyzing mechanisms of injuryKinetic Energy – Energy contained in a moving bodyDirectly proportional to massDirectly proportional to the square of velocityDuring scene size-up, get the best estimate of the speed of the vehicle or vehicles at the time of the collisionKinetic energy of two moving bodies that collide will be combined
4 Acceleration and Deceleration The motion of an object will not change unless force acts upon itAcceleration – An increase in speedDeceleration – A decrease in speedFaster acceleration or deceleration results in greater force on the human body
5 Kinetics of Trauma Energy Changes Form and Direction If energy is transmitted to a body in a straight line, injure may not occurIf energy is interrupted, injury can occurMay be interrupted by a curve of boneby an organ between a hard surfaceby tissue pulled against a fixed point
6 Kinetics of Trauma Impacts Types of ImpactsVehicle collision – Vehicle suddenly stops and gets bent out of shapeBody collision – Patient comes to a quick stop on some part or parts of the insideOrgan collision – Internal organs come to a quick stopInvestigating kineticsPerson in or on a moving vehicle gets thrown has a much greater chance of injury than one who is restrained or remains within the vehicleThe faster a vehicle is travelling, the greater the kinetic energey, greater the force, and greater the potential for injury
7 Mechanism of Injury Vehicle Collisions Situations that should have a high index of suspicion:Death of another occupantUnresponsive patient or patient with an altered mental statusIntrusion of greater than 12” for the occupant side or greater than 18” anywhere on the vehicleEjection
8 Mechanism of Injury Vehicle Collisions Classification of collisionsFrontal ImpactRear-end impactLateral impactRotational/rolloverVehicle-pedestrianRestraintsConsiderations for infants and childrenMotorcycle collisions
9 Frontal Impact Frontal impact Abdomen, Chest, Face, Head, and neckIn a frontal collision, the occupant continues to move forward at the same speed the vehicle was moving.The up-and-over pathway causes impact to the head, neck, chest, and abdomen.
10 Frontal ImpactThe down-and-under pathway causes impact to the knees, femurs, hips, acetabulum, and spine.Examples of mechanisms of injury associated with frontal impact.
12 Rear-end impact Injuries to suspect: Head or Neck (a) In a rear impact with an unrestrained occupant, initial movement is backward, causing potential neck injury(b) The occupant then moves forward, causing impact to the head and chest
13 Lateral impact Injuries to suspect: Lateral impact causes impact to the head, shoulder, lateral chest, lateral abdomen, lateral pelvis, and femur.
14 Rotational or Rollover crash In a rollover of an unrestrained occupant, impact to the body is difficult to predict and commonly results in multiple system injuryEjection is commonCrushinginjuries
17 Considerations for infants and children Any parts of the body that are not restrained continue to move forwardChildren should always be restrained in the back seat to avoid injury from air bag deployment
19 Mechanism of Injury Falls Severity factorsDistanceSurfaceBody part impacted firstObjects that interrupt the fall
20 Mechanism of Injury Falls Feet-first fallsFractures of the heels and fractures/dislocations of the ankles are commonSpine will absorb the force at every curve of the lumbarFalls more than 20 ‘ the internal organs are likely to be injured from deceleration forcesA fracture of the wrist is commonIf the body is thrown backward, the most common injuries are head, back, and pelvis
21 Mechanism of Injury Falls Head-first fallsInjury begins with the arms and extends up to the shouldersThe head may be forcibly hyperextended, hyperflexed, or compressedExtensive damage to the cervical spine can occurChest, lower spine, and pelvis injuries are common
22 Mechanism of Injury Penetrating injuries The severity of injury caused by penetrating trauma is related to the velocity of the penetrating object.Low-velocity injuriesAn object impaled exerts damage to the immediate area of the impact and its underlying structuresThe length of the object used provides valuable clues about the injury
23 Mechanism of Injury Penetrating injuries Medium-and-high velocity injuriesTrajectory - the path or motion of a projectile during its travelDissipation of energy is the way energy is transferred to the human body from the force acting upon it;DragProfileCavitationFragmentation
24 Fatal wounds – 90% involves the head, thorax, and abdomen Wounds also occur to the neck and extremitiesHead;Projectile entering the skull causes brain tissue to be compressedProjectile entering the face threatens the airwayChestPneumothorax is commonOuter covering of the heart may be able to seal itself from low-velocity, high-velocity causes significant woundsSuspect both thorax and abdominal injuries if entrance wound between nipple and waistAbdomenOften secondarily injured when chest involvedMajority are not rapidly fatal but needs surgeryExtremitiesBone injury becomes bony fragments turning into secondary missilesMuscle expands, resulting in capillary tears and swellingVessels can be severed, ripped, buckled, and/or obstructedGunshot woundsA wound resulting from close-range shotgun blast. Note the tattooing of the skin from the gunpowder.
25 Mechanism of Injuries Blast injuries Primary phase injuries are due to the pressure wave of the blastSecondary phase are due to flying debris propelled by the force of the blastTertiary phase injuries occur when the patient is thrown away from the source of the blast
26 Blast injuries can cause injury with the initial blast, when the patient is struck by debris, or by the patient being thrown from the site of the blast.Blast injuries can cause injury with the initial blast, when the patient is struck by debris, or by the patient being thrown from the site of the blast
27 Blast injuries can cause injury with the initial blast, when the patient is struck by debris, or by the patient being thrown from the site of the blast.Blast injuries can cause injury with the initial blast, when the patient is struck by debris, or by the patient being thrown from the site of the blast
28 The Multisystem Trauma Patient Has multiple injuries or involvement of more than one body systemMultiple organ injuries also are considered to by multisystem traumaMultisystem trauma carries a high incidence of morbidity and mortality
29 The Golden PeriodRelates to the time during which a patient needs intervention in order to surviveLength of time indicated by the “golden period” depends on the patient injuryEMT’s must assess, treat, and transport the injured patient as quickly as possible
30 The Golden PeriodThe “platinum ten minutes” is the maximum time the EMS team should devote to on-scene activities with patient assessment, emergency care for life threats, and preparation for transportIf a patient is not severely injured, more time can be devoted to completing normal on-scene assessment and emergency care before transport
31 The Trauma SystemDesigned to provide immediate surgical intervention for patients with internal traumaRequires significant resources and is expensive to maintainCommon designation of trauma centers;Level 1 – Regional Trauma CenterLevel II – Area Trauma CenterLevel III – Community Trauma CenterLevel IV – Trauma FacilityCrucial that EMS personnel triage patients accurately for transport to the appropriate trauma center
32 Special Considerations in Trauma Care Principles of out-of-hospital trauma care;Ensure at all times the safety of EMS personnel, patients, and bystandersQuickly determine need for additional resourcesDetermine the MOI and kinematics involvedProvide a primary assessmentEstablish and maintain spinal stabilizationEstablish and maintain airwayEstablish and maintain adequate oxygenationProvide ventilation
33 Special Considerations in Trauma Care Principles of out-of-hospital trauma care;Control external hemorrhage with direct pressureTreat for shockConsider application of PASG (Whatcom Co Protocol Page 17)Maintain manual spinal stabilization until patient is immobilized on backboardTransport critically injured or multisystem trauma patients with 10 minutesObtain a history from patient, relatives, bystandersPerform secondary assessment
34 Special Considerations in Trauma Care Your personal safety is of utmost importanceAirway management, adequate ventilation, and oxygenation are key elementsStop significant bleedingAssessment of trauma patient is conducted in a sequence that promotes a rapid systemic approachRapid transport is essentialA backboard can secure suspected fractures in an unstable patient who requires rapid transportDo not develop tunnel vision and become focused on dramatic injuries or dramatic patients