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

Head on

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

Donor Cycles

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

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