1. The Many Faces of Trauma

2. Today’s Discussion Kinematics of trauma
forces involved with the transfer of energy
kinematics of different types of trauma
Energy is neither created nor destroyed; however, it can be changed in form

3. Definitions Kinetic energy - the energy contained in a moving body
Kinetic energy is equal to mass multiplied by velocity squared divided by two
Therefore, of the two factors, which has the greater impact on amount of damage; mass or velocity?

4. The Rules of Kinematics
A body in motion or a body at rests tends to remain in that state until acted on by an outside force
This is the law of inertia
Force equals mass times deceleration (acceleration)
This means that the rate at which something speeds up or slows down also impacts the degree of damage done in an accident

5. Types of Impacts Primary Impact - (vehicular collision)
something the patient is in impacts an object
Secondary Impact - (body collision)
patient’s body strikes something in the vehicle
Tertiary Impact - (organ collision)
internal organ strikes a rigid object within the body

6. Blunt Trauma Vehicular Impact Pedestrian Impact Motorcycle Crashes
Assaults
Falls
Blasts

7. Types of Injury Categories
Compression
paper bag syndrome to lungs
Deceleration
renal pedicle, ligamentum teres, descending aorta stop while mobile organs continue forward movement
Restraint injury
occasional cardiac contusion, broken clavicle
patient would have died without the seatbelt

8. Frontal Impact Pattern
Down and under
fx/dis of knee/ankle
Femur fx
posterior dislocation of acetabulum
Up and over
head injury
chest injury

9. Rear Impact Most commonly occurs when vehicle is at a complete stop
Without proper headrest position, head does not accelerate with body
Frontal impact often occurs if car is in a line of vehicles

10. Other impacts Rollover Ejection
Patient can impact any part of vehicle
Best indicator is impact points found on skin
As a rule, more serious because of the multiple and violent motions involved
Ejection
Injuries from ejection may be greater than from ground impact
Likelihood of injury is increased by 300% over patient that is not ejected

11. Pedestrian Injuries Three phases of impact
Frontal vehicular bumper
Vehicular hood and windscreen
Ground
In pediatrics the pattern is different and depends on the size of the patient

12. Pedestrian Injury Triad

13. Motorcycle Collisions
Frontal impact
head and chest may impact handlebars
femurs hit handlebars
Lateral
crush injuries to extremities
ejection injuries from ground impact
Laying down the bike
causes rider to move slower than bike
avulsions, abrasions, burns

14. Falls and Blasts Blasts are caused by rapidly expanding gases
Primary injuries
direct injury to gas containing organs
Secondary injuries
flying debris
Tertiary injuries
individual becomes a missile and is thrown against solid objects

15. Cavitation Definition:
energy transfer which occurs when body tissue cells are placed in motion directly away from the site of impact by the energy exchange

16. Size of Cavitation Determined by: amount of energy exchanged
which is determined by number of tissue particles impacted
which is determined by the density of the tissue
Larger the surface area and denser the tissue, the more particles affected.
The reverse is also true

17. Penetrating Trauma
Factors affecting cavitation at the wound impact point
Shape of the missile
tumble and yaw
Fragmentation
Maximum velocity of a lead bullet is 2000 f/sec
Kinetic Energy = mass x velocity

18. Bullet Velocities Kinetic Energy = mass x velocity
High energy bullets may cavitate 30 times greater than the diameter of the missile

19. Entrance vs. Exit Entrance Exit
Only two sure signs, powder burns, or only one hole
Hints
round or oval wound
gases beneath skin (close range)
burns (weapon inches from skin)
stippling (weapon 4-6 inches from skin)
Exit
Usually stellate shape
No other distinguishing features

20. Trauma Assessment Starts with a Story

21. Final Thought Plan for the worst and you will never be surprised or
disappointed