ObjectivesObjectivesDiscuss how organ motion contributes to injury in each Discuss how organ motion contributes to injury in each body regionbody region
Identify injury patterns associated with motorcycle and Identify injury patterns associated with motorcycle and allall--terrain vehicle collisionsterrain vehicle collisions
Chapter 20: Trauma Systems and Mechanism of Injurys
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ScenarioScenarioIt takes a while to find the patient in the It takes a while to find the patient in the woody location. He is a 40woody location. He is a 40--yearyear--old who was old who was shot in the abdomen. His skin is pale and wet, shot in the abdomen. His skin is pale and wet, and his clothes are saturated with blood. You and his clothes are saturated with blood. You administer oxygen, remove his clothing, and administer oxygen, remove his clothing, and load and go, starting two large bore IV lines load and go, starting two large bore IV lines en route. His vital signs are: BPen route. His vital signs are: BP--70 by 70 by palpation, Ppalpation, P--136/min, R136/min, R--28/min.28/min.
DiscussionDiscussionWhat is your first concern when responding to a What is your first concern when responding to a shooting?shooting?
Why should you try to find out what type of gun and Why should you try to find out what type of gun and ammunition were used?ammunition were used?
What clues can you look for to determine what distance What clues can you look for to determine what distance he was from the shooter?he was from the shooter?
How will you distinguish entrance from exit wounds?How will you distinguish entrance from exit wounds?
Level of care and hospital choice is based on:Level of care and hospital choice is based on:Patient needs and conditionPatient needs and conditionAdvice of medical directionAdvice of medical direction
Energy transfer from external source to human bodyEnergy transfer from external source to human body
Extent of injury determined by:Extent of injury determined by:Type of energy appliedType of energy appliedHow quickly it is appliedHow quickly it is appliedTo what part of the body it is appliedTo what part of the body it is applied
Consider:Consider:PatientPatient’’s ages ageProtective factorsProtective factorsMechanism of injuryMechanism of injuryForce of energy appliedForce of energy appliedAnatomyAnatomyEnergy Energy
Blunt TraumaBlunt TraumaInjury produced by compression and change of speedInjury produced by compression and change of speed
May disrupt tissueMay disrupt tissue
Direct compression or pressure on a structureDirect compression or pressure on a structureMost common type of force in blunt traumaMost common type of force in blunt trauma
Injury depends on:Injury depends on:Time of compressionTime of compressionForce of compressionForce of compressionArea compressedArea compressed
Three impacts as energy is transferredThree impacts as energy is transferredVehicle strikes objectVehicle strikes objectOccupant collides with inside of carOccupant collides with inside of carInternal organs collide inside bodyInternal organs collide inside body
Vehicle crash injuries depend on:Vehicle crash injuries depend on:Type of collisionType of collisionPosition of occupant Position of occupant Use or nonuse of restraint systemsUse or nonuse of restraint systems
Occupant goes downward Occupant goes downward into vehicle seat and into vehicle seat and forward into dashboard or forward into dashboard or steering columnsteering column
Knees strike dashboardKnees strike dashboardUpper legs absorb impactUpper legs absorb impact
Vehicle is struck from sideVehicle is struck from side
Injury patterns differ if vehicle:Injury patterns differ if vehicle:Remains in place Remains in place Moves away from point of impactMoves away from point of impact
Rollover AccidentsRollover AccidentsOccupant tumbles inside autoOccupant tumbles inside auto
Injured wherever body strikes vehicleInjured wherever body strikes vehicleImpacts at many different anglesImpacts at many different anglesMay be multipleMay be multiple--system injuriessystem injuries
Injuries difficult to predictInjuries difficult to predictMay produce any injury pattern seen in other types May produce any injury pattern seen in other types of collisionsof collisions
After impact organs continue to pull against After impact organs continue to pull against structures that attach them to the bodystructures that attach them to the body
Organs may separate from attachmentsOrgans may separate from attachmentsVascular pedicle or mesenteric attachment injury Vascular pedicle or mesenteric attachment injury may cause hemorrhagemay cause hemorrhage
Abdominal organs and Abdominal organs and retroperitoneal retroperitoneal structures (most structures (most commonly the kidneys) commonly the kidneys) may be affected by may be affected by deceleration forcesdeceleration forces
Head InjuriesHead InjuriesCompression to head may cause:Compression to head may cause:
Open fracturesOpen fracturesClosed fracturesClosed fracturesBone fragment penetration (depressed skull Bone fragment penetration (depressed skull fracture)fracture)
Associated injuriesAssociated injuriesBrain contusionBrain contusionLacerations of brain tissueLacerations of brain tissue
If facial structures are involved, soft tissue If facial structures are involved, soft tissue trauma and facial bone fractures may occurtrauma and facial bone fractures may occur
Consider CNS injury and cervical fractureConsider CNS injury and cervical fracture
Solid organ ruptureSolid organ ruptureVascular organ hemorrhageVascular organ hemorrhageHollow organ perforation into peritoneal cavityHollow organ perforation into peritoneal cavity
Common injuriesCommon injuriesLacerations to spleen, liver, and kidneyLacerations to spleen, liver, and kidneyRupture of a full bladderRupture of a full bladder
Injuries may include:Injuries may include:Head and neckHead and neckChest and abdomenChest and abdomenFemur, lower leg fracturesFemur, lower leg fracturesPerineal injuriesPerineal injuries
Rider caught between bike and another Rider caught between bike and another objectobject
Crush injuries to affected sideCrush injuries to affected sideOpen fractures of femur, tibia, fibulaOpen fractures of femur, tibia, fibulaFracture dislocation of malleolusFracture dislocation of malleolus
Personal Protective EquipmentPersonal Protective Equipment
Riders of small motor vehiclesRiders of small motor vehiclesBootsBootsLeather clothingLeather clothingEye protectionEye protectionHelmetsHelmets
•• Absorb energy, reduce head and facial injuriesAbsorb energy, reduce head and facial injuries•• Helmet nonHelmet non--use increases head injuries > 300%use increases head injuries > 300%
Impacts in autoImpacts in auto--pedestrian collisionspedestrian collisionsBumper of vehicle strikes bodyBumper of vehicle strikes bodyPedestrian strikes vehicle hoodPedestrian strikes vehicle hoodPedestrian strikes ground or another objectPedestrian strikes ground or another object
Predictable injuries depend on:Predictable injuries depend on:Age of pedestrianAge of pedestrianHeight of pedestrian relative to bumper and hood Height of pedestrian relative to bumper and hood of carof carVelocity of vehicleVelocity of vehicle
Factors that determine which of the two Factors that determine which of the two mechanisms of injury predominates:mechanisms of injury predominates:
Character of penetrating objectCharacter of penetrating objectSpeed of penetrationSpeed of penetrationType of tissue it passes through or intoType of tissue it passes through or into
Opening produced by a force pushing body Opening produced by a force pushing body tissues laterally away from tract of a projectiletissues laterally away from tract of a projectile
Cavitation related to:Cavitation related to:Tissue density Tissue density Ability of tissue to return to its original shape and Ability of tissue to return to its original shape and positionposition
BallisticsBallisticsProjectileProjectile’’s effect on body determined by s effect on body determined by energy created and dissipated by object into energy created and dissipated by object into surrounding tissuessurrounding tissues
Damage and energy levels of projectilesDamage and energy levels of projectilesLow, medium, and highLow, medium, and high
Stab WoundsStab WoundsAttempt to identify wounding objectAttempt to identify wounding object
Consider:Consider:Multiple woundsMultiple woundsEmbedded penetrating objectsEmbedded penetrating objectsDamage to organs of thorax and abdomenDamage to organs of thorax and abdomenPenetration of multiple body cavitiesPenetration of multiple body cavitiesStab wounds to back and flankStab wounds to back and flank——high riskhigh risk
Short range, low velocity Short range, low velocity
Tissue damage depends on:Tissue damage depends on:Gauge of gunGauge of gunSize of pelletsSize of pelletsPowder chargePowder chargeDistance from victimDistance from victim
May be abrasion rim or collarMay be abrasion rim or collar
If discharged at intermediate or close range:If discharged at intermediate or close range:Powder burns (tattooing) may be presentPowder burns (tattooing) may be present
Generally larger than entrance woundsGenerally larger than entrance wounds
Skin may Skin may ““explodeexplode””::Ragged and torn tissueRagged and torn tissueSplitting and tearing often produces a starSplitting and tearing often produces a star--burst or burst or stellate woundstellate wound
Severe injury to pulmonary and vascular Severe injury to pulmonary and vascular systems possiblesystems possible
Pneumothorax and tension pneumothorax Pneumothorax and tension pneumothorax Internal and external hemorrhageInternal and external hemorrhageThoracic trauma possible without visible chest Thoracic trauma possible without visible chest woundswounds
Surgery often needed to determine extent of Surgery often needed to determine extent of injuryinjury
May affect multiple organ systemsMay affect multiple organ systemsDamage to airDamage to air--filled and solid organsfilled and solid organsVascular injuryVascular injurySpinal column and spinal cord injurySpinal column and spinal cord injury
Gunshot wounds to extremities:Gunshot wounds to extremities:Occasionally life threateningOccasionally life threateningMay result in lifelong disabilityMay result in lifelong disability
