Trauma and Shock

Trauma Leading cause of death for people under 40 Occurs as a result of physical forces applied to the body Blunt forces Penetrating forces

Mechanism of Injury The way in which forces act on the body to cause an injury Kinetic energy- the energy of a moving object, and is the relationship of mass (weight) and velocity (speed) Kinetic Energy = mass/2 x velocity2 If weight doubles energy doubles If speed doubles energy quadruples

Mechanism of Injury Knowledge of different types of MOIs allow us to predict injuries A high index of suspicion for multisystem trauma and unseen injuries in the following situations Falls from heights Motor vehicle and motorcycle crashes Car vs pedestrian / bicycle / motorcycle Gunshot wounds / stabbings

Blunt Trauma Vehicle collisions 3 impacts Vehicle strikes something Passenger impacts interior of vehicle Passengers organs impact solid structures in body

Vehicular Crashes Frontal Collisions Rear end Collisions Deceleration injuries Rear end Collisions Whiplash injuries Lateral Collisions (T Bone) Rollover Crashes Injuries unpredictable due to multiple impacts Restrained vs Unrestrained Partial or full ejection

Vehicular Crashes Car vs Pedestrian Car vs Bicycle Car vs Motorcycle Usually presents with graphic injuries but be alert for unseen injuries Car vs Bicycle Similar findings as pedestrian May be wearing a helmet Car vs Motorcycle Lay down vs impact with larger object Protective equipment (helmet, leather clothing)

Situations that Indicate Trauma Death of other vehicle occupant Severe damage to the vehicle Severe damage to front or rear Moderate damage to laterally Rotational or rollover Patient with altered mental status Ejection

Concerns with MVC’s Speed Safety equipment Seat belts SRS systems Did safety systems deploy or were they used.

Falls How far did they fall? 15 feet or 3 x persons height considered significant What part of body impacted ground? (head vs feet) What was ground surface? (cement, grass)

Penetrating Trauma Low velocity/ knife or ice pick Medium / High velocity Hand gun Rifle Shot gun Military weapons Try to get as much info as possible about weapon for hospital.

Blast Injuries Primary blast injuries – pressure wave from blast Disruption of blood vessels Rupture of major organs (especially hollow organs) Secondary blast injuries – injuries caused by being struck by flying debris Tertiary blast injuries – occurs when persons body is thrown back Miscellaneous injuries – burns, inhalation injuries

Multisystem Trauma Injuries to head Bleeding or bruising to the brain Swelling in the brain causes pressure against skull All signs may not be evident early in assessment conditions may deteriorate with time Frequent reassessment is crucial

Multisystem Trauma Injuries to neck and throat Life threatening injuries possible Trachea Major blood vessels Cervical spine

Multisystem Trauma Injuries to chest Lungs Pneumothorax Tension Pneumothorax Heart Contusion Tamponade Great Vessels Rib Fractures

Multisystem Trauma Abdomen Solid organs Liver, Spleen, Pancreas, Kidneys Hollow Organs Stomach, Large and Small intestine, urinary bladder Organs very vascular risk for internal bleeding high

Main Priorities of Trauma Care Scene Safety/ appropriate resources MOI / high degree of suspicion Identify and manage life threats Try to limit on scene time to 10 minutes “the platinum 10 minutes” Give receiving facility a “heads up” Transport considerations (ground vs air) Secondary assessment and non life threatening treatments enroute Reassess every 5 min

SHOCK Shock (hypoperfusion) means a state of collapse and failure of the cardiovascular system. In the early stages, the body attempts to maintain homeostasis. As shock progresses, blood circulation slows and eventually ceases.

Shock As an EMT, you cannot go wrong assuming that every patient is in shock or may go into shock. Shock can occur because of medical or traumatic events. Heart attack Severe allergic reaction Automobile crash Gunshot wound

Shock Shock refers to a state of collapse and failure of the cardiovascular system that leads to inadequate circulation. Shock is an unseen life threat caused by a medical disorder or traumatic injury. If the symptoms of shock are not promptly addressed, the patient will soon die.

Cardiovascular System Cardiovascular system has three parts: Pump (heart) Set of pipes (blood vessels and arteries) Contents (the blood)

Causes of Shock

Cardiogenic Shock Caused by inadequate function of the heart A major effect is the backup of blood into the lungs. Resulting buildup of pulmonary fluid is called pulmonary edema Edema is the presence of abnormally large amounts of fluid between cells in body tissues, causing swelling.

Obstructive Shock Obstructive shock occurs when conditions that cause mechanical obstruction of the cardiac muscle also affect the pump function Common examples include cardiac tamponade and tension pneumothorax. Tension pneumothorax Caused by damage to lung tissue The air normally held within the lung escapes into the chest cavity. This air applies pressure to the organs, including the heart.

Distributive Shock Results from widespread dilation of small arterioles, venules, or both The circulating blood volume pools in the expanded vascular beds. Tissue perfusion decreases. Septic shock Occurs as a result of severe infections in which toxins are generated by bacteria or by infected body tissues Toxins damage vessel walls, causing increased cellular permeability. Vessel walls leak and are unable to contract well.

Distributive Shock Neurogenic shock Usually a result of injury to the part of the nervous system that controls the size and muscle tone of the blood vessels Causes include damage to the spinal cord, brain conditions, tumors, pressure on the spinal cord, and spina bifida. Muscles in the blood vessel walls are cut off from nerve impulses that cause them to contract.

Distributive Shock Anaphylactic shock Occurs when a person reacts violently to a substance to which he or she has been sensitized Sensitization means becoming sensitive to a substance that did not initially cause a reaction. Each subsequent exposure tends to produce a more severe reaction.

Distributive Shock

Distributive Shock Psychogenic shock Caused by a sudden reaction of the nervous system Produces temporary vascular dilation Results in fainting (syncope) Serious causes include irregular heartbeat and brain aneurysm.

Hypovolemic Shock Result of an inadequate amount of fluid or volume in the system Hemorrhagic causes and non-hemorrhagic causes Loss of 20% of circulating blood volume is considered severe. Occurs with severe thermal burns Intravascular plasma is lost. Dehydration, the loss of water or fluid from body tissues, can cause or aggravate shock. Fluid loss may be a result of severe vomiting and/or diarrhea.

Progression of Shock Three stages in the progression of shock: Compensated shock: early stage when the body can still compensate for blood loss Decompensated shock: late stage when blood pressure falls Irreversible shock: terminal stage when transfusion is not enough to save patient

Progression of Shock Use caution when caring for elderly patients. Treating a pediatric or geriatric patient in shock is no different than treating other shock patients. Expect shock in many emergency medical situations. Also expect shock if a patient has any one of the following conditions: Multiple severe fractures, abdominal or chest injury, spinal injury, severe infection, major heart attack or anaphylaxis

Summary of Shock Perfusion requires an intact cardiovascular system and a functioning respiratory system. Most types of shock are caused by dysfunction in the heart, blood vessels, or volume of blood. Shock is the collapse and failure of the cardiovascular system, when blood circulation slows and eventually stops. Blood is the vehicle for carrying oxygen and nutrients through the vessels to the capillary beds to tissue cells, where these supplies are exchanged for waste products.

Summary of Shock Blood contains red blood cells, white blood cells, platelets, and a liquid called plasma. The systolic pressure is the peak arterial pressure. The diastolic pressure is the pressure maintained within the arteries while the heart rests between heartbeats. Remember, by the time a drop in blood pressure is detected, shock is usually in an advanced stage. Treating a pediatric or geriatric patient in shock is no different than treating any other shock patient.