Principles of Trauma
Objectives Define: Kinematics, Mechanism of Injury, Index of Suspicion Compare and Contrast high and low velocity injuries Compare and Contrast the 5 MOIs Describe the role of a trauma center in improving the survival of a trauma patient Describe the management of a trauma patient in outdoor or wilderness settings
Kinematics The branch of mechanics that studies the movement of body segments without consideration given to its mass or the forces making it move KE=(1/2)mv2
Mechanism of Injury The Force that Produced the injury, its intensity and direction Types of Force: Direct Twisting Forced Flexion or Hyperextension Indirect
What are the Final/Fabulous Five? https://www.youtube.com/watch?v=wt25tUS92m8
1. Penetrating Injury An injury that breaks the skin and damages underlying structures High-Velocity Wounds: faster than 2,000 ft/sec. Low-Velocity Wounds: slower than 2,000 ft/sec. https://www.youtube.com/watch?v=Bb5tMhOeg5I
2. Blunt Kinetic energy doesn’t break skin Causes bruised tissue, internal bleeding, broken bones, organ damage
3. Blast Injury Primary: Massive pressure wave striking the body Secondary: Airborne objects that strike the body Tertiary: Body is thrown into other objects Quaternary: Other blast related factors https://www.youtube.com/watch?v=Wym9K35SVEk minute 1:25
4. Rotational Direction of kinetic energy through the body that is not compatible with normal range of motion https://www.youtube.com/watch?v=_MvdhlO5F04
5. Crush Body part caught between two or more objects
Three Phases of Injury 1. Pre-Injury Phase: Events and Conditions leading up to the injury 2. Injury Phase: Period during which energy is transferred through a patients body 3. Post- injury Phase: when energy transfer complete
Post-Injury Phase Golden Hour: first hour Three peaks when traumatic death generally occurs: First seconds to minutes following a catastrophic injury First minutes to an hour following a critical injury Days to weeks following initial injury
Trauma Centers Level I: 24 hour, in-house trauma surgeons as well as prompt availability of all major surgical subspecialties, anesthesia, etc. must have ongoing research and surgical residency program Level II: Level I without research or residency Level III: Trauma surgeon available, not every subspecialist Level IV and V: Trained Trauma nurses and a physician available. Basic resuscitative measures