Quantum Physics and the Time-Space Continuum An in depth and highly detailed analysis of the physical universe and it’s relevance to the pre-hospital emergency medical practicum.

An Introduction to the Physics of Trauma TRAUMA KINEMATICS An Introduction to the Physics of Trauma

Trauma Statistics Over 150,000 trauma deaths/year Over 40, 000 are auto related Leading cause of death for ages 1-40 One-third are preventable Cost exceeds $220 billion (2001) Unnecessary deaths are often caused by injuries missed because of low index of suspicion

Kinematics Physics of Trauma Understanding kinematics allows prediction of injuries based on forces and motion involved in an injury event.

Basic Principles Conservation of Energy Law Newton’s First Law of Motion Newton’s Second Law of Motion Kinetic Energy

Newton’s First Law Body in motion stays in motion unless acted on by outside force Body at rest stays at rest unless acted on by outside force

Major factor is velocity Newton’s Second Law Force of an object = mass (weight) x acceleration or deceleration (change in velocity) Major factor is velocity “Speed Kills” Kinetic energy is the energy of a moving object and is calculated with the formula: K.E.=1/2mv2 (m = mass, v2 = velocity X 2). This means that the energy that is available to cause injury doubles when an object’s weight doubles, but quadruples when it’s speed doubles. Note: Increasing he speed limit from 50 mph to 70 mph quadruples the energy that is available to cause injury. In GSW, consideration of firearm type/caliber must be determined as the speed of the bullet (high- velocity compared with low-velocity) has a greater impact on producing injury than the mass (size) of the bullet. The amount of kinetic injury that is converted to do work on the body dictates the severity of the injury!

Law of Conservation of Energy For every action there is an opposite and equal reaction Energy cannot be created or destroyed Energy can only change from one form to another

Kinetic energy = ½ mass of an object X (velocity)2 Energy of Motion Kinetic energy = ½ mass of an object X (velocity)2 Injury doubles when weight doubles but quadruples when velocity doubles

So… When a moving body is acted on by an outside force and changes its motion, then kinetic energy must change to some other form of energy. If the moving body is a human being and the energy transfer occurs too rapidly, then trauma results.

Cavitation towards or away from the injury Blunt Force Trauma Force without penetration “Unseen injuries” Cavitation towards or away from the injury

Penetrating Trauma Piercing or penetration of body with damage to soft tissues and organs Depth of injury

Mechanism of Injury Profiles

Motor Vehicle Collisions Five major types of motor vehicle collisions: Head-on Rear-end Lateral Rotational Roll-over

Motor Vehicle Collisions In each collision, three impacts occur: Vehicle Occupants Occupant organs

Head-On Collision

Head-on Collision Vehicle stops Occupants continue forward Two pathways Down and under Up and over

Frontal Collision Down and under pathway Knees impact dash, causing knee dislocation/patella fracture Force fractures femur, hip, posterior rim of acetabulum (hip socket) Pelvic injuries kill!

Frontal Collision Down and under pathway Upper body hits steering wheel Broken ribs Flail chest Pulmonary/myocardial contusion Ruptured liver/spleen

Frontal Collision Down and under pathway Paper bag pneumothorax Aortic tear from deceleration Head thrown forward C-spine injury Tracheal injury

Frontal Collision Up and over pathway Chest/abdomen hit steering wheel Rib fractures/flail chest Cardiac/pulmonary contusions/aortic tears Abdominal organ rupture Diaphragm rupture Liver/mesenteric lacerations

Frontal Collision Up and over pathway Head impacts windshield Scalp lacerations Skull fractures Cerebral contusions/hemorrhages C-spine fracture

Rear-end Collision

Rear-end Collision Car (and everything touching it) moves forward Body moves, head does not, causing whiplash Vehicle may strike other object causing frontal impact Worst patients in vehicles with two impacts

Lateral Collision

Lateral Collision Car appears to move from under patient Patient moves toward point of impact Increased potential for “shearing” injuries Increased cervical spine injury

Lateral Collision Chest hits door Lateral rib fractures Lateral flail chest Pulmonary contusion Abdominal solid organ rupture Suspect upper extremity fractures and dislocations

Lateral Collision Hip hits door Head of femur driven through acetabulum Pelvic fractures C-spine injury Head injury

Rotational Collision

Rotational Collision Off-center impact Car rotates around impact point Patients thrown toward impact point Injuries combination of head-on, lateral Point of greatest damage = point of greatest deceleration = worst patients

Rollover

Roll-Over Multiple impacts each time vehicle rolls Injuries unpredictable Assume presence of severe injury Justification for Transport to Level I or II Trauma Center

Restrained vs Unrestrained Patients Ejection causes 27% of motor vehicle collision deaths 1 in 13 suffers a spinal injury Probability of death increases six-fold

Restrained with Improper Positioning Seatbelts Above Iliac Crest Compression injuries to abdominal organs T12 - L2 compression fractures Seatbelts Too Low Hip dislocations

Restrained with Improper Positioning Seatbelts Alone Head, C-Spine, Maxillofacial injuries Shoulder Straps Alone Neck injuries Decapitation

Motorcycle Collisions Rider impacts motorcycle parts Rider ejected over motorcycle or trapped between motorcycle and vehicle No protection from effects of deceleration Limited protection from gear

Pedestrian vs. Vehicle Child Faces oncoming vehicle Waddell’s Triad Bumper Femur fracture Hood Chest injuries Ground Head injuries

Pedestrian vs. Vehicle Adult Turns from oncoming vehicle O’Donohue’s Triad Bumper Tib-fib fracture Knee injuries Hood Femur/pelvic

Falls Critical Factor Height Surface Objects struck during fall Increased height + Increased injury Surface Type of impact surface increases injury Objects struck during fall Body part of first impact Feet Head Buttocks Parallel

Falls Assess body part that impacts first, usually sustains the bulk of injury Think about the path of energy through body and what other organs/systems could be impacted (index of suspicion)

Falls onto Head/Spine Injuries may not be obvious C-spine precautions! Watch for delayed head injury S/S

Falls onto Hands Bilateral colles fractures Potential for radial/ulna fractures and dislocations

Fall onto Buttocks Pelvic fracture Coccygeal (tail bone) fracture Lumbar compression fracture

Fall onto Feet* Don Juan Syndrome Bilateral heel fractures Compression fractures of vertebrae Bilateral Colles’ fractures

Index of Suspicion

Stab Wounds Damage confined to wound track Four-inch object can produce nine-inch track Gender of attacker Males stab up; Females stab down Evaluate for multiple wounds Check back, flanks, buttocks

Stab Wounds Chest/abdomen overlap Chest below 4th ICS = Abdomen until proven otherwise Abdomen above iliac crests = Chest until proven otherwise

Stabbings Always maintain high degree of suspicion with stab wounds Remember: small stab wounds do NOT mean small damage

Gunshot Wounds Damage CANNOT be determined by location of entrance/exit wounds Missiles tumble Secondary missiles from bone impacts Remote damage from Blast effect Cavitation

Gunshot Wounds Severity cannot be evaluated in the field or Emergency Department Severity can only be evaluated in OR

Significant ALS MOI Multi-system trauma Fractures in more than one location MVA – death in same vehicle, high speed or significant vehicle damage Falls > 2 X body height Thrown > 10 – 15 feet Penetrating trauma to the “box” Age co-factors: < 6 or > 60 “Lucky Victim”

Conclusion Think about mechanisms of injury Always maintain an increased index of suspicion Doing YOUR job as an EMT will lead to: Fewer missed injuries Increased patient survival