National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 17 Principles of Trauma

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 17.1 Define the following terms: a.kinematics b.mechanism of injury c.index of suspicion 17.2 Compare and contrast high-velocity injuries and low-velocity injuries Compare and contrast the five mechanisms of injury. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 17.4 Describe the role of a trauma center in improving the survival of a trauma patient Describe and demonstrate the management of a trauma patient in outdoor or wilderness settings.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Kinematics and Mechanism of Injury Pathophysiology Injury Phases Trauma Systems Assessment Management Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation A skier has fallen in the moguls and slid 50 feet down hill. He is responsive and alert, complaining of pain in the right hip and flank. He thinks he is OK and wants to return to his condo. Bystanders thought the crash was spectacular!

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Kinematics and Mechanism of Injury Kinematics Consider : ◦ Mass of patient or object that struck patient ◦ Speed of patient or object that struck patient ◦ Energy transmitted

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Kinematics and Mechanism of Injury Kinematics ◦ Kinetic Energy (KE) = mass x velocity 2 2 This means that the speed the patient is traveling is more important than their weight. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Kinematics and Mechanism of Injury continued Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Kinematics and Mechanism of Injury continued Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Kinematics and Mechanism of Injury continued Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Kinematics and Mechanism of Injury continued Copyright Scott Smith

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Kinematics and Mechanism of Injury Copyright Scott Smith continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Kinematics and Mechanism of Injury Kinematics ◦ Stopping Distance ◦ Kinetic energy to the body of a patient traveling at a constant speed More=hitting a tree Less= hitting a pliable net continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pathophysiology Severity of bodily injuries is directly related to Mechanism of Injury (MOI) MOI = amount of kinetic energy absorbed + direction the energy travels + density of the structures impacted continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pathophysiology Five Mechanisms of Injury: ◦ Blunt ◦ Penetrating ◦ Rotational ◦ Crush ◦ Blast continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Pathophysiology Copyright Craig Brown

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Injury Phases Pre-injury ◦ Events and conditions leading up to injury ◦ Includes preventive intervention efforts Injury ◦ Energy transfer damages Patroller will develop an index of suspicion based on MOI continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Injury Phases Post-Injury ◦ Immediately after energy transfer ◦ Three “peaks” when death generally occurs First few seconds to minutes – Life saving interventions Minutes to an hour – “Golden Hour” Days to weeks – Complications ◦ Back country rescues increase difficulty of care and transport continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Injury Phases Copyright Craig Brown

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Trauma Systems Designations for patient destinations Levels I to V based on staff qualifications and experience with trauma ◦ More severe injuries = higher trauma level ◦ Specialized centers are available for pediatrics

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update What index of suspicion was apparent due to the MOI? What patient findings confirm this? What actions must be taken with this patient?

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Trauma assessment implements all previously covered skills (Ch 7) Additional topics may include ◦ MOI and the forces involved ◦ Treatment rendered before your arrival Determine treatment and transportation plan Reassessment is vital

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Mitigate hazards Correct immediate life threats ◦ Spinal stabilization Use oxygen Monitor/treat for shock Prepare patient for transport Document your assessment and treatment

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition You suspect a fractured pelvis and internal bleeding. You place the patient on high-flow oxygen by nonrebreather mask and prepare to evacuate him from the slopes as expeditiously as possible. You notify the base clinic of your impending arrival. You assist the ALS provider start an IV. They transport him to a Level II trauma center just a few air miles farther.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Trauma prevention is as important as trauma management. Injuries can be divided into three phases: pre-injury, injury, and post- injury. The five mechanisms of trauma are penetrating injury, blunt injury, crush injury, rotational injury, and blast injury. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary A trauma center is a specialized medical facility geared toward addressing the specific needs of trauma patients. Whenever possible, multi-system trauma patients should be taken to a trauma center. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary When indicated by the MOI, early immobilization of a trauma patient’s spine is essential. The three goals of serious trauma management are early recognition, correction of threats to life, and rapid transportation to a trauma center.