Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Division 3 Trauma Emergencies

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 17 Blunt Trauma

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Introduction to Kinetics Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Introduction to Kinetics Most common cause of trauma death and disability Energy exchange between an object and the human body, without intrusion through the skin © Robert J. Bennett

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Kinetics of Blunt Trauma (1 of 3) Inertia –“A body in motion will remain in motion unless acted upon by an outside force.” –“A body at rest will remain at rest unless acted upon by an outside force.” Conservation of energy –“Energy can neither be created nor destroyed. It is only changed from one form to another.” Kinetic versus potential energy

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Kinetic Energy –Energy in motion KE = mass (weight) x velocity (speed) 2 2 –Double weight = double energy –Double speed = quadruple energy Kinetics of Blunt Trauma (2 of 3) Speed is the greatest determinant.

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Force –Emphasizes the importance of rate at which an object changes speed (acceleration or deceleration) Force = Mass x Acceleration Kinetics of Blunt Trauma (3 of 3)

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Types of Trauma Blunt –Closed injury –Indirect injury to underlying structures –Transmission of energy into the body Tearing of muscle, vessels, and bone Rupture of solid organs Organ injury Ligamentum teres Penetrating –Open injury –Direct injury to underlying structures

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crashes (1 of 4) 44,000 people die each year on U.S. highways. Events of Impact: –Vehicle collision –Body collision –Organ collision –Secondary collisions Objects inside vehicle strike occupant. –Additional injuries Vehicle receives a second impact.

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crashes (2 of 4) Inertia and MVCs

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crashes (3 of 4) Restraints –Seatbelts Occupant slows with the vehicle Shoulder and lap belts MUST be worn together Injuries if worn separately –Airbags (SRS) Reduce blunt chest trauma Cause hand, forearm, and facial injury Check for steering wheel deformity Side airbags –Child Safety Seats Infants and small children: Rear facing Older child: Forward facing

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crashes (4 of 4) Types of Impact –Frontal: 32% –Lateral: 15% –Rotational: 38% Left and right – front and rear –Rear-end: 9% –Rollover: 6%

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Frontal Impact (1 of 2) Up-and-over –Tenses legs = bilateral femur fracture –Hollow organ rupture and liver laceration –Similar chest trauma –Axial loading

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Frontal Impact (2 of 2) Down-and-under –Knee, femur, and hip fracture –Chest trauma – steering wheel Paper bag syndrome

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Ejection –Due to up-and-over pathway –Contact with the vehicle and external object

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crashes (1 of 4) Lateral Impact –15% of MVCs but 22% of deaths –Upper extremity injury –Rib, clavicle, humerus, pelvis, femur fracture –Lateral compression Ruptured diaphragm Spleen fracture Aortic injury EVALUATE the unrestrained occupant.

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crashes (2 of 4) Rotational –Vehicle struck at oblique angle –Less serious injuries unless strike a secondary object Rear-end –Seat propels the occupant forward –Head is forced backward Stretching of neck muscles and ligaments Hyperextension and hyperflexion –RARELY see significant injuries if head rest is properly positioned Rollover –Multiple points of impact –Ejection or partial ejection –Less injury with restraints

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crashes (3 of 4) Vehicle Crash Analysis –Hazards –Crumple zones –Intrusion –Deformity of vehicle –Use of restraints Undeployed airbags should be deactivated by trained fire/extrication personnel. Intoxication –Fatal collisions: >50% involve ETOH –Recreational accidents

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crashes (4 of 4) Vehicular Mortality –Head: 48% –Internal (torso): 37% –Spinal and chest fracture: 8% –Extremity fracture: 2% –All other: 5%

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Crash Evaluation Collision Questions –How did collision occur? –Direction? –Speed? –Similar/different sized? –Secondary collisions? Cause of Crash –Weather and visibility? –Alcohol involved? –Skid marks? Auto Interior –Starring of windshield? –Steering wheel deformity? –Dash deformity? –Intrusion?

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Motorcycle Crashes Serious injuries can occur with high- and low-speed collisions. Types of Impact –Frontal –Angular –Sliding –Ejection Initial bike/object collision Rider/object Rider/ground

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pedestrian Collisions Adults –Adults turn away –Bumper strikes lower legs first –Victim rolls up and over and is thrown Children –Children turn toward –Femurs, pelvis often injured –Thrown away or run over

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Recreational Vehicle Collisions Lack structure and restraint system Types of vehicles –Snowmobiles –Personal watercraft –ATVs Often see injuries in children due to lack of skills and training

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Blast Injuries Blast injuries –Dust, fumes, explosive compounds Explosion –Fuel + oxidant combine instantaneously –Heat and pressure wave

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Explosion (1 of 4) Pressure Wave –Structural collapse –Blast wind Burns Projectiles –Terrorist devices may contain nails, screws, or other materials meant to cause additional injury and destruction. Personnel Displacement Blast Injury Phases –Primary: Heat of the explosion –Secondary: Trauma caused by projectiles –Tertiary: Personnel displacement and structural collapse

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Explosion (2 of 4) Blast injury assessment –Be alert for secondary device. –Initial scene size-up important. –Establish Incident Command System (ICS). –Evaluate for secondary hazards. –Injury patterns: Rupture of air- or fluid-filled organs Lung: late manifestation (heat and pressure) Hearing loss

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Explosion (3 of 4) Blast injury care –Lungs Forceful compression and distortion of chest cavity Compression and decompression Pulmonary embolism, dyspnea, hemoptysis, pneumothorax –Abdomen Compression and decompression Release of bowel contents Diaphragm rupture from pushing of organs up into thorax area

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Explosion (4 of 4) Blast injury care –Ears Initial hearing loss Injury improves over time –Penetrating wounds Care as any serious open wound or impaled object –Burns Treatment consistent with traditional management

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Other Types of Blunt Trauma (1 of 3) Falls –Stairs, force, surface –Landing area Surface type Body part –Height of fall –Elderly

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Other Types of Blunt Trauma (2 of 3) Sports Injuries –Various injury patterns Produced by extreme exertion, fatigue, or direct trauma Acceleration, deceleration, compression, rotation, hyperextension, or hyperflexion Unconsciousness, neurological defect, or decreased mental status require physician follow-up. –Protective gear reduces injury pattern. Helmet removal If loose, remove. If tight, remove face mask and immobilize in place. Take helmet to hospital.

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Other Types of Blunt Trauma (3 of 3) Compartment syndrome –Any condition in which a structure such as a nerve or tendon is being constricted in a space. Crush syndrome –The result of prolonged continuous pressure on a large muscle; e.g., the leg or arm. As a result of trauma, the muscle disintegrates.

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Crush Injury/ Compartment Syndrome Cause –Structural collapse, explosion, MVC, industrial, or agricultural Great force to soft tissue and bones –Tissue stretching and compression –Extended pressure results in anaerobic metabolism distal to compression –Return of blood flow, toxins to entire body –Severe hemorrhage due to severe damaged blood vessels

Bledsoe et al., Essentials of Paramedic Care: Division 1II © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Introduction to Kinetics Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma