1. 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.

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

3. 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

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

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

6. 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

7. 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!

8. 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

9. 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

10. 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.

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

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

13. Mechanism of Injury Profiles

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

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

16. Head-On Collision

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

18. 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!

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

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

21. 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

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

23. Rear-end Collision

24. 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

25. Lateral Collision

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

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

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

29. Rotational Collision

30. 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

31. Rollover

32. 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

33. 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

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

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

36. 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

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

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

39. 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

40. 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)

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

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

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

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

45. Index of Suspicion

46. 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

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

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

49. 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

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

51. 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”

52. 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