1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 4 Trauma Emergencies

2. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 2 Blunt Trauma

3. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Topics Introduction to Blunt Trauma Kinetics of Impact Biomechanics of Trauma

4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction to Blunt Trauma

5. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Introduction to Blunt Trauma Blunt trauma is the most common cause of trauma-related death and disability. –Results from an energy exchange between an object and the human body, without intrusion through the skin. True nature of the injury is often hidden.

6. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Kinetics of Impact

7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Kinetics of Impact Kinetics is a branch of physics dealing with objects in motion and the energy exchanges that occur as objects collide. Two basic principles of kinetics: –Laws of inertia –Energy conservation Kinetic energy and force formulas quantify the energy exchange process between the moving object and the human body.

8. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Law of Inertia Newton’s first law: –“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.”

9. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Energy Conservation Law of Energy Conservation –“Energy can neither be created nor destroyed. It can only be changed from one form to another.” –All the energy of motion converts to other energy forms. © Mark C. Ide

10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Kinetic Energy Kinetic energy of an object while in motion is measured by the following formula: KE = mass (weight) x velocity (speed) 2 2

11. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Kinetic Energy When you double an object’s weight, you double its kinetic energy. As speed (velocity) increases, there is a larger (squared) increase in kinetic energy. Releasing energy slowly, as occurs with braking, results in a tolerable transfer of energy while stopping.

12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Force Newton’s second law of motion explains the forces at work during a collision: Force = Mass (Weight) X Acceleration (or Deceleration)

13. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Force The formula emphasizes the importance of the rate at which an object changes speed. –Gradual changes in speed are usually uneventful. When significant kinetic energy is applied to human anatomy, we call it trauma.

14. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Biomechanics of Trauma

15. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Biomechanics of Trauma The biomechanics of trauma describes the actual injury process. The biomechanics of trauma are bound by the laws of physics: –Inertia, energy conservation, and force Trauma is divided into two general categories: –Blunt –Penetrating

16. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Biomechanics of Trauma Blunt –Closed injury –Indirect injury to underlying structures –Transmission of energy into the body –Stretch forces –Shear forces

17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Biomechanics of Trauma Penetrating –Open injury –Direct injury to underlying structures

18. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Collisions 44,000 people die each year on U.S. highways. Events of Impact: –Vehicle collision –Body collision –Organ collision –Secondary collisions –Additional injuries Vehicle receives a second impact

19. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Collisions

20. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Collisions Restraints –Seatbelts –Airbags (SRS) Reduce blunt chest trauma Cause: hand, forearm, and facial injury Check for steering wheel deformity Side airbags –Child Safety Seats

21. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Collisions Types of Impact –Frontal –Lateral –Rotational Left and right – front and rear –Rear-end –Rollover

22. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Frontal Impact Up-and-Over –Tenses legs = bilateral femur fracture –Hollow organ rupture and liver laceration –Similar chest trauma –Axial loading Down-and-Under –Knee, femur, and hip fracture –Chest trauma – steering wheel Paper bag syndrome Ejection

23. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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

24. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Rotational Impact Vehicle struck at oblique angle Less serious injuries unless strike a secondary object © Mark C. Ide

25. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Rear-End Collisions Rear-end –Seat propels the occupant forward –Head is forced backward Stretching of neck muscles and ligaments Hyperextension and hyperflexion © Mark C. Ide

26. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Rollover –Multiple points of impact –Ejection or partial ejection –Less injury with restraints © Mark C. Ide

27. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Collisions Click here to view an animation on collisions.here

28. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Vehicle Collision 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 legal intoxication –Recreational accidents

29. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Collisions Vehicular Mortality –Head: 48% –Internal (torso): 37% –Spinal and chest fracture: 8% –Extremity fracture: 2% –All other: 5%

30. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Collision Evaluation Collision Questions –How did collision occur? –Direction? –Speed? –Similar/different sized? –Secondary collisions? Cause of Collision –Weather and visibility? –Alcohol involved? –Skid marks? Auto Interior –Starring of windshield? –Steering wheel deformity? –Dash deformity? –Intrusion?

31. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Automobile Collision Evaluation © Ray Kemp/911 Imaging

32. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Motorcycle Collisions Serious injuries can occur with high- and low- speed collision Types of Impact –Frontal –Angular –Sliding –Ejection Initial bike/object collision Rider/object Rider/ground

33. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 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 thrown

34. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pedestrian Collisions Children –Children turn toward –Femurs, pelvis often injured –Thrown away or run over

35. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 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

36. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Blast Injuries Explosion Pressure Wave Blast Wind Victim Displacement © Joshua Menzies

37. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Blast Injuries

38. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Explosion 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

39. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Explosion Blast Injury Phases –Primary: Heat of the explosion –Secondary: Trauma caused by projectiles –Tertiary: Personnel displacement and structural collapse

40. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Explosion 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

41. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Explosion 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

42. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Explosion 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

43. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Types of Blunt Trauma Falls –The initial impact may involve other body surfaces with the forces of deceleration –Evaluating a fall Determine the point of impact The fall height The impact surface The transmission pathway of forces along the skeleton

44. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Types of Blunt Trauma Sports Injuries –Sports injuries are most commonly produced by extreme exertion, fatigue, or by direct trauma forces. Injuries can be secondary to acceleration, deceleration, compression, rotation, hyperextension, or hyperflexion.

45. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Other Types of Blunt Trauma Crush Injury –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

46. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Summary Introduction to Blunt Trauma Kinetics of Impact Biomechanics of Trauma