1. Blunt Trauma

2. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma
Sections
Introduction to Blunt Trauma
Kinetics of Blunt Trauma
Types of Trauma
Blunt Trauma
Explosion
Other Blunt Trauma
Examination, Diagnosis

3. Introduction to Blunt Trauma
Most common cause of trauma death and disability
Energy exchange between an object and the human body, without intrusion through the skin

4. Kinematics
Process of examining the scene to determine potential injuries that result from the forces of motion
Windshield, steering wheel, dashboard
Was the patient flying thru the air?
Roll-over?
Engine block on lap? (intrusion)

5. Mechanism of injury MOI
description of the mechanical and physiological changes that result in anatomical or functional damage of tissue
Translation: What hit the patient???, what did the patient hit???!

6. Index of Suspicion Based on the MOI and kinetics
Predict expected injuries
Experience counts here!
Be obsessive and compulsive, its OK!!

7. Kinetics of Blunt Trauma
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.” (Newton)
Conservation of Energy
“Energy can neither be created nor destroyed. It is only changed from one form to another.” (Newton)

11. Kinetics of Blunt Trauma
Force (Newton’s 2nd law of motion)
Emphasizes the importance of rate at which an object changes speed (acceleration or deceleration)

12. SOOOO
The Force that puts an object in motion must be absorbed before the object will stop.
Guess what absorbs that force????
This absorption is what causes tissue injury in the body.

13. Kinetics of Blunt Trauma
Kinetic Energy
Energy in Motion
Double Weight = Double Energy
Double Speed = Quadruple Energy
SPEED IS THE GREATEST DETERMINANT

14. Physics (UGH!) Three types of forces in blunt trauma Compression Shear
Overpressure

15. Compression
Like laying an organ on a table and hitting it with a hammer, every time you hit it, cells are getting compressed and crushed.
Enough said…..

16. Shear
Occur when the organ and the organ’s attachment do not accelerate or decelerate at the same rate of speed, or two parts of an organ accelerate or decelerate at different rates.
Examples are arch of aorta, spleen, kidney.

17. Overpressure
Like hitting a closed paper bag with the open hand….the bag pops.
Examples are like steering column hitting abdomen…pop! goes the diaphragm. Also can pop bladder, bowel, lungs……

18. 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 in the chest for example

19. Blunt Trauma: Car Crashes
44,000 people die each year on US highways
Events of Impact
Vehicle Collision
Body Collision
Organ Collision
Secondary Collisions
Objects inside vehicle strike occupant
Additional Injuries
Vehicle receives a second impact

20. Inertia and MVC’s

21. Protections (think Volvo!)
Steel frame
Belts
Bags
Seat construction
Roof
Crumple Zones

22. Blunt Trauma: Car Crashes
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, & Facial Injury
Check for steering wheel deformity
Side Airbags
Child Safety Seats
Infants and Small Children: Rear facing
Older Child: Forward facing

23. Benefits of Air bags
lives saved if all vehicles had head protecting SABs per year
In side impacts where someone died, 60% suffered brain injury.
Only 92 cases of SAB injury, 6 involving children, with no major injuries, only one minor injury (skin lac).

26. Bags and Belts Burns, abrasions
Do not protect when a second collision hits!
Abdominal injuries (seat too close)
Chest injuries (short, elderly)
Seat belt abrasions above the pelvis account for a 30-60% incidence of intra-abdominal injuries: intestinal rupture, mesenteric injury, vascular disruption

27. Blunt Trauma: Automobile Crashes
Types of Impact
Frontal: 32%
Lateral: 15%
Rotational: 38%
Left & Right – Front & Rear
Rear-end: 9%
Rollover: 6%

28. Blunt Trauma: Car Crashes
Frontal Impact
Down-and-Under (legs lead point)
Knee, femur, and hip fracture (dislocation of knee, fx acetabulum)
Chest trauma-Steering Wheel
Up-and-Over (head lead point)
Head, c-spine injuries
Tenses legs = Bilateral femur fracture
Hollow organ rupture and liver laceration
Similar chest trauma
Axial Loading
Ejection
Due to up-and-over pathway
Contact with the vehicle & external object

29. Blunt Trauma: Automobile Crashes
Lateral Impact (intersection race)
15% of MVC’s but 22% of deaths
Upper extremity injury
Rib, clavicle, humerus, pelvis, femur fracture, c-spine dislocations, locked facets.
Lateral compression
Ruptured diaphragm, Spleen fracture, Aortic injury
EVALUATE the unrestrained occupant

30. Blunt Trauma:Car Crashes
Rotational
Vehicle struck at oblique angle
Less serious injuries unless strike a secondary object

31. Blunt Trauma:Car Crashes
Rear-end
Seat propels the occupant forward
Head is forced backwards
Stretching of neck muscles and ligaments
Hyperextension & hyperflexion (think carotid)
Rollover
Multiple points of impact
Ejection or partial ejection (think: arm out of window, then roll….)
Less injury with restraints

32. Blunt Trauma: Automobile Crashes
Vehicle Crash Analysis
Crumple Zones
Intrusion (one inch for each mile per hour)
Deformity of Vehicle
Use of Restraints
Intoxication
Fatal Accidents: >50% involved ETOH
Recreational Accidents

33. Blunt Trauma: Automobile Crashes
Vehicular Mortality
Head: 48%
Internal (Torso): 37%
Spinal & Chest fracture: 8%
Extremity fracture: 2%
All Other: 5%

34. Blunt Trauma: Automobile Crashes Crash Evaluation
Collision Questions
How did collision occur?
Direction?
Speed?
Similar/Different sized?
Secondary collisions?
Cause of Crash
Weather & visibility?
Alcohol involved?
Skid marks?
Auto Interior
Starring of windshield?
Steering wheel deformity?
Dash deformity?
Intrusion?

35. The “Lucky Other Guy”
The passenger in the same car as the deceased driver for example.
BUT, this “lucky”person was in the same vehicle and the energy exchange on the body was the same.
So you’d better find that unrecognized injury!

45. Blunt Trauma: Motorcycle Crashes
Serious injuries can occur with high and low speed collision.
Types of Impact
Frontal
Angular
Sliding (“laying the bike down”)
Ejection
Initial Bike/Object Collision
Rider/Object
Rider/Ground

46. Motorcycle Injuries
No helmet use increases chance of head injury by 300%.
Does not protect c-spine, but does not injure it either.
Anti-helmet organizations such as American Motorcycle Association may say different………

47. Blunt Trauma:Pedestrian Struck
Adults
Adults turn away and run (lat,post injuries)
Bumper strikes lower legs first
Victim rolls up and over and thrown
Children
Children turn toward (ant injuries)
Femurs, Pelvis often injured
Thrown away or run over

48. Blunt Trauma: Recreational Vehicle Accidents
Lack structure and restraint system
Types of Vehicles
Snowmobiles
Personal watercraft
ATV’s

49. Other Types of Blunt Trauma
Falls
Stairs, Force, Surface
Landing Area
Surface Type
Body Part
Height of Fall (3 times height of victim)
Elderly
Axial Loading…..

50. Maam, you aren’t on Coumadin, are you??????

51. Other Types of Blunt Trauma
Crush Injuries
Cause
Structural collapse, explosion, 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
Care
Prolonged crush Medications
Sodium Bicarbonate: Reduce Acidosis
Morphine: Pain management

52. Blunt Trauma: Blast Injuries
Dust, Fumes, Explosive Compounds
Explosion
Fuel + Oxidant combine instantaneously
Heat & Pressure Wave

53. Primary Injuries
rapid changes in atmospheric pressure from movement of blast wave
hollow organs more susceptible
blast wave rapidly passes through tissue of varying density; if lower density is adjacent to higher density surface tissue of denser tissue is disrupted- “spalling” as wave transverses the walls of the alveoli (high density), they rupture as the wave encounters the air within the alveoli (low density); massive destruction of alveoli and diffuse hemorrhage in lung

54. Implosion
pressure wave passes through the lung, it forces blood out of the vascular space and into the alveoli
wave of high pressure is followed by wave of low pressure allowing alveoli to expand rapidly with further tearing of the lung parenchyma, atelectasis, hemorrhage

55. Secondary Injury
Results from flying debris created by the explosion and carried by blast winds
injuries are typically severe and penetrating due to high KE of projectiles

56. Tertiary Injuries
Blast winds are sufficient force to cause victims to become human missiles
victim strikes the ground

57. Associated Injuries
Injuries resulting from changes in the environment as a consequence of the explosion
fire; burns
combustion of toxic products; poisoning
leaks of toxic chemicals; asphyxiation

58. Explosion Pressure Wave Burns Projectiles Personnel Displacement
Structural Collapse
Blast Wind
Burns
Projectiles
Personnel Displacement
Blast Injury Phases
Primary: Heat of the explosion
Secondary: Trauma caused by projectiles
Tertiary: Personnel displacement and structural collapse

59. 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 & pressure)
Hearing loss

60. Explosion Blast Injury Care Lungs Abdomen
Forceful compression and distortion of chest cavity
Compression and decompression
Pulmonary Embolism, Dyspnea, Hemoptysis, Pneumothorax
Abdomen
Compression & Decompression
Release of bowel contents
Diaphragm rupture from pushing of organs up into thorax area

61. Explosion Blast Injury Care Ears Penetrating Wounds Burns
Initial Hearing Loss
Injury improves over time
Penetrating Wounds
Care as any serious open wound or impaled object
Burns
Treatment consistent with traditional management.