Chapter 25: Trauma Overview

Introduction

• Traumatic and unintentional injuries: Leading causes of death in the US for ages 1-44.
• Proper pre-hospital care reduces suffering, disability, and death risk.
• Emergencies categorized as medical or trauma.
• Trauma results from physical forces.
• Medical conditions can lead to trauma (e.g., stroke causes a car accident).
• Understanding trauma helps in assessing vehicular crash scenes.

Energy and Trauma

• Traumatic injury: Occurs when body tissues are exposed to excessive energy.
• Mechanism of Injury (MOI): Describes forces causing injury.
• Key Energy Concepts: Potential, Kinetic, Work
  • Potential Energy: Mass, gravity, height (e.g., falling worker).
  • Kinetic Energy: Mass & velocity (e.g., speeding car).
  • Work: Force over distance (e.g., bending metal).
• Energy conversion in crashes: Vehicle's kinetic energy converts to work (damage/stop).
• Speed has a greater impact on injury than mass (e.g., bullet wounds).

Mechanism of Injury Profiles

• Non-significant Injuries: Isolated injuries or falls without loss of consciousness.
• Significant Injuries: Multi-system trauma, falls from heights, vehicle crashes, gunshot wounds.
• Blunt vs. Penetrating Trauma
  • Blunt: Force without penetration (e.g., bat injury).
  • Penetrating: Objects pierce the body (e.g., bullets, stabbings).

Vehicular Crashes

• Types: Frontal, rear-end, lateral, rollover, rotational.
• Three Collisions in a Crash
  1. Vehicle vs. Object
  2. Passenger vs. Vehicle Interior
  3. Internal Organs vs. Body Structures
• Assessment: Inspect vehicle damage for clues to injury severity.
• Frontal Crashes: Consider supplemental restraints (seatbelts, airbags).
• Rear-end Crashes: Risk of whiplash and cervical spine injuries.
• Lateral Crashes: High risk of aortic injuries and fatalities.
• Rollover Crashes: High risk of ejection, multiple impacts.
• Rotational Crashes: Combine rotation and lateral impact.

Pedestrian and Cyclist vs. Vehicle

• High suspicion of unseen injuries.
• Assess speed, impact points, and damage.

Motorcycle Crashes

• Protection from gear, but vulnerable to severe injuries.
• Types of impacts: Head-on, angular, ejection, controlled crashes.

Falls

• Injury potential related to fall height.
• Consider syncope or medical conditions as causes.

Penetrating Trauma

• Types: Low-energy (knives) vs. medium/high-velocity (bullets).
• Path and cavitation: Trajectory and tissue damage.

Blast Injuries

• Four types: Primary, secondary, tertiary, quaternary.
• Primary: Pressure wave causes internal damage.
• Secondary: Debris causes injury.
• Tertiary: Body displacement by blast wind.
• Quaternary: Burns, inhalation injuries, etc.

Multi-system Trauma

• Involves multiple body systems.
• Requires rapid treatment and transportation.

Golden Principles of Pre-hospital Trauma Care

• Ensure safety, assess MOI, control hemorrhage, manage airway/breathing, minimize scene time.
• Transport to appropriate trauma center.

Patient Assessment

• Key Components: Scene size-up, primary assessment, history, secondary assessment, reassessment.
• Injuries by System:
  • Head: Risk of brain injury; frequent neuro checks.
  • Neck and Throat: Assess for airway compromise and vascular damage.
  • Chest: Risk of rib fractures, pneumo/hemothorax.
  • Abdomen: Solid organ bleeding, hollow organ rupture.

Management, Transport, and Destination

• Familiarize with trauma system resources.
• Limit on-scene time ("platinum 10 minutes").
• Trauma Center Levels: 1-4, with varying resources and capabilities.
• Consider helicopter transport for severe cases.

Special Considerations

• Stay calm, assess systematically, and prioritize life threats.
• Contact ALS or medical control for guidance.