Overview
This lecture covers the foundational principles of trauma care, focusing on the mechanisms of injury, types of trauma, injury patterns, assessment, and pre-hospital management strategies.
Energy and Trauma Basics
- Trauma is the leading cause of death for people under 44 in the US.
- Trauma results from external physical forces; mechanism of injury (MOI) helps predict unseen injuries (index of suspicion).
- Three basic energy concepts: kinetic energy (movement), potential energy (height/gravity), and work (force over distance).
- Kinetic energy depends on mass and velocity; potential energy relates to mass, gravity, and height.
Mechanisms and Types of Injury
- Non-significant MOIs involve isolated injuries; significant MOIs include multi-system trauma (falls, vehicle crashes, gunshots, stabbings).
- Trauma types:
- Blunt trauma (force without penetration; hidden injuries common).
- Penetrating trauma (object pierces the body; damage along object's path).
Motor Vehicle and Impact Injuries
- MVCs involve three collisions: vehicle-object, body-interior, organs-body.
- Assess vehicle deformity and intrusion for injury clues.
- Types of crashes: frontal, rear-end (whiplash), lateral (side impact), rollover (ejection risk), rotational (spins).
- Safety devices (seatbelts, airbags) prevent certain injuries but can cause others if improperly used.
Pedestrian, Bicycle, and Motorcycle Trauma
- Assess scene details: speed, distance thrown, surface, helmet use.
- Always suspect spinal injury in car vs. bicycle crashes.
- Four motorcycle impact types: head-on, angular, ejection, and controlled crash ("laying the bike down").
Falls and Penetrating Trauma
- Fall injury severity depends on height, landing surface, and body part hit.
- Falls >20 feet are significant.
- Penetrating trauma can be low (knives) or high velocity (guns).
- High-velocity injuries cause cavitation and extensive tissue damage; exit wounds often larger than entry.
Blast Injuries
- Blast injuries classified as primary (blast wave), secondary (debris), tertiary (body thrown), quaternary (burns, toxic exposure).
- Air-filled organs (lungs, middle ear, GI tract) are most vulnerable; pulmonary blast injuries may cause pneumothorax or air embolism.
Multi-System Trauma and Prehospital Care
- Multi-system trauma involves more than one body system; rapid recognition and transport are critical.
- Priorities: scene safety, rapid assessment, hemorrhage control, airway management, spinal immobilization, and rapid transport.
- Limit on-scene time for critical patients to under 10 minutes.
Patient Assessment
- Assess head (neurologic exams), neck (airway, jugular veins), chest (decap BTLS, lung sounds), abdomen (organ damage).
- Frequent reassessment required for early detection of hidden injuries.
Transport and Trauma Centers
- Trauma centers: Level 1 (full care), Level 2 (initial definitive), Level 3 (stabilization), Level 4 (basic/ALS).
- Air transport indicated for remote locations, long ground transport, multiple casualties, or overwhelmed hospitals.
- Always complete organized assessment and contact ALS or medical control as needed.
Key Terms & Definitions
- Kinetic Energy — energy of a moving object, calculated as ½ mass × velocity².
- Potential Energy — stored energy due to position (height × mass × gravity).
- Blunt Trauma — injury from force that does not break the skin.
- Penetrating Trauma — injury from an object piercing the body.
- Cavitation — cavity formed by a projectile passing through tissue.
- Index of Suspicion — awareness of possible unseen injuries.
- Decap BTLS — assessment mnemonic: Deformities, Contusions, Abrasions, Punctures/Penetrations, Burns, Tenderness, Lacerations, Swelling.
Action Items / Next Steps
- Review mechanisms of injury patterns and assessment strategies.
- Complete assigned readings for Chapter 25.
- Practice trauma assessment skills and decision-making for transport.