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Understanding Trauma and Injury Mechanisms

Sep 4, 2024

Chapter 25: Trauma Overview - Emergency Care and Transportation of the Sick and Injured, 12th Edition

Key Objectives

  • Understand the basic concepts of energy and its effects on the human body.
  • Recognize general injury patterns from impacts, falls, and penetrating trauma.
  • Apply physics laws in trauma patient assessment.
  • Develop critical thinking to predict injuries and adjust the index of suspicion during scene size-up.
  • Identify common injury patterns in major body systems.

Trauma and Mechanism of Injury

  • Trauma Emergencies: Leading cause of death for people under 44 in the U.S.
  • Mechanism of Injury (MOI): Describes forces causing injury.
    • Index of Suspicion: Awareness of potentially serious unseen injuries.
  • Energy Concepts in Trauma:
    • Potential Energy: Mass, gravity, height (e.g., falling objects).
    • Kinetic Energy: Mass and velocity of moving objects.
    • Energy of Work: Force acting over a distance.

Types of Injury Mechanisms

  • Non-Significant Mechanisms: Isolated injuries, falls without loss of consciousness.
  • Significant Mechanisms: Multi-system trauma, falls from heights, crashes, gunshots, stabbings.

Blunt vs. Penetrating Trauma

  • Blunt Trauma: Injuries without tissue penetration; common in crashes/falls.
  • Penetrating Trauma: Injuries from objects piercing the body.

Motor Vehicle Crashes

  • Three Collision Phases: Vehicle, passenger, internal organs.
  • Types of Crashes:
    • Frontal: Assess restraint systems, points of contact.
    • Rear-End: Whiplash injuries common, headrest importance.
    • Lateral: High death risk, lateral chest and abdominal injuries.
    • Rollover: Ejection risk, high center of gravity.
    • Rotational: Spin, secondary impacts.

Pedestrian and Bicycle Crashes

  • Evaluation based on vehicle speed, patient trajectory, and landing surface.
  • Helmet inspection is crucial in bicycle accidents.

Motorcycle Crashes

  • Impact Types: Head-on, angular, ejection, controlled.

Falls

  • Injury potential related to fall height.
  • Falls over 20 feet are significant.
  • Consider energy absorption in the body.

Penetrating Trauma

  • Low-Energy: Knives, impalements; damage path close to the object.
  • Medium/High-Velocity: Unpredictable paths, cavitation effects.

Blast Injuries

  • Primary: From pressure waves.
  • Secondary: From debris.
  • Tertiary: Force hurling victim.
  • Quaternary: Burns, inhalation injuries.
  • Tissues at Risk: Air-containing organs (ears, lungs, GI tract).

Multi-System Trauma

  • Involves multiple body systems; requires rapid transport and intervention.

Pre-Hospital Trauma Care

  • Prioritize safety, identify life threats, focus on hemorrhage and airway management.
  • Limit scene time; ensure rapid transport.

Patient Assessment

  • Conduct thorough and frequent assessments, especially for head, neck, chest, and abdomen injuries.

Transport and Destination Considerations

  • Trauma Centers: Levels 1-4, based on care capabilities.
  • Air Medical Services: Criteria for use include distance, access, and patient condition.

Types of Transport

  • Ground: EMTs and paramedics.
  • Air: Critical care nurses and paramedics.

This lecture concludes with assessment exercises and emphasizes the importance of understanding kinetic energy, mechanism of injury, and types of impacts in trauma scenarios.

Full transcript