Trauma Introduction

1
Trauma Introduction

• EMS Professions
• Temple College

2
Topics

• Morbidity Mortality
• Trauma Systems
• Prevention
• Kinematics Energy Transfer
• Predicting Injuries

3
Morbidity Mortality

• Leading cause of death 1 - 44 years
• 4th cause overall
• 140,000 unexpected deaths/yr
• gt 40,000 related to automobiles
• Expense
• 177 billion in 1991

4
Morbidity and Mortality

• Focus of EMT creation in 1960s
• Survival largely (not entirely) dependent upon
  time to definitive care
• The Golden Hour Concept vs. Rule
• EMS role
• Early recognition through assessment
• Prevention of Secondary Injury
• Rapid transport to appropriate facility

5
Trauma System Components

• Injury prevention
• Prehospital care
• Transportation
• Trauma triage guidelines
• Emergency department care

• Interfacility transportation
• Trauma critical care
• Rehabilitation
• Data collection/ trauma registry
• Research

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Trauma Systems

• Trauma centers
• Levels
• I, II, III and IV
• Qualifications
• Essential
• Desired
• Voluntary Designation

7
Trauma Transport Considerations

• Level of receiving facility needed
• Mode of transport
• Ground transport
• Appropriate facility reached within reasonable
  time
• To a landing zone for air medical transport
• Air medical transport
• Indications
• Contraindications
• Procedure

8
Prevention

• Integral part of EMS
• Early
• Immediate
• Late

9
Recognition Mechanisms of Injury

• Simple Classifications of Mechanisms
• Cause Related
• Motor Vehicle Accident/Crash
• Fall
• GSW
• Stabbing
• Useful in initial assessment

• Classification by True Mechanism
• Force / Energy Related (Kinematics)
• Deceleration vs Acceleration
• Blunt vs. Penetrating
• Blast
• Thermal/Chemical

10
Predicting Severe Injury

• Incident Biomechanics
• Ejection from Vehicle
• Death of other occupant
• Falls gt 10 feet
• Pedestrian (gt 20 mph)
• High energy Transfer
• Head on, T-bone
• Significant Intrusion
• Motorcycle, ATV, Bicycle
• Prolonged Extrication/Transport

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Predicting Severe Injury

• Co-Morbid Factors
• Extremes of Age
• Underlying Disease Poor General Health
• Pregnancy
• Environmental Extremes
• Protective Devices
• TIME

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Kinematics vs. Mechanism

• Whats the difference?

13
Kinematics Energy Transfer

• Physical Laws
• Newtons First Law
• A body at rest or a body in motion will remain in
  that state until acted upon by an outside force
• Multiple collisions
• Conservation of energy
• Energy cannot be created nor destroyed
• It can change form

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Kinematics Energy Transfer

• Physical Laws
• Force
• Force Mass x Acceleration
• Force Mass x Deceleration
• Kinetic energy (KE)
• KE ½ m x V2
• What factor has the greatest influence on KE?

15
Energy Transfer

• Cavitation
• Energy exchange produces particle motion
• Temporary cavity
• Short lived
• Produced by stretching
• Dependent on the elasticity of the object
  involved
• Produces particle compression at the limits of
  the cavity
• Permanent cavity
• Visible when the energy exchange has been
  completed
• Produced by compression and destruction

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Energy Transfer

• Dependent on number of particles Density of
  bodies involved in the interaction
• Air Density
• Lungs, Intestinal Tract
• Water Density
• Vascular system, Liver, Spleen, Muscle
• Solid Density
• Bone, asphalt, steel
• Area of Interaction
• Shape, Position, or Fragmentation of Object

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Energy Transfer

• Blunt
• Tissue not penetrated
• Cavitation away from site of impact
• Cavitation in direction of impact
• Penetrating
• Tissue penetrated
• Cavitation at 90o to bullet pathway
• Tissue inline to penetration is crushed

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Predicting Injuries

• Frontal Collisions
• Lateral Impact
• Rear-End Collisions
• Rotational Roll-Over

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Frontal Collision

• What are the potential injuries?
• Key determining factors
• Down Under
• Up Over

20
Lateral Impact

• What are the potential injuries?
• Key determining factors

21
Rear-End Collisions

• What are the potential injuries?
• Key determining factors

22
Rotational Roll-Over

• What are the potential injuries?

23
Organ Collisions

• Blunt Trauma
• Compression
• Change in Velocity
• Acceleration or Deceleration
• Shear or Avulsion

24
Organ Collisions

• Restraint Systems
• Lap Belt
• Hold torso away from dash and steering column
• Prevents multiple impacts in rollover
• Prevents ejection
• Shoulder Harness
• Prevents forward motion of upper torso
• Prevents hyperflexion of upper torso around lap
  belt

25
Organ Collisions

• Restraint Systems
• Air Bags
• Alter rate of deceleration
• Child Safety Seats

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Motorcycle Collisions

• Differences from Automobile
• Rider impacts motorcycle parts
• Rider ejected over motorcycle
• Trapped between motorcycle and vehicle
• No protection from effects of deceleration

• Limited Protection
• Helmet
• 300 increased risk of brain injury w/o helmet
• Leathers
• Boots

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Pedestrian vs Motor Vehicle

• Injury patterns depend on
• height
• body surface facing impact
• child vs adult
• Waddells triad Femur/Pelvis, Abdomen/Chest,
  Head
• collisions
• initial, hood/windshield, ground

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Falls

• Factors Contributing to Injury
• Height of fall
• Surface of the impact
• Objects struck during the fall
• Body part of first impact
• Feet first
• Head first
• Parallel

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Penetrating Injuries

• Energy Exchange
• Area of Interaction
• Density
• Bullet deformation
• Tumbling
• Fragmentation
• Cavitation
• Permanent
• Temporary
• Available Energy

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Penetrating Injuries

• Available Energy
• Low Energy Weapons
• knife, ice pick, axe
• injury primarily due to cutting edge
• minimal cavitation

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Penetrating Injuries

• Available Energy
• Medium Energy Weapons
• muzzle velocity lt 1500 ft/sec
• hand guns, low power rifle
• small projectile
• moderate cavitation dependent on frontal area of
  bullet

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Penetrating Injuries

• Available Energy
• High Velocity Weapons
• muzzle velocity gt 1500 ft/sec
• military-type small caliber weapons (AK47, M16)
• severe cavitation dependent on frontal area of
  bullet

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Penetrating Injuries

• Pathway of missile
• Entrance wound
• skin tissue crushed inward at site of entry
• usually small, dark round or oval wound
• may have abrasions at edge of wound
• may have burn near site due to close proximity of
  weapon to skin
• Exit wound
• skin tissue pushed outward
• may be larger than entrance
• rough edges

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Blast Injuries

• Sources of Blasts
• 3 phases with different energy patterns
• Primary
• pressure wave
• heat wave
• Secondary
• struck by flying debris
• Tertiary
• patient becomes flying object

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Patient Management

• Primary Focus
• Rapid Assessment
• Airway Control
• Immediate and/or Preventative
• Ventilatory Ability
• ? Inspired O2
• Adequate rate and TV
• Correct mechanical obstacles

• Organ Perfusion
• BP target gt90 mm Hg
• Control internal external bleeding
• Prevent further Spinal Injury
• Immediate Continued
• Minimize Secondary Injury

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Patient Management

• Therapies
• Extrication
• SMR
• Airway Control
• Suctioning
• Endotracheal Intubation
• Ventilation
• Oxygen
• BVM
• Chest decompression

• Perfusion
• Controllable Bleeding
• IV Access
• Cautious fluids
• PASG/MAST
• Minimize 2 injury
• RAPID TRANSPORT to Surgical Facility

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Summary

• Traumatic mechanisms constitute a significant
  portion of EMS responses
• Most result in minor or no injury
• Small percentage are severe or life-threatening
  injuries
• Paramedics role lies in recognition and
  aggressive management of this small group
• Focus
• preventing secondary injury
• appropriate transport