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Paramedic CarePrinciples & Practice

Volume 4Trauma Emergencies

Second Edition

Chapter 2

Blunt Trauma

Figure 2-1 Blunt trauma is the most common cause of injury and trauma-related death. It is a physical exchange of energy from an object or surface transmitted through the skin into the body’s interior. (© Craig Jackson/In the Dark Photography)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-2 Increasing mass directly increases kinetic energy, while increasing velocity exponentially increases kinetic energy.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

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Figure 2-3 (a) Blunt trauma results when an object or force impacts the body and kinetic energy is transferred to the involved body tissues. (b) Penetrating injury is produced when an object enters the body resulting in direct injury

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

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Figure 2-4   An automobile crash generates four major collisions: (a) the vehicle collision, (b) the body collision, (c) the organ collision, and (d) secondary collisions.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-4 (continued)   An automobile crash generates four major collisions: (a) the vehicle collision, (b) the body collision, (c) the organ collision, and (d) secondary collisions.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-4 (continued)   An automobile crash generates four major collisions: (a) the vehicle collision, (b) the body collision, (c) the organ collision, and (d) secondary collisions.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-4 (continued)   An automobile crash generates four major collisions: (a) the vehicle collision, (b) the body collision, (c) the organ collision, and (d) secondary collisions.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-5 Air bags cushion the driver from the forces of impact and significantly reduce mortality and morbidity in frontal impact collisions.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-6 Incidence of motor vehicle impacts.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-7 Frontal impact often results in a significant exchange of energy and serious injuries. (© Craig Jackson/In the Dark Photography)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-8 The up-and-over pathway is associated with frontal impact collisions.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-9 The “paper bag” syndrome results from compression of the chest against the steering column.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

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Figure 2-10 Crumple zones provide significant protection with both frontal and rear-end impacts but much less in cases of lateral impacts.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-11 A lateral impact collision presents the least amount of crumple zone between the vehicle’s exterior and its passenger compartment. (© Craig Jackson/In the Dark Photography)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-12 In a lateral impact collision, an occupant may experience lateral impact to the head, lateral bending of the neck, twisting of the heart and the aorta, and fractures of the humerus, clavicle, pelvis, and femur.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-13 In rotational impacts, the energy exchange is more gradual and there may be less injury than vehicle damage suggests. There may, however, be multiple impacts. (© Mark C. Ide)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-14 In rear-end impacts there is generally good protection for the body, except for the head and neck. (© Craig Jackson/In the Dark Photography)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-15 A rear-end collision affects the occupant of a vehicle.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-16 Rollover crashes result in multiple impacts and, possibly, multiple injury mechanisms. (© Jeff Forster)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

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Figure 2-17 Study the interior of a crashed vehicle carefully to identify the strength and direction of forces expressed to the patient. (© Jeff Forster)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-18 Motorcycle crashes result in serious trauma because the cycle provides little protection for its rider. (© Jeff Forster)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-19 An adult frequently turns away from a collision with an automobile and thus impacts the vehicle first with a leg. Because of a higher center of gravity, such patients are often thrown onto the hood and into the windshield.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-20 In collisions with autos, children often turn toward the impact and, because of their lower body heights, are frequently thrown in front of the vehicle.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-21 Watercraft crashes are common, may involve either objects on the surface or submerged, and present the risks of drowning or hypothermia. (© Craig Jackson/ In the Dark Photography)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-22 All-terrain vehicles (ATVs) can cause a multitude of injuries due to their speed and instability and lack of rider protection.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-23 An explosion releases tremendous amounts of heat energy, generating a pressure wave, blast wind, and projection of debris.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-24 Blasts can cause injury with the initial blast, when the victim is struck by debris, or when the victim is thrown by the blast or injured by structural collapse.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-25 In falls, energy is transmitted along the skeletal system.

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Figure 2-26 Contact sports may result in the exchange of great kinetic forces and produce serious injuries. (© Jeff Forster)

Bryan E. Bledsoe, Robert S. Porter, and Richard A. CherryParamedic Care, Principles & Practice: Trauma Emergencies

Copyright ©2006 by Prentice-Hall, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

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