TraumaTraumaComprehensive Review Comprehensive Review

Time vs. SurvivalTime vs. Survival Relationship of time to Relationship of time to

survival survival The “golden hour”The “golden hour” Importance of an Importance of an

organized approach to organized approach to traumatrauma

Scene Size-upScene Size-up

Body substance isolation reviewBody substance isolation review Scene safetyScene safety Total number of patientsTotal number of patients Essential equipment and Essential equipment and

resources needed on-sceneresources needed on-scene Mechanisms of injuryMechanisms of injury

It is important to be It is important to be aware of mechanisms of aware of mechanisms of

injury because…injury because…

Basic Mechanisms of Motion Basic Mechanisms of Motion InjuryInjury

Blunt injuriesBlunt injuries Rapid forward deceleration (collisions)Rapid forward deceleration (collisions) Rapid vertical deceleration (falls)Rapid vertical deceleration (falls) Energy transfer from blunt objects Energy transfer from blunt objects

(bat, stick)(bat, stick) Penetrating injuriesPenetrating injuries

ProjectilesProjectiles KnivesKnives Falls upon fixed objectsFalls upon fixed objects

Clues to Injury Clues to Injury Motor Vehicle CollisionMotor Vehicle Collision

Vehicle damageVehicle damage What forces were involved in the collision?What forces were involved in the collision?

Intrusion > 12 in occupant compartmentIntrusion > 12 in occupant compartment Intrusion > 18 in anywhere elseIntrusion > 18 in anywhere else

Damage to interior structuresDamage to interior structures What did the patient hit?What did the patient hit?

Injury patterns on the patientInjury patterns on the patient What anatomic areas were hit?What anatomic areas were hit?

Newtons LawNewtons Law

Says what……….?Says what……….?

LinkLink

3 “Impacts” in each Accident3 “Impacts” in each Accident

1.1. Car vs Slower or stopped objectCar vs Slower or stopped object

2.2. Person vs Car (e.g wheel)Person vs Car (e.g wheel)

3.3. Organs vs Boney cage (e.g brain Organs vs Boney cage (e.g brain vs inside of cranium)vs inside of cranium)

History taking History taking Scene survey (use your knowledge of trauma kinetics to extract Scene survey (use your knowledge of trauma kinetics to extract

information from the scene)information from the scene) Ask bystanders what they saw, heard and their initial assessmentAsk bystanders what they saw, heard and their initial assessment Ask first responders their initial impressionsAsk first responders their initial impressions Ask patient some questions?Ask patient some questions? Keep in mind what the trauma team wants to know. 4 main questionsKeep in mind what the trauma team wants to know. 4 main questions

11 22 33 44

Time frame – actual vs perceivedTime frame – actual vs perceived History taking and “recreation” of the crash is the only thing that History taking and “recreation” of the crash is the only thing that

separates the real medic from the layperson who looks at the separates the real medic from the layperson who looks at the destruction and crash scenedestruction and crash scene

What also does it do re: patient injuries and expectations?What also does it do re: patient injuries and expectations?

Rapid forward deceleration

Rapid vertical deceleration

Energy transfer from blunt instruments

ITLSITLS

See table 1-3 Mechanism of injury and See table 1-3 Mechanism of injury and potential injury patternspotential injury patterns

Read Chapter 1Read Chapter 1

Different Kinds of MVC’sDifferent Kinds of MVC’s

Fontal (head on)Fontal (head on) T boned 0 side impactT boned 0 side impact RolloverRollover Rear endedRear ended

Head onHead on

Patient TrappedPatient Trapped

““down and under”down and under” Forces on upper legs to force them under the Forces on upper legs to force them under the

dashboarddashboard Specific injuries occurSpecific injuries occur

Head on CrashHead on Crash

LinkLink

Lateral-impact Collision- T boneLateral-impact Collision- T bone

Machine Machine collisioncollision

Body collisionBody collision Organ collisionOrgan collision

Courtesy of Bonnie Meneely, EMT-P

Rear-impact CollisionRear-impact Collision

Machine Machine collisioncollision

Body collisionBody collision Organ collisionOrgan collision

Courtesy of Bonnie Meneely, EMT-P

Occupant Restraint SystemsOccupant Restraint Systems

Lap beltsLap belts Cross-chest lap beltCross-chest lap belt Air bagsAir bags

Passive restraint system.Passive restraint system. No hazardous materials are released.No hazardous materials are released. Always “lift and look” under the air bag.Always “lift and look” under the air bag.

Deformity of wheel suggests impact.Deformity of wheel suggests impact.

Small Vehicle CrashesSmall Vehicle Crashes

MotorcyclesMotorcycles MopedsMopeds E BikesE Bikes All-terrain vehiclesAll-terrain vehicles Personal watercraftPersonal watercraft SnowmobilesSnowmobiles

Car Vs PedestrianCar Vs Pedestrian

Pedestrian InjuriesPedestrian Injuries

Patient sustains Patient sustains high-energy high-energy transfer.transfer. Even with low-Even with low-

speed collisionspeed collision Patient may have Patient may have

“second impact” “second impact” injuries.injuries.

Courtesy of Bonnie Meneely, EMT-P

Donor CyclesDonor Cycles

HelmetHelmet Ensure you review helmet removal Ensure you review helmet removal

techniquetechnique Look at it carefullyLook at it carefully Inspect for damageInspect for damage Bring to ER with youBring to ER with you Helmet tells a story too!Helmet tells a story too!

Patients may not look as injuredPatients may not look as injured

ExplosionsExplosions

Need to know the force involvedNeed to know the force involved Patient thrown?Patient thrown? How far?How far? Contact surface?Contact surface? Heat or fire involved?Heat or fire involved? Assume trauma and full c- spine supportAssume trauma and full c- spine support Hazmat?Hazmat? Three phases…Three phases…

Blast InjuriesBlast Injuries

Scene Size-upScene Size-up Scene safety!Scene safety! May involve May involve

multiple multiple patientspatients

MechanismMechanism PrimaryPrimary SecondarySecondary TertiaryTertiary Courtesy of Bonnie Meneely, EMT-P

FallsFalls

FALLSFALLSInjuries depend upon 3 factors:Injuries depend upon 3 factors:

Distance of fallDistance of fall Elderly may fracture hip from “trivial” fall.Elderly may fracture hip from “trivial” fall.

Anatomic area impactedAnatomic area impacted Patients landing on their feet may have Patients landing on their feet may have

injury to knees, hips, or lumbar spine.injury to knees, hips, or lumbar spine. Patients landing on their heads may have Patients landing on their heads may have

cervical spine injury.cervical spine injury.

Surface hitSurface hit

ForcesForces in fallsin falls

Something called Axial loadingSomething called Axial loading Along the long axis of the bodyAlong the long axis of the body

Case StudyCase Study

Classic 21 yr old datingClassic 21 yr old dating

A 14 year old. Parents A 14 year old. Parents

Come home and “Don” jumps out 3Come home and “Don” jumps out 3rdrd story story balcony!balcony!

Fractures ankles and wrist ? Lumbar #Fractures ankles and wrist ? Lumbar #

Tractor AccidentsTractor Accidents Rear overturns Rear overturns

(15%)(15%) More likely to More likely to

crush the drivercrush the driver Side overturns Side overturns

(85%)(85%) MechanismMechanism

Crush injuriesCrush injuries Thermal & Thermal &

chemical burnschemical burnssy of Roy Alson, M.D.

Courtesy of Roy Alson, M.D.

Penetrating InjuriesPenetrating InjuriesKnives & Other ObjectsKnives & Other Objects

Severity depends upon:Severity depends upon: SiteSite Length of objectLength of object Angle of penetrationAngle of penetration

Below 4th intercostal Below 4th intercostal space may involve chest space may involve chest and abdomen.and abdomen.

Do not remove impaled Do not remove impaled object.object.

Courtesy of Bonnie Meneely, EMT-P

Penetrating InjuriesPenetrating InjuriesGunshot WoundsGunshot Wounds

Remember scene safety!Remember scene safety! Severity depends upon:Severity depends upon:

Anatomic area struck & Anatomic area struck & tissue densitytissue density

Missile velocity & sizeMissile velocity & size Type of bullet Type of bullet (hollow(hollow

point, shot shell, jacketed)point, shot shell, jacketed)

Preserve evidence if Preserve evidence if possible.possible. Courtesy of Bonnie Meneely, EMT-P

Collision SummaryCollision Summary Note type of collision.Note type of collision. Note evidence of high-energy Note evidence of high-energy

transfer.transfer. Maintain high index of suspicion.Maintain high index of suspicion. Keep scene time to a minimum.Keep scene time to a minimum. Relay observations to receiving Relay observations to receiving

physician.physician.

More to comeMore to come

Ensure you do the readings of ITLS and Ensure you do the readings of ITLS and Bledsoe for traumaBledsoe for trauma

Tomorrow TTGTomorrow TTG