Chapter 17Chapter 17Blunt TraumaBlunt Trauma

Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma

Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma

TopicsTopics

Most common cause of trauma death and disability

Energy exchange between an object and the human body, without intrusion through the skin

Most common cause of trauma death and disability

Energy exchange between an object and the human body, without intrusion through the skin

Introduction toIntroduction toBlunt TraumaBlunt Trauma

Blunt trauma can be deceptive because the true nature of the

injury is often hidden and evidence of the serious injury is

very subtle or even absent.

Blunt trauma can be deceptive because the true nature of the

injury is often hidden and evidence of the serious injury is

very subtle or even absent.

Kinetics of Blunt Kinetics of Blunt TraumaTrauma Inertia

“A body in motion will remain in motion unless acted upon by an outside force.”

“A body at rest will remain at rest unless acted upon by an outside force.”

Conservation of Energy “Energy can neither be created nor

destroyed. It is only changed from one form to another.”

Kinetic versus Potential Energy

Inertia “A body in motion will remain in motion

unless acted upon by an outside force.” “A body at rest will remain at rest unless

acted upon by an outside force.”

Conservation of Energy “Energy can neither be created nor

destroyed. It is only changed from one form to another.”

Kinetic versus Potential Energy

Kinetic Energy Energy in Motion

Double Weight = Double Energy Double Speed = Quadruple Energy

SPEED IS THE GREATESTDETERMINANT

Kinetic Energy Energy in Motion

Double Weight = Double Energy Double Speed = Quadruple Energy

SPEED IS THE GREATESTDETERMINANT

Kinetics of Blunt Kinetics of Blunt TraumaTrauma

2

)()( 2speedVelocityweightMassKE

Force

Emphasizes the importance of rate at which an object changes speed (acceleration or deceleration)

Force

Emphasizes the importance of rate at which an object changes speed (acceleration or deceleration)

Kinetics of Blunt Kinetics of Blunt TraumaTrauma

onAcceleratiMassForce

Blunt Closed injury Indirect injury to underlying structures Transmission of energy into the body

Tearing of muscle, vessels and bone Rupture of solid and hollow organs Organ injury

• Ligamentum teres• Aorta tear

Penetrating Open injury Direct injury to underlying structures

Blunt Closed injury Indirect injury to underlying structures Transmission of energy into the body

Tearing of muscle, vessels and bone Rupture of solid and hollow organs Organ injury

• Ligamentum teres• Aorta tear

Penetrating Open injury Direct injury to underlying structures

Types of TraumaTypes of Trauma

44,000 people die each year on US highways

Events of Impact Vehicle Collision Body Collision Organ Collision Secondary Collisions

Objects inside vehicle strike occupant Additional Injuries

Vehicle receives a second impact

44,000 people die each year on US highways

Events of Impact Vehicle Collision Body Collision Organ Collision Secondary Collisions

Objects inside vehicle strike occupant Additional Injuries

Vehicle receives a second impact

Blunt Trauma: Blunt Trauma: Automobile CrashesAutomobile Crashes

Inertia and MVC’sInertia and MVC’s

Restraints Seatbelts

Occupant slows with the vehicle Shoulder and Lap belts MUST be worn together

Airbags (SRS) Reduce blunt chest trauma Cause: Hand, Forearm, Facial Injury & Neck Check for steering wheel deformity Side Airbags

Child Safety Seats Infants and Small Children: Rear facing Older Child: Forward facing

Restraints Seatbelts

Occupant slows with the vehicle Shoulder and Lap belts MUST be worn together

Airbags (SRS) Reduce blunt chest trauma Cause: Hand, Forearm, Facial Injury & Neck Check for steering wheel deformity Side Airbags

Child Safety Seats Infants and Small Children: Rear facing Older Child: Forward facing

Blunt Trauma: Blunt Trauma: Automobile CrashesAutomobile Crashes

Types of Impact Frontal: 32% Lateral: 15% Rotational: 38%

Left & Right – Front & Rear

Rear-end: 9% Rollover: 6%

Types of Impact Frontal: 32% Lateral: 15% Rotational: 38%

Left & Right – Front & Rear

Rear-end: 9% Rollover: 6%

Blunt Trauma: Blunt Trauma: Automobile CrashesAutomobile Crashes

Down-and-Under Knee, femur, and hip fracture Chest trauma-Steering Wheel

Paper Bag Syndrome

Up-and-Over Tenses legs = Bilateral femur fracture Hollow organ rupture and liver laceration Similar chest trauma to down under Axial Loading

Ejection Due to up-and-over pathway Contact with the vehicle & external object

Down-and-Under Knee, femur, and hip fracture Chest trauma-Steering Wheel

Paper Bag Syndrome

Up-and-Over Tenses legs = Bilateral femur fracture Hollow organ rupture and liver laceration Similar chest trauma to down under Axial Loading

Ejection Due to up-and-over pathway Contact with the vehicle & external object

Frontal ImpactFrontal Impact

15% of MVC’s but 22% of deaths Upper extremity injury Rib, clavicle, humerus, pelvis,

femur fracture, skull and brain Lateral compression

Ruptured diaphragm, Spleen fracture, Aortic injury

EVALUATE the unrestrained occupant on opposite side

15% of MVC’s but 22% of deaths Upper extremity injury Rib, clavicle, humerus, pelvis,

femur fracture, skull and brain Lateral compression

Ruptured diaphragm, Spleen fracture, Aortic injury

EVALUATE the unrestrained occupant on opposite side

Lateral ImpactLateral Impact

Rotational Vehicle struck at oblique angle Less serious injuries unless strike a secondary object

Rear-end Seat propels the occupant forward Head is forced backwards, then forwards

Stretching of neck muscles and ligaments Hyperextension & hyperflexion

Rollover Multiple points of impact Ejection or partial ejection Less injury with restraints

Rotational Vehicle struck at oblique angle Less serious injuries unless strike a secondary object

Rear-end Seat propels the occupant forward Head is forced backwards, then forwards

Stretching of neck muscles and ligaments Hyperextension & hyperflexion

Rollover Multiple points of impact Ejection or partial ejection Less injury with restraints

Other Types of Other Types of CrashesCrashes

Vehicle Crash Analysis Hazards Crumple Zones Intrusion Deformity of Vehicle Use of Restraints and airbags

Intoxication LOA, Head Injury, Pain sensation, Fatal Accidents: >50% involved ETOH Recreational Accidents

Vehicle Crash Analysis Hazards Crumple Zones Intrusion Deformity of Vehicle Use of Restraints and airbags

Intoxication LOA, Head Injury, Pain sensation, Fatal Accidents: >50% involved ETOH Recreational Accidents

Blunt Trauma: Blunt Trauma: Automobile CrashesAutomobile Crashes

Head: 48% Internal (Torso): 37% Spinal & Chest fracture: 8% Extremity fracture: 2% All Other: 5%

Head: 48% Internal (Torso): 37% Spinal & Chest fracture: 8% Extremity fracture: 2% All Other: 5%

Vehicular MortalityVehicular Mortality

Collision Questions

How did collision occur?

Direction? Speed? Similar/Different

sized? Secondary

collisions?

Collision Questions

How did collision occur?

Direction? Speed? Similar/Different

sized? Secondary

collisions?

Cause of Crash Weather & visibility? Alcohol involved? Skid marks?

Auto Interior Starring of

windshield? Steering wheel

deformity? Dash deformity? Intrusion?

Cause of Crash Weather & visibility? Alcohol involved? Skid marks?

Auto Interior Starring of

windshield? Steering wheel

deformity? Dash deformity? Intrusion?

Crash EvaluationCrash Evaluation

Serious injuries can occur with high and low speed collision.

Types of Impact Frontal Angular Sliding Ejection

Initial Bike/Object Collision Rider/Object Rider/Ground

Serious injuries can occur with high and low speed collision.

Types of Impact Frontal Angular Sliding Ejection

Initial Bike/Object Collision Rider/Object Rider/Ground

Motorcycle CrashesMotorcycle Crashes

Adults Adults turn away Bumper strikes lower legs first Victim rolls up and over and thrown

Children Children turn toward Femurs, Pelvis often injured Thrown away or run over

Adults Adults turn away Bumper strikes lower legs first Victim rolls up and over and thrown

Children Children turn toward Femurs, Pelvis often injured Thrown away or run over

Pedestrian AccidentsPedestrian Accidents

Lack structure and restraint system

Often are off road scenes Types of Vehicles

Snowmobiles Personal watercraft ATV’s

Lack structure and restraint system

Often are off road scenes Types of Vehicles

Snowmobiles Personal watercraft ATV’s

Recreational Vehicle Recreational Vehicle AccidentsAccidents

Blast Injuries Dust, Fumes, Explosive Compounds

Explosion Fuel + Oxidant combine instantaneously Heat & Pressure Wave

Blast Injuries Dust, Fumes, Explosive Compounds

Explosion Fuel + Oxidant combine instantaneously Heat & Pressure Wave

Blast InjuriesBlast Injuries

ExplosionExplosion Pressure Wave

Structural Collapse Blast Wind

Burns Projectiles Personal Displacement Blast Injury Phases

Primary: Heat of the explosion and pressure wave Secondary: Trauma caused by projectiles Tertiary: Personnel displacement and structural

collapse

Pressure Wave Structural Collapse Blast Wind

Burns Projectiles Personal Displacement Blast Injury Phases

Primary: Heat of the explosion and pressure wave Secondary: Trauma caused by projectiles Tertiary: Personnel displacement and structural

collapse

Be alert for secondary device Initial scene size-up important Establish Incident Command

System (ICS) Evaluate for secondary hazards Injury Patterns

Rupture of Air or Fluid Filled Organs Lung: Late manifestation (heat & pressure) Hearing loss

Be alert for secondary device Initial scene size-up important Establish Incident Command

System (ICS) Evaluate for secondary hazards Injury Patterns

Rupture of Air or Fluid Filled Organs Lung: Late manifestation (heat & pressure) Hearing loss

Blast Injury Blast Injury AssessmentAssessment

Lungs Forceful compression and distortion of chest

cavity Compression and decompression

Pulmonary Embolism, Dyspnea, Hemoptysis, Pneumothorax

Oxygen and ventilation

Abdomen Compression & Decompression Release of bowel contents Diaphragm rupture from pushing of organs

up into thorax area

Lungs Forceful compression and distortion of chest

cavity Compression and decompression

Pulmonary Embolism, Dyspnea, Hemoptysis, Pneumothorax

Oxygen and ventilation

Abdomen Compression & Decompression Release of bowel contents Diaphragm rupture from pushing of organs

up into thorax area

Blast Injury CareBlast Injury Care

Ears Initial Hearing Loss Injury improves over time

Penetrating Wounds Care as any serious open wound or impaled

object

Burns Treatment consistent with traditional

management.

Ears Initial Hearing Loss Injury improves over time

Penetrating Wounds Care as any serious open wound or impaled

object

Burns Treatment consistent with traditional

management.

Blast Injury CareBlast Injury Care

Falls Force = mass x acceleration(deceleration) Stairs, Force, Surface Landing Area

Surface Type Body Part

Height of Fall Elderly

Falls Force = mass x acceleration(deceleration) Stairs, Force, Surface Landing Area

Surface Type Body Part

Height of Fall Elderly

Other Types of Other Types of Blunt TraumaBlunt Trauma

Various Injury Patterns Produced by extreme exertion, fatigue or direct

trauma Acceleration, deceleration, compression, rotation,

hyperextension, or hyperflexion

Unconsciousness, neurological defect or decreased mental status require physician follow-up

Protective Gear reduces injury pattern Helmet Removal

Various Injury Patterns Produced by extreme exertion, fatigue or direct

trauma Acceleration, deceleration, compression, rotation,

hyperextension, or hyperflexion

Unconsciousness, neurological defect or decreased mental status require physician follow-up

Protective Gear reduces injury pattern Helmet Removal

Sports InjuriesSports Injuries

Cause Structural collapse, explosion, industrial,

agricultural, vehicles

Great force to soft tissue and bones

Tissue stretching and compression Extended pressure results in anaerobic

metabolism distal to compression Return of blood flow, toxins to entire body Severe hemorrhage due to severe damaged

blood vessels

Cause Structural collapse, explosion, industrial,

agricultural, vehicles

Great force to soft tissue and bones

Tissue stretching and compression Extended pressure results in anaerobic

metabolism distal to compression Return of blood flow, toxins to entire body Severe hemorrhage due to severe damaged

blood vessels

Crush InjuriesCrush Injuries

Blunt Trauma Types Causes of Blunt Trauma Assessment of Injury Injury Patterns

Blunt Trauma Types Causes of Blunt Trauma Assessment of Injury Injury Patterns

SummarySummary