Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma...

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Transcript of Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma...

Page 1: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Blunt Trauma

Page 2: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis

Sections

Page 3: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Most common cause of trauma death and disability

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

Introduction toBlunt Trauma

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KinematicsKinematics

Process of examining the scene to determine potential injuries that result from the forces of motion

Windshield, steering wheel, dashboard Was the patient flying thru the air? Roll-over? Engine block on lap? (intrusion)

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MOIMOI

Mechanism of injury description of the mechanical and

physiological changes that result in anatomical or functional damage of tissue

Translation: What hit the patient???, what did the patient hit???!

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Index of SuspicionIndex of Suspicion

Based on the MOI and kinetics Predict expected injuries Experience counts here! Be obsessive and compulsive, its OK!!

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Kinetics of Blunt Trauma 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.” (Newton)

Conservation of Energy “Energy can neither be created nor

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

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Force (Newton’s 2nd law of motion)

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

Kinetics of Blunt Trauma

onAcceleratiMassForce

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SOOOO

The Force that puts an object in motion must be absorbed before the object will stop.

Guess what absorbs that force???? This absorption is what causes tissue

injury in the body.

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Kinetic Energy Energy in Motion

Double Weight = Double Energy Double Speed = Quadruple Energy

SPEED IS THE GREATESTDETERMINANT

Kinetics of Blunt Trauma

2

)()( 2speedVelocityweightMassKE

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Physics (UGH!)

Three types of forces in blunt trauma Compression Shear Overpressure

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Compression

Like laying an organ on a table and hitting it with a hammer, every time you hit it, cells are getting compressed and crushed.

Enough said…..

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Shear

Occur when the organ and the organ’s attachment do not accelerate or decelerate at the same rate of speed, or two parts of an organ accelerate or decelerate at different rates.

Examples are arch of aorta, spleen, kidney.

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Overpressure

Like hitting a closed paper bag with the

open hand….the bag pops. Examples are like steering column hitting

abdomen…pop! goes the diaphragm. Also can pop bladder, bowel, lungs……

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

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

Ligamentum teres in the chest for example

Types of Trauma

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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: Car Crashes

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Inertia and MVC’s

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Protections (think Volvo!)

Steel frame Belts Bags Seat construction Roof Crumple Zones

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Restraints Seatbelts

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

Injuries if worn separately Airbags (SRS)

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

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

Blunt Trauma: Car Crashes

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Benefits of Air bags

700-1000 lives saved if all vehicles had head protecting SABs per year

In side impacts where someone died, 60% suffered brain injury.

Only 92 cases of SAB injury, 6 involving children, with no major injuries, only one minor injury (skin lac).

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Bags and Belts

Burns, abrasions Do not protect when a second collision hits! Abdominal injuries (seat too close) Chest injuries (short, elderly) Seat belt abrasions above the pelvis account for

a 30-60% incidence of intra-abdominal injuries: intestinal rupture, mesenteric injury, vascular disruption

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

Left & Right – Front & Rear Rear-end: 9% Rollover: 6%

Blunt Trauma: Automobile Crashes

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Frontal Impact Down-and-Under (legs lead point)

Knee, femur, and hip fracture (dislocation of knee, fx acetabulum) Chest trauma-Steering Wheel

Up-and-Over (head lead point) Head, c-spine injuries Tenses legs = Bilateral femur fracture Hollow organ rupture and liver laceration Similar chest trauma Axial Loading

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

Blunt Trauma: Car Crashes

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Lateral Impact (intersection race) 15% of MVC’s but 22% of deaths Upper extremity injury Rib, clavicle, humerus, pelvis, femur fracture, c-

spine dislocations, locked facets. Lateral compression

Ruptured diaphragm, Spleen fracture, Aortic injury

EVALUATE the unrestrained occupant

Blunt Trauma: Automobile Crashes

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

secondary object

Blunt Trauma:Car Crashes

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

Stretching of neck muscles and ligaments Hyperextension & hyperflexion (think carotid)

Rollover Multiple points of impact Ejection or partial ejection (think: arm out of

window, then roll….) Less injury with restraints

Blunt Trauma:Car Crashes

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Vehicle Crash Analysis Crumple Zones Intrusion (one inch for each mile per hour) Deformity of Vehicle Use of Restraints

Intoxication Fatal Accidents: >50% involved ETOH Recreational Accidents

Blunt Trauma: Automobile Crashes

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

Blunt Trauma: Automobile Crashes

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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 CrashWeather & visibility?Alcohol involved?Skid marks?

Auto InteriorStarring of windshield?Steering wheel deformity?Dash deformity?Intrusion?

Cause of CrashWeather & visibility?Alcohol involved?Skid marks?

Auto InteriorStarring of windshield?Steering wheel deformity?Dash deformity?Intrusion?

Blunt Trauma: Automobile CrashesCrash Evaluation

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The “Lucky Other Guy”

The passenger in the same car as the deceased driver for example.

BUT, this “lucky”person was in the same vehicle and the energy exchange on the body was the same.

So you’d better find that unrecognized injury!

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Serious injuries can occur with high and low speed collision.

Types of Impact Frontal Angular Sliding (“laying the bike down”) Ejection

Initial Bike/Object Collision Rider/Object Rider/Ground

Blunt Trauma: Motorcycle Crashes

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Motorcycle Injuries

No helmet use increases chance of head

injury by 300%. Does not protect c-spine, but does not

injure it either. Anti-helmet organizations such as

American Motorcycle Association may say different………

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Adults Adults turn away and run (lat,post injuries) Bumper strikes lower legs first Victim rolls up and over and thrown

Children Children turn toward (ant injuries) Femurs, Pelvis often injured Thrown away or run over

Blunt Trauma:Pedestrian Struck

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Lack structure and restraint system Types of Vehicles

Snowmobiles Personal watercraft ATV’s

Blunt Trauma: Recreational Vehicle Accidents

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Falls Stairs, Force, Surface Landing Area

Surface Type Body Part

Height of Fall (3 times height of victim) Elderly Axial Loading…..

Other Types of Blunt Trauma

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Maam, you aren’t on Coumadin, are you??????

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Crush Injuries Cause

Structural collapse, explosion, industrial; or agricultural 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 Care

Prolonged crush Medications Sodium Bicarbonate: Reduce Acidosis Morphine: Pain management

Other Types of Blunt Trauma

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Blast Injuries Dust, Fumes, Explosive Compounds

Explosion Fuel + Oxidant combine instantaneously Heat & Pressure Wave

Blunt Trauma: Blast Injuries

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Primary InjuriesPrimary Injuries rapid changes in atmospheric pressure from

movement of blast wave hollow organs more susceptible blast wave rapidly passes through tissue of

varying density; if lower density is adjacent to higher density surface tissue of denser tissue is disrupted- “spalling” as wave transverses the walls of the alveoli (high density), they rupture as the wave encounters the air within the alveoli (low density); massive destruction of alveoli and diffuse hemorrhage in lung

Page 54: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Implosion pressure wave passes through the lung, it

forces blood out of the vascular space and into the alveoli

wave of high pressure is followed by wave of low pressure allowing alveoli to expand rapidly with further tearing of the lung parenchyma, atelectasis, hemorrhage

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Secondary InjurySecondary Injury

Results from flying debris created by the explosion and carried by blast winds

injuries are typically severe and penetrating due to high KE of projectiles

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Tertiary InjuriesTertiary Injuries

Blast winds are sufficient force to cause victims to become human missiles

victim strikes the ground

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Associated InjuriesAssociated Injuries

Injuries resulting from changes in the environment as a consequence of the explosion fire; burns combustion of toxic products; poisoning leaks of toxic chemicals; asphyxiation

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Explosion

Pressure Wave Structural Collapse Blast Wind

Burns Projectiles Personnel Displacement Blast Injury Phases

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

collapse

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Blast Injury Assessment 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

Explosion

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Blast Injury Care Lungs

Forceful compression and distortion of chest cavity

Compression and decompression Pulmonary Embolism, Dyspnea, Hemoptysis,

Pneumothorax Abdomen

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

into thorax area

Explosion

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Blast 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.

Explosion

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Blunt Chest Trauma

Blunt Chest Trauma

Blunt Ankle Trauma

Blunt Ankle Trauma

Cervical Injuries and Blunt Trauma

Cervical Injuries and Blunt Trauma

Chapter 17 Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma

Chapter 17 Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma

Imaging of Blunt Abdominal Trauma

Imaging of Blunt Abdominal Trauma

BLUNT TRAUMA TO EYE

BLUNT TRAUMA TO EYE

Pediatric Blunt Abdominal Trauma

Pediatric Blunt Abdominal Trauma

Blunt Trauma Forensic Medicine

Blunt Trauma Forensic Medicine

blunt trauma on the eye

blunt trauma on the eye

Secondary survey - ICET NEPEAN€¦ · Two most common forms of injury are blunt trauma and penetrating trauma . Blunt trauma – compression injury . Blunt trauma – shearing injury

Secondary survey - ICET NEPEAN€¦ · Two most common forms of injury are blunt trauma and penetrating trauma . Blunt trauma – compression injury . Blunt trauma – shearing injury

Abdominal Trauma - Blunt · 2018-05-15 · Abdominal Trauma - Blunt Inclusion Criteria: • Blunt Abdominal Trauma • Cooperative patient • Stable Vital Signs (RR>8 or

Abdominal Trauma - Blunt · 2018-05-15 · Abdominal Trauma - Blunt Inclusion Criteria: • Blunt Abdominal Trauma • Cooperative patient • Stable Vital Signs (RR>8 or

Blunt Force Trauma-final

Blunt Force Trauma-final

Blunt Thoracic Trauma

Blunt Thoracic Trauma

Blunt Abdominal Trauma: Evaluation

Blunt Abdominal Trauma: Evaluation

Blunt Abdominal Trauma - Mosbrook Design

Blunt Abdominal Trauma - Mosbrook Design

Blunt and Penetrating Trauma - Medscape

Blunt and Penetrating Trauma - Medscape

Blunt Force Trauma

Blunt Force Trauma

Trauma– Blunt Abdominal Trauma

Trauma– Blunt Abdominal Trauma

Blunt abdominal trauma

Blunt abdominal trauma

Blunt injury abdomen(renal trauma&mesenteric trauma)

Blunt injury abdomen(renal trauma&mesenteric trauma)