Chapter 27

Trauma Overview: The TraumaPatient and the Trauma System

Copyright ©2010 by Pearson Education, Inc.All rights reserved.

Prehospital Emergency Care, Ninth EditionJoseph J. Mistovich • Keith J. Karren

Objectives

1. Define key terms introduced in this chapter.2. Explain why an understanding of kinetics is helpful to

understanding injury and trauma (slides 12-13).3. Describe the relationship of mass and velocity to

kinetic energy, including the relative contribution ofeach to the amount of kinetic energy (slide 14-15).

4. Explain the effects of acceleration and deceleration onkinetic energy and the potential for injury (slides 16-17).

5. Describe the impacts that take place in a typical motorvehicle collision (slides 20-21).

6. List situations in motor vehicle collisions in which youshould have a high index of suspicion for criticalinjuries (slides 24-25).

Objectives

7. Explain the typical patterns of injury associated witheach of the following types of motor vehicle impacts(slides 26-36):a. Frontalb. Rearc. Laterald. Rotational and rollovere. Vehicle–adult pedestrianf. Vehicle–child pedestrian

8. Discuss the effects of the use of restraint systems inmotor vehicle collisions (slides 37-38).

9. Explain the typical patterns of injury associated withmotorcycle collisions (slides 41-42).

Objectives

10. Describe factors that affect the pattern and severity ofinjury produced in falls (slides 43-46).

11. Compare and contrast injury patterns produced bylow-, medium-, and high-velocity penetratingmechanisms of injury (slides 47-53).

12. Describe the mechanisms by which blast injuriesproduce injury (slides 54-55).

13. Describe the principles of care for multisystem traumapatients (slides 56-57).

14. Explain the term “golden period” and identifyindications for an on-scene time of 10 minutes or lesswhen caring for trauma patients (slides 58-59).

Objectives

15. Differentiate the characteristics of Levels I, II, III, and IVtrauma centers (slides 60-61).

16. Identify patients who meet trauma triage criteria fortransportation to a trauma center (slide 59).

17. Discuss the “golden principles” and specialconsiderations in trauma care (slide 62-65).

Multimedia Directory

Slide 22 Types of Injuries from Motor Vehicle CollisionsAnimation

Slide 34 Mechanisms of Injuries in Vehicle CollisionsAnimation

Slide 53 Entrance and Exit Wounds Animation

Topics

The Kinetics of TraumaMechanisms of InjuryThe Multisystem Trauma PatientThe Golden PeriodThe Trauma SystemGolden Principles of Prehospital Trauma Care

CASE STUDYCASE STUDY

Dispatch

Respond to 49 Elm Street for a minor motorvehicle collision with a driver complaining

of pain in his knees.

EMS Unit 632

Time out 1307

• Police state they were taking a report of a minormotor vehicle collision when the patient begancomplaining of knee pain

• Patient’s vehicle appears to have been rear-ended

Upon Arrival

How would you proceed to assess andcare for this patient?

Back to Topics

The Kinetics ofTrauma

• Mechanism of injury (MOI)• Kinetics of trauma• Kinetics• Kinetic energy

(© Mark C. Ide) Back to Objectives

Mass and Velocity

Back to Objectives

(© Mark C. Ide)

Kinetic energy = mass x velocity² 2

Acceleration andDeceleration

Back to Objectives

• Law of inertia• Acceleration• Deceleration

Energy Changes Form andDirection

• Energy travels in a straight lineunless it meets interference

• Energy then changes form

Impacts

Back to Objectives

• Vehicle collision• Body collision• Organ collision

Types of Injuries from MotorVehicle Collisions

Return to Directory

Click here to view an animation on types of injuries from motor vehicle collisions.

Mechanisms of Injury

Back to Topics

Vehicle Collisions

Back to Objectives

• Speed• High index of suspicion

– Death of another occupant– Unresponsive or AMS– Intrusion of >12 inches– Ejection from the vehicle

• Types of collision

(© Mark C. Ide)

Vehicle Collisions

Frontal Impact

Back to Objectives

Frontal Impact

Vehicle Collisions

Rear-End Impact

(© Mark C. Ide)

Rear-EndImpact

Vehicle Collisions

Lateral Impact

(© Mark C. Ide)

Lateral Impact

Vehicle Collisions

Rotational or RolloverCrash

(© Mark C. Ide)

(© Jeff Forster)

Mechanisms of Injuries inVehicle Collisions

Return to Directory

Click here to view an animation on the mechanisms of injuries in vehiclecollisions.

Vehicle Collisions

Vehicle-PedestrianCollision

Vehicle-PedestrianCollision

• Depends on velocity• Common child injury pattern• Common adult injury pattern

(© Mark C. Ide)

Vehicle Collisions

Restraints: A Cause ofHidden Injuries

Back to Objectives

Restraints:A Cause of

Hidden Injuries

• Lap belts• Lap and

shoulder belts• Frontal air

bags

(© Edward T. Dickinson, MD)

Vehicle Collisions

Considerations forInfants and Children

• Car seats• Results in a

collision• Avoid

placement nearairbags

Considerationsfor Infants and

Children

Vehicle Collisions

Motorcycle Collisions

Back to Objectives

(© Mark C. Ide)

MotorcycleCollisions

• Head-on impact• Angular impact• Ejection• “Laying the Bike Down”• All-Terrain Vehicles

Falls

Feet-First Falls

Back to Objectives

Feet-First Falls

• Energy travel• Common injuries• Injuries from falls

more than 20 feet

Falls

Head-First Falls

• Hyperextension• Flexion• Compression• Types of injuries

Head-FirstFalls

Penetrating Injuries

Low-Velocity Injuries

Back to Objectives

• Area damaged• Types of injuries• Length of penetrating object

Penetrating Injuries

Medium- andHigh-Velocity Injuries

• Trajectory• Dissipation of

energy – Drag – Profile – Cavitation – Fragmentation

Medium- and High-Velocity Injuries

Penetrating Injuries

Gunshot Wounds

GunshotWounds

• Head• Chest• Abdomen• Extremities

Entrance and Exit Wounds

Return to Directory

Click here to view an animation about entrance and exit wounds.

Blast Injuries

Back to Objectives

The MultisystemTrauma Patient

Back to Topics

• Definition ofmultisystemtrauma

• High incidence ofmorbidity andmortality

• Rapid transportto trauma center

(© Mark C. Ide) Back to Objectives

The Golden Period

Back to Topics

• Definition• “Platinum ten minutes”• “High index of suspicion”

(© Ray Kemp/911 Imaging)Back to Objectives

The Trauma System

Back to Topics

(© Ray Kemp/911 Imaging)

• Level I – Regional trauma center• Level II – Area trauma center• Level III – Community trauma center• Level IV – Trauma facility

Back to Objectives

Golden Principles ofPrehospital Trauma

Care

Back to Topics

(© Ray Kemp/911 Imaging)

• Safety• Additional resources• Primary assessment• Spine stabilization• Patent airway• Adequate

oxygenation• PPV if needed• Control bleeding• Treat for shock

Back to Objectives

Special Considerations inTrauma Care

• Personal safety• Airway

management andventilation

• Stop significantbleeding

• Rapid transport• Use a backboard

to secure possiblefractures inunstable patients

• Don’t get tunnelvision

(© Ray Kemp/911 Imaging)

CASE STUDYCASE STUDY

Follow-Up

Primary Assessment• Patient’s name is Mike; 40-year-old

male• Complains of pain in knees; denies

wearing seatbelt• Alert and oriented; ABCs are fine• States he went down and under the

dashboard during impact

CASE STUDYCASE STUDY

Secondary Assessment• No evidence of bruising, swelling, or

deformity of knees• Apply cervical collar, place KED,

then place patient onto spine board• Once in ambulance, patient

complains of lumbar pain

CASE STUDYCASE STUDY

Secondary Assessment• Allergic to sulfa• Takes medications for allergies• Has history of asthma• Ate breakfast two hours ago

CASE STUDYCASE STUDY

Treatment and Reassessment• Reassess every 15 minutes• Place cold packs on knees• No change en route• Upon arrival, transfer care to ED

staff and prepare for next call

CASE STUDYCASE STUDY

• 62-year-old male struck a cement barrierhead-on while driving on the freeway

• PD estimates speed of 65 mph on impact• The windshield has an impact mark on the

driver’s side, the air bag deployed, and thehead rest is completely down

• He was wearing lap and shoulder restraints• The patient is unresponsive

Critical Thinking Scenario

1. Based on the mechanism of injury, whatinjuries do you suspect the patientpossibly has suffered?

2. What type of impact was involved in thecollision?

3. What two different pathway patterns ofinjury may be involved in this collision?

Critical Thinking Questions

Reinforce and Review

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