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

Dec 28, 2015

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Beryl Lambert

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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

Page 4: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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)

Page 5: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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???!

Page 6: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Index of SuspicionIndex of Suspicion

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

Page 7: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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)

Page 8: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.
Page 9: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.
Page 10: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.
Page 11: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 12: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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.

Page 13: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Kinetic Energy Energy in Motion

Double Weight = Double Energy Double Speed = Quadruple Energy

SPEED IS THE GREATESTDETERMINANT

Kinetics of Blunt Trauma

2

)()( 2speedVelocityweightMassKE

Page 14: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Physics (UGH!)

Three types of forces in blunt trauma Compression Shear Overpressure

Page 15: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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…..

Page 16: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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.

Page 17: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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……

Page 18: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 19: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 20: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Inertia and MVC’s

Page 21: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Protections (think Volvo!)

Steel frame Belts Bags Seat construction Roof Crumple Zones

Page 22: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 23: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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).

Page 24: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.
Page 25: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.
Page 26: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 27: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

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

Blunt Trauma: Automobile Crashes

Page 28: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 29: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 30: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

secondary object

Blunt Trauma:Car Crashes

Page 31: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 32: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 33: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Blunt Trauma: Automobile Crashes

Page 34: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 35: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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!

Page 36: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.
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Page 43: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.
Page 44: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.
Page 45: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 46: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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………

Page 47: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 48: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Lack structure and restraint system Types of Vehicles

Snowmobiles Personal watercraft ATV’s

Blunt Trauma: Recreational Vehicle Accidents

Page 49: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 50: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 51: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 52: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Blast Injuries Dust, Fumes, Explosive Compounds

Explosion Fuel + Oxidant combine instantaneously Heat & Pressure Wave

Blunt Trauma: Blast Injuries

Page 53: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 55: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 56: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

Tertiary InjuriesTertiary Injuries

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

victim strikes the ground

Page 57: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 58: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 59: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 60: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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

Page 61: Blunt Trauma. Introduction to Blunt Trauma Kinetics of Blunt Trauma Types of Trauma Blunt Trauma Explosion Other Blunt Trauma Examination, Diagnosis Sections.

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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