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Quantum Physics and the Time-Space Continuum An in depth and highly detailed analysis of the physical universe and it’s relevance to the pre-hospital emergency medical practicum.
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Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Mar 26, 2015

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Page 1: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Quantum Physics and the Time-Space Continuum

An in depth and highly detailed analysis of the physical universe and it’s

relevance to the pre-hospital emergency medical practicum.

Page 2: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

TRAUMA KINEMATICS

An Introduction to the Physics of Trauma

Page 3: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Trauma Statistics

• Over 150,000 trauma deaths/year– Over 40, 000 are auto related

• Leading cause of death for ages 1-40• One-third are preventable

• Cost exceeds $220 billion (2001)• Unnecessary deaths are often caused by injuries

missed because of low index of suspicion

Page 4: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Kinematics

• Physics of Trauma

• Understanding kinematics allows prediction of injuries based on forces and motion involved in

an injury event.

Page 5: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Basic Principles

• Conservation of Energy Law• Newton’s First Law of Motion• Newton’s Second Law of Motion

• Kinetic Energy

Page 6: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Newton’s First Law

• Body in motion stays in motion unless acted on by outside force

• Body at rest stays at rest unless acted on by outside force

Page 7: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Newton’s Second Law

• Force of an object = mass (weight) x acceleration or deceleration (change in

velocity)• Major factor is velocity

• “Speed Kills”

Page 8: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Law of Conservation of Energy

• For every action there is an opposite and equal reaction

• Energy cannot be created or destroyed• Energy can only change from one form

to another

Page 9: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Kinetic Energy

• Energy of Motion• Kinetic energy = ½ mass of an object X

(velocity)2• Injury doubles when weight doubles but

quadruples when velocity doubles

Page 10: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

So…

When a moving body is acted on by an outside force and changes its motion,

then kinetic energy must change to some other form of energy.

If the moving body is a human being and the energy transfer occurs too rapidly,

then trauma results.

Page 11: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Blunt Force Trauma

• Force withoutpenetration• “Unseen

injuries”• Cavitation

towards or away from the

injury

Page 12: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Penetrating Trauma

• Piercing or penetration of body with damage to soft tissues and organs

• Depth of injury

Page 13: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Mechanism of Injury Profiles

Page 14: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Motor Vehicle Collisions

• Five major types of motor vehicle collisions:–Head-on–Rear-end– Lateral–Rotational–Roll-over

Page 15: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Motor Vehicle Collisions

• In each collision, three impacts occur:–Vehicle–Occupants

–Occupant organs

Page 16: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Head-On Collision

Page 17: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Head-on Collision

• Vehicle stops• Occupants continue forward• Two pathways–Down and under–Up and over

Page 18: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Frontal Collision

• Down and under pathway–Knees impact dash, causing knee

dislocation/patella fracture– Force fractures femur, hip, posterior rim of

acetabulum (hip socket)–Pelvic injuries kill!

Page 19: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Frontal Collision

• Down and under pathway–Upper body hits steering wheel• Broken ribs• Flail chest• Pulmonary/myocardial contusion• Ruptured liver/spleen

Page 20: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Frontal Collision

• Down and under pathway–Paper bag pneumothorax–Aortic tear from deceleration–Head thrown forward• C-spine injury• Tracheal injury

Page 21: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Frontal Collision

• Up and over pathway–Chest/abdomen hit steering wheel• Rib fractures/flail chest• Cardiac/pulmonary contusions/aortic

tears• Abdominal organ rupture• Diaphragm rupture• Liver/mesenteric lacerations

Page 22: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Frontal Collision

• Up and over pathway–Head impacts windshield• Scalp lacerations• Skull fractures• Cerebral contusions/hemorrhages

–C-spine fracture

Page 23: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Rear-end Collision

Page 24: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Rear-end Collision

• Car (and everything touching it) moves forward

• Body moves, head does not, causing whiplash• Vehicle may strike other object causing frontal

impact• Worst patients in vehicles with two impacts

Page 25: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Lateral Collision

Page 26: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Lateral Collision

• Car appears to move from under patient• Patient moves toward point of impact

• Increased potential for “shearing” injuries• Increased cervical spine injury

Page 27: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Lateral Collision

• Chest hits door– Lateral rib fractures– Lateral flail chest–Pulmonary contusion–Abdominal solid organ rupture

• Suspect upper extremity fractures and dislocations

Page 28: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Lateral Collision

• Hip hits door–Head of femur driven through acetabulum–Pelvic fractures

• C-spine injury• Head injury

Page 29: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Rotational Collision

Page 30: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Rotational Collision

• Off-center impact• Car rotates around impact point

• Patients thrown toward impact point• Injuries combination of head-on, lateral

• Point of greatest damage = point of greatest deceleration = worst patients

Page 31: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Rollover

Page 32: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Roll-Over

• Multiple impacts each time vehicle rolls

• Injuries unpredictable• Assume presence of severe injury• Justification for Transport to Level I

or II Trauma Center

Page 33: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Restrained vs Unrestrained Patients

• Ejection causes 27% of motor vehicle collision deaths

• 1 in 13 suffers a spinal injury• Probability of death increases six-fold

Page 34: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Restrained with Improper Positioning

• Seatbelts Above Iliac Crest–Compression injuries to abdominal

organs– T12 - L2 compression fractures

• Seatbelts Too Low–Hip dislocations

Page 35: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Restrained with Improper Positioning

• Seatbelts Alone–Head, C-Spine, Maxillofacial injuries

• Shoulder Straps Alone–Neck injuries–Decapitation

Page 36: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Motorcycle Collisions• Rider impacts motorcycle parts

• Rider ejected over motorcycle or

trapped between motorcycle and

vehicle• No protection from

effects of deceleration

• Limited protection from gear

Page 37: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Pedestrian vs. Vehicle

• Child– Faces oncoming vehicle–Waddell’s Triad• Bumper Femur fracture• Hood Chest injuries• Ground Head injuries

Page 38: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Pedestrian vs. Vehicle

• Adult– Turns from oncoming vehicle–O’Donohue’s Triad• Bumper Tib-fib fracture

Knee injuries• Hood Femur/pelvic

Page 39: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Falls

• Critical Factor– Height

• Increased height + Increased injury

– Surface• Type of impact surface increases injury

– Objects struck during fall– Body part of first impact

• Feet• Head Buttocks• Parallel

Page 40: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Falls

• Assess body part that impacts first, usually sustains the bulk of injury

• Think about the path of energy through body and what other organs/systems could be impacted (index of suspicion)

Page 41: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Falls onto Head/Spine

• Injuries may not be obvious

• C-spine precautions!

• Watch for delayed head injury S/S

Page 42: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Falls onto Hands

• Bilateral colles fractures

• Potential for radial/ulna fractures and dislocations

Page 43: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Fall onto Buttocks

• Pelvic fracture• Coccygeal (tail

bone) fracture• Lumbar

compression fracture

Page 44: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Fall onto Feet*• Don Juan

Syndrome– Bilateral heel

fractures– Compression

fractures of vertebrae

– Bilateral Colles’ fractures

Page 45: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Index of Suspicion

Page 46: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Stab Wounds

• Damage confined to wound track– Four-inch object can produce nine-inch

track• Gender of attacker–Males stab up; Females stab down

• Evaluate for multiple wounds–Check back, flanks, buttocks

Page 47: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Stab Wounds

• Chest/abdomen overlap–Chest below 4th ICS = Abdomen until

proven otherwise–Abdomen above iliac crests = Chest

until proven otherwise

Page 48: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Stabbings• Always maintain

high degree of suspicion with stab wounds

• Remember: small stab wounds do NOT mean small damage

Page 49: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Gunshot Wounds

• Damage CANNOT be determined by location of entrance/exit wounds–Missiles tumble– Secondary missiles from bone impacts–Remote damage from• Blast effect• Cavitation

Page 50: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Gunshot Wounds

• Severity cannot be evaluated in the field or Emergency Department

• Severity can only be evaluated in OR

Page 51: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Significant ALS MOI

• Multi-system trauma• Fractures in more than one location• MVA – death in same vehicle, high speed or

significant vehicle damage• Falls > 2 X body height• Thrown > 10 – 15 feet• Penetrating trauma to the “box”• Age co-factors: < 6 or > 60• “Lucky Victim”

Page 52: Quantum Physics and the Time- Space Continuum An in depth and highly detailed analysis of the physical universe and its relevance to the pre-hospital emergency.

Conclusion

• Think about mechanisms of injury• Always maintain an increased index of

suspicion• Doing YOUR job as an EMT will lead to:

– Fewer missed injuries– Increased patient survival