Chapter 27: Trauma Overview
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Mechanism of Injury
(MOI) – how person was injured
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Kinetics of Trauma
– predict the kind and extent of injuries as a basis for your priority decisions regarding
continuing assessment, care, and transport
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Trauma nearly always the result of 2 or more bodies colliding with each other
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Kinetics
– branch of mechanics dealing with movements of bodies
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Kinetic Energy
– body in motion
kinetic energy = mass X velocity X velocity / 2
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Law of Inertia
– Body in motion will remain in motion unless outside force acts on it
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The faster rate of deceleration exerts more force
Impacts
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Vehicle Collision – vehicle comes to a quick stop
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Body Collision – patient comes to a quick stop because of part of the vehicle
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Organ Collision – Organs come to a stop by hitting the inside of the body
High Index of Suspicion
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Death of another occupant
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Unresponsive patient or Altered Mental Status
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Intrusion of Greater that 12 inches for occupants site or 18 in any other part of the vehicle
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Ejection from the vehicle – chances of death increases 25X
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Frontal Impact
– Unrestrained = Up & Over Direction (head, neck, chest, & abdomen) or Down & Under (knees,
femurs, hips, acetabulum, & spine)
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Head collision look for spider web on windshield
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Paper bag syndrome results from compression of chest against the steering wheel
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Rear-End Impact
– neck hyperextends and anterior spinal ligaments stretched or torn = whiplash
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Lateral – skull thinnest at temporal bone, vertebrae not supposed to bend laterally, clavicle broken
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Rollover/Rotational
– Multisystem injuries, ejection is common, crushing injuries common
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Vehicle
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Pedestrian
– Child turns towards car and usually gets ran over by same car, adult turns away and most
impact is on the side.
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Seat Belts
– too low = dislocated hips; too high = abdominal compression & spinal fracture
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Air Bags
– most prone to injury = old adults, short adults (< 5’2”), infants and children less than 12 y/o
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SCIWORA
– spinal cord injury without injury to vertebrae
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Motorcycle
– head on = ejection, angular = multisystem and amputation, Laying it down = abrasions
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Falls
– Adult severe = 20ft, child severe = 2 or 3 X height or 10ft
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Feet First
– spinal injury along with leg injuries, internal organs affected, silver fork/Colles is split in wrist on
impact
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Head First
– hyperextended, hyper flexed, or compressed
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Penetrating
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Low Velocity – Knife
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Medium-High Velocity – Bullets
Trajectory – path or motion of projectile
Dissipation of energy – way energy transferred to human body with force acting on it
High Velocity/Medium Energy = small area of damage
High Velocity/High Energy = large area of damage and exploded limb/shattered bone
Drag = slow down; Profile = impact size; Cavitation = expansion from pressure; Fragmentation = bullet breaks
up;
Gunshot wounds = 90% to head, thorax, or abs
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Blast
– Primary = Pressure of wave; Secondary = flying debris; Tertiary = patient thrown
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Multisystem Trauma
– high incidence of morbidity and mortality
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Golden Period
