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1、Blunt Trauma,Introduction to Blunt TraumaKinetics of Blunt TraumaTypes of TraumaBlunt TraumaExplosionOther Blunt Trauma,Sections,Most common cause of trauma death and disabilityEnergy exchange between an object and the human body,without intrusion through the skin,Introduction toBlunt Trauma,Kinemat
2、ics,Process of examining the scene to determine potential injuries that result from the forces of motion,MOI,Mechanism of injurydescription of the mechanical and physiological changes that result in anatomical or functional damage of tissue,Index of Suspicion,Based on the MOI and kineticspredict exp
3、ected injuries,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.”Conservation of Energy“Energy can neither be created nor destroyed.It is only changed from one form
4、 to another.”Kinetic versus Potential Energy,Kinetic EnergyEnergy in MotionDouble Weight=Double EnergyDouble Speed=Quadruple EnergySPEED IS THE GREATESTDETERMINANT,Kinetics of Blunt Trauma,ForceEmphasizes the importance of rate at which an object changes speed(acceleration or deceleration),Kinetics
5、of Blunt Trauma,BluntClosed injuryIndirect injury to underlying structuresTransmission of energy into the bodyTearing of muscle,vessels and boneRupture of solid organsOrgan injuryLigamentum teresPenetratingOpen injuryDirect injury to underlying structures,Types of Trauma,44,000 people die each year
6、on US highwaysEvents of ImpactVehicle CollisionBody CollisionOrgan CollisionSecondary CollisionsObjects inside vehicle strike occupantAdditional InjuriesVehicle receives a second impact,Blunt Trauma:Automobile Crashes,Inertia and MVCs,RestraintsSeatbeltsOccupant slows with the vehicleShoulder and La
7、p belts MUST be worn togetherInjuries if worn separatelyAirbags(SRS)Reduce blunt chest traumaCause:Hand,Forearm,&Facial InjuryCheck for steering wheel deformitySide AirbagsChild Safety SeatsInfants and Small Children:Rear facingOlder Child:Forward facing,Blunt Trauma:Automobile Crashes,Types of Impa
8、ctFrontal:32%Lateral:15%Rotational:38%Left&Right Front&RearRear-end:9%Rollover:6%,Blunt Trauma:Automobile Crashes,Frontal ImpactDown-and-UnderKnee,femur,and hip fractureChest trauma-Steering WheelPaper Bag SyndromeUp-and-OverTenses legs=Bilateral femur fractureHollow organ rupture and liver lacerati
9、onSimilar chest traumaAxial LoadingEjectionDue to up-and-over pathwayContact with the vehicle&external object,Blunt Trauma:Automobile Crashes,Lateral Impact15%of MVCs but 22%of deathsUpper extremity injuryRib,clavicle,humerus,pelvis,femur fractureLateral compressionRuptured diaphragm,Spleen fracture
10、,Aortic injuryEVALUATE the unrestrained occupant,Blunt Trauma:Automobile Crashes,RotationalVehicle struck at oblique angleLess serious injuries unless strike a secondary objectRear-endSeat propels the occupant forwardHead is forced backwardsStretching of neck muscles and ligamentsHyperextension&hype
11、rflexionRolloverMultiple points of impactEjection or partial ejectionLess injury with restraints,Blunt Trauma:Automobile Crashes,Vehicle Crash AnalysisHazardsCrumple ZonesIntrusionDeformity of VehicleUse of RestraintsIntoxicationFatal Accidents:50%involved ETOHRecreational Accidents,Blunt Trauma:Aut
12、omobile Crashes,Vehicular MortalityHead:48%Internal(Torso):37%Spinal&Chest fracture:8%Extremity fracture:2%All Other:5%,Blunt Trauma:Automobile Crashes,Collision QuestionsHow did collision occur?Direction?Speed?Similar/Different sized?Secondary collisions?,Cause of CrashWeather&visibility?Alcohol in
13、volved?Skid marks?Auto InteriorStarring of windshield?Steering wheel deformity?Dash deformity?Intrusion?,Blunt Trauma:Automobile CrashesCrash Evaluation,Serious injuries can occur with high and low speed collision.Types of ImpactFrontalAngularSlidingEjectionInitial Bike/Object CollisionRider/ObjectR
14、ider/Ground,Blunt Trauma:Motorcycle Crashes,AdultsAdults turn awayBumper strikes lower legs firstVictim rolls up and over and thrownChildrenChildren turn towardFemurs,Pelvis often injuredThrown away or run over,Blunt Trauma:Pedestrian Accidents,Lack structure and restraint systemTypes of VehiclesSno
15、wmobilesPersonal watercraftATVs,Blunt Trauma:Recreational Vehicle Accidents,Blast InjuriesDust,Fumes,Explosive CompoundsExplosionFuel+Oxidant combine instantaneouslyHeat&Pressure Wave,Blunt Trauma:Blast Injuries,Primary Injuries,rapid changes in atmospheric pressure from movement of blast wavehollow
16、 organs more susceptibleblast 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
17、alveoli(low density);massive destruction of alveoli and diffuse hemorrhage in lung,Implosionpressure wave passes through the lung,it forces blood out of the vascular space and into the alveoliwave of high pressure is followed by wave of low pressure allowing alveoli to expand rapidly with further te
18、aring of the lung parenchyma,atelecasis,hemorrhage,Secondary Injury,Results from flying debris created by the explosion and carried by blast windsinjuries are typically severe and penetrating due to high KE of projectiles,Tertiary Injuries,Blast winds are sufficient force to cause victims to become
19、human missilesvictim strikes the ground,Associated Injuries,Injuries resulting from changes in the environment as a consequence of the explosionfire;burnscombustion of toxic products;poisoning leaks of toxic chemicals;asphyxiation,Explosion,Pressure WaveStructural CollapseBlast WindBurnsProjectilesP
20、ersonnel DisplacementBlast Injury PhasesPrimary:Heat of the explosionSecondary:Trauma caused by projectilesTertiary:Personnel displacement and structural collapse,Blast Injury AssessmentBe alert for secondary deviceInitial scene size-up importantEstablish Incident Command System(ICS)Evaluate for sec
21、ondary hazardsInjury PatternsRupture of Air or Fluid Filled OrgansLung:Late manifestation(heat&pressure)Hearing loss,Explosion,Blast Injury CareLungsForceful compression and distortion of chest cavityCompression and decompressionPulmonary Embolism,Dyspnea,Hemoptysis,PneumothoraxAbdomenCompression&De
22、compressionRelease of bowel contentsDiaphragm rupture from pushing of organs up into thorax area,Explosion,Blast Injury CareEarsInitial Hearing LossInjury improves over timePenetrating WoundsCare as any serious open wound or impaled objectBurnsTreatment consistent with traditional management.,Explos
23、ion,FallsStairs,Force,SurfaceLanding AreaSurface TypeBody PartHeight of FallElderly,Other Types of Blunt Trauma,Sports InjuriesVarious Injury PatternsProduced by extreme exertion,fatigue or direct traumaAcceleration,deceleration,compression,rotation,hyperextension,or hyperflexionUnconsciousness,neur
24、ological defect or decreased mental status require physician follow-upProtective Gear reduces injury patternHelmet RemovalIf loose removeIf tight,remove face mask and immobilize in placeTake helmet to hospital,Other Types of Blunt Trauma,Crush InjuriesCauseStructural collapse,explosion,industrial;or
25、 agriculturalGreat force to soft tissue and bonesTissue stretching and compressionExtended pressure results in anaerobic metabolism distal to compressionReturn of blood flow,toxins to entire bodySevere hemorrhage due to severe damaged blood vesselsCareProlonged crush MedicationsSodium Bicarbonate:Reduce AcidosisDopamine:Improve Kidney FunctionMorphine:Pain management,Other Types of Blunt Trauma,Blunt Trauma TypesCauses of Blunt TraumaAssessment of InjuryInjury Patterns,Summary,
