Energy and Trauma

Energy and Trauma ● Mechanism of Injury (MOI) - the way traumatic injuries occur; it describes the forces acting on the body that cause injury. ● Three concepts of energy are typically associated with injury ○ Potential energy ○ Kinetic Energy ○ The energy of work Kinetic and Potential Energy ● The energy that is available to cause injury doubles when an object's weight doubles and quadruples when its speed doubles ● The amount of kinetic energy that is converted to do work on the body dictates the severity of the injury ● High energy injuries often produce such severe damage that patients required immediate transport to an appropriate facility to have any hope of survival ● Potential energy is the product of mass, force of gravity, and height. ○ Mostly associated with the energy of falling objects Blunt and Penetrating Trauma ● Examples of significant MOIs include: ○ Injury to more than one body system ○ Falls from heights ○ Motor Vehicle accidents ○ Car vs pedestrian ○ Gunshot wounds ○ Stabbings ● Whether one body system of more than on system is involved, maintain a high index of suspicion for serious unseen injuries ● Blunt trauma - the result of force to the body that causes injury without anything penetrating the soft tissues, or internal organs and cavities ● Penetrating Trauma - results in the injury by objects that pierce and penetrate the surface of the body and injure the underlying soft tissues, internal organs, and body cavities ● Damage to deep underlying tissue is more traumatic Vehicular Crashes ● Classified as: ○ Rontal ○ Read ended ○ Lateral ○ Rollover ○ Rotational ● The main difference in the direction of the force of impact ● Car vs ca, tree, or object ○ If the vehicle has significant damages, you're index of suspicion for the presence of life threatening injuries should automatically increase ● Collision of the passenger against the interior of the car ○ Common passenger injuries include ■ Low extremity fracture ■ Rib features ■ Head trauma ● Collision of the passengers internal organs against the solid structures of the body ○ Most often life threatening ○ As the passengers head hits the windshield, the brain continues to move forward until it comes to rest by striking the inside of the skull ■ This can result in compression injury to the anterior portion of the brain and stretching of the posterior portion of the brain ○ In the thoracic cage, the heart may slam into the sternum; this impact may rupture the aorta and cause fatal bleeding ● Significant MOIs are suggested by: ○ Death of an occupant in the vehicle ○ Severe deformity to the vehicle or intrusions to the vehicle ○ Moderate intrusion from lateral type of accident ○ Severe damage from the rear ○ Crashes in which the rotation is involved ○ Ejection ● Digital photos might be valuable to the trauma center ● Seatbelts ○ May decrease severity of third collision ○ Cause occupant to travel down ■ Lower extremities and the pelvis will crash into the dashboard ○ May cause abdominal injuries, especially in pediatric patients Types of Crashes ● Frontal crashes ○ If there is no intrusion into the passenger compartment, you might see that an unrestrained front seat passenger has come into contact with the dashboard or instrument panel at the knees, transferring loads from the knee through the femur to the pelvis and hip joint. ○ Passenger face often hits the steering wheel ○ Most indicators of these injuries can be found by inspecting the interior of the vehicle during extrication ● Lateral crashes ○ T bone crashes ○ Common cause of death ○ The organs within the abdomen are at risk because of possible third collision ● Rollover crashes ○ Certain vehicles with high center of gravity are more prone to rollover accidents ○ More life threatening in the accidents is partial or complete ejection ○ Can cause injury when the roof of the vehicle hits the ground Falls ● Fall from more than 20 ft is considered significant ● Always consider syncope ● Patients who fall and land on their feet may have less severe internal injuries, but more serious lower extremity injuries ● Take into account ○ Height of fall ○ Type of surface patient struck ○ Part of the body that hit first Penetrating Trauma ● Low energy trauma may be caused by accident by impalement or intentionally ny a knife, ice pick, or other weapon ● Try to determine length ● The path the projectile takes is referred to as a trajectory ● Cavitation - results from the rapid changes in tissues and fluid pressure that occur with the passage of the projectile ○ Can result in serious injury to internal organs distant to the actual path of the bullet ○ Temporary cavitation injury results from a stretching of the tissues, that occurs within the pressure changes ○ Permanent cavitation injury is found closer to the bullet path, where the pressure fluctuations are greatest, and persists after the projectile has passed through the tissue. ● Air resistance, often referred to as drag, slows the projectile, decreasing the depth of penetration and energy of the projectile and in turn reducing the damage to the tissues. ● Try to determine the type of weapon that inflicted the injury ○ Medium velocity may be caused by guns and some rifles ○ High velocity may be caused by a military weapon Blast Injuries ● People who are injured in explosions may be injured by any four of the different mechanisms: ○ Primary blast injuries ■ Due entirely to the blast itself ○ Secondary blast injuries ■ Damage To the body results from being struck by flying debris ○ Tertiary blast injuries ■ Occur when the patient is hurled by force ○ Quaternary blast injuries ■ These miscellaneous injuries include: ● Burns from hot gasses ● Respiratory injury ● Suffocation ● Poisoning ● Medical emergencies incurred as a result of the explosion ● Injuries from the collapse of buildings ● Contamination of wounds ● Mental health emergencies Assess in the order ● Measure vital signs and LOC ● Assess the anatomy of injury ● Assess the MOI and evidence of high energy impact ● Transport Questions 1. Which of the following factors has the greatest impact on the risk of injury? a. Speed 2. How many collisions are there in a typical vehicle impact? a. 3 3. In which type of vehicle crash are you most likely to find a patient with whiplash injuries? a. Rear ended 4. The phenomenon in which the rapid changes in tissue and fluid pressure that occur within the passage of a projectile result in serious injury to internal organs distinct to the actual path of the bullet is known as a. Cavitation 5. Which type of blast injury occurs when objects are propelled by the force of the blast wave and strike the victim, causing injury? a. Secondary 6. What type of trauma center provides prompt assessment, resuscitation, and stabilization of injured patients and emergency operations? a. Level 3 7. You are assessing a patient who opens her eyes when you speak to her, who can respond to you but seems confused as to time and place, who localizes pain. What is her GCS score? a. 12 8. You are assessing a patient who was in a front-end car crash. His CGS score is 12, his systolic blood pressure is 81 mm Hg, and his respiratory rate is 22 breaths/min. What is this patient’s Revised Trauma Score? a. 10 9. You would mostly commonly use the Revised Trauma Score scoring system for a patient with the potential for what type of trauma? a. Head 10. At what step in the ACS-COT/CDC updated field triage decision scheme would you assess the mechanism of injury and evidence of high-energy impact? a. Step 3