Blunt Trauma

Question 1

Law of Inertia

Answer 1

Tendency of an object to remain at rest or remain in motion unless acted upon by an outside force
– Car into tree
– Passenger collisions within a car
– Organ collisions within a body

Question 2

During an auto crash, energy of mo/on converted into

Answer 2

– Sound of impact
– Deformation of the auto’s structure
– Heat in the twisted steel
– Physical injuries to the patient as they collide with the interior

Question 3

Kinetic energy

Answer 3

•  Energy of motion
– Function of object’s mass and velocity
•  Speed is the greatest determinant of energy involved

Question 4

Newton’s second law of motion

Answer 4

Emphasizes the importance of rate at which an object changes speed (acceleration or deceleration)

Question 5

Blunt Trauma

Answer 5

– Occurs when a body is struck by or strikes an object
– Closed injury
– Transmission of energy injures underlying tissues and organs
•  Tearing of muscle, vessels and bone
•  Rupture of solid organs
•  Organ injury

Question 6

Penetrating Trauma

Answer 6

– Wounds that break the skin, energy source enters into body
–  Low energy
•  Knives
•  Injury limited to the path of the weapon
– High energy
•  Guns
•  Energy may be transmitted to surrounding tissue, extending the trauma

Question 7

Blunt traumas

Answer 7

•   Explosions
•   Falls
•   Crush injuries
•   Sporting injuries

Question 8

Automobile Collisions

Answer 8

•   Vehicle collision
•   Body collision
•   Organ collision
•   Secondary collision
•   Additional impacts

Question 9

Restraints

Answer 9

•  Profound effect in reducing collision-­related deaths
•  Seatbelts
– Occupant slows with vehicle
– Shoulder and lap belts should be worn together
•  Injuries occur if they are worn separately
– EMS should model the behaviour

Question 10

Restraints Airbags

Answer 10

– Reduce blunt chest trauma
– Cause: Hand, Forearm, & Facial Injury
– Check for steering wheel deformity
– Side Airbags

Question 11

Restraints Child Safety Seats

Answer 11

– Provide the best protect for infants and small children riding in vehicles
–  Infants and Small Children: Rear facing
– Older Child: Forward facing

Question 12

Types of Impact

Answer 12

•  Frontal:  32% 
•  Lateral:  15% 
•  Rotational:  38% 
–  LeF & Right – Front & Rear 
•  Rear-­end:  9% 
•  Rollover:  6%

Question 13

Frontal Impact

Answer 13

•  Most common type of impact
•  Often result in significant exchange of energy and serious injuries
•  Produces three pathways of occupant travel
– Down and under pathway
– Up and over pathway
– Ejection

Question 14

Down and Under Pathway

Answer 14

•  Occupant slides downward as vehicle comes to a stop
•  Knees come into contact with firewall and absorb the initial impact
–  Knee, femur, and hip fracture or dislocations
•  Upper body rotates forward and hits steering wheel
–  Chest trauma
•  Driver may take a deep breath in anticpation of the impact
–  Paper Bag Syndrome

Question 15

Paper bag syndrom

Answer 15

Rupture of the lungs that occurs as the chest meets with blunt trauma after taking a deep breath, usually during a motor vehicle crash, similar to rupture of an air-filled paper bag.

Question 16

Up and Over Pathway

Answer 16

•  Occupant tenses legs in anticipation of the impact
•  Upper body pivots forward and upward
•  Steering wheel impinges on the femurs
–  Possible bilateral fractures
–  Compresses and injures abdominal contents
•  Lower chest strikes steering wheel
–  Thoracic injuries
•  Forward motion propels head into windshield
–  Head and neck injuries
–  Axial loading

Question 17

Ejection

Answer 17

•  Due to up-­and­‐over pathway
•  Victims experience two impacts
– Contact with vehicle interior and windshield
–  Impact with ground, trees or other objects
•  Responsible for 27% of vehicular fatalities

Question 18

Crumple Zones

Answer 18

•   Frontal impacts interpose more vehicle between the point of impact and patients
•   Modern vehicles use this area to absorb impact forces and limit occupant injury
•   Patients in collisions involving vans or lateral impacts do not benefit the same way

Question 19

Lateral Impact

Answer 19

•  15% of MVC’s but 22% of deaths
•  Kinetics the same as in a frontal impact
•  Two exceptions:
– Occupants present a different profile
–  Less structural steel to protect occupants

Question 20

Lateral Impact

Answer 20

•  Increased upper extremity injuries
–  Lateral rib fractures
– Head and neck injuries
•  Lateral compression
– Ruptured diaphragm, spleen fracture, aortic injury
•  Consider any unrestrained passengers
– Becomes an object that will collide with driver

Question 21

Rotational Impact

Answer 21

•  Vehicle struck at oblique angle
•  Energy exchange generally more gradual
– Deflected form path rather than stopped
–  Longer stopping distance
– Deceleration more gradual
•  Less serious injuries unless there are multiple impacts

Question 22

Rear-­End Collision

Answer 22

•  Seat propels the occupant forward
– Generally good protection for the body
– Poor protection for the head
•  Head is forced backwards and then forwards
– Stretching of neck muscles and ligaments
– Hyperextension & hyperflexion

Question 23

Rollover

Answer 23

•  Generally caused by:
– Change in elevation
– Vehicle with high centre of gravity
•  Occupant experiences impact at each impact of vehicle
•  Often involves ejection or partial ejection
•  Injuries are usually compounded by multiple subsequent impacts

Question 24

Vehicle Collision Analysis

Answer 24

•   Hazards
•   Crumple Zones
•   Intrusion
•   Deformity of Vehicle
•   Use of Restraints

Question 25

Hazards

Answer 25

•  Heat – Hot engine and transmission parts – Hot fluids (radiator coolant, engine oil) •  Caustic substances – Batery acid, automatic transmission fluid, steering fluids •  Sharp jagged edges of metal and broken glass

Question 26

Intoxication

Answer 26

•  36.5% of deaths on Canadian Highways were alcohol related(2001 CCMTA statistics) •  Patient effects: – Alters level of consciousness – Masks signs and symptoms of injury – Anesthetizes patient somewhat •  Makes mechanism of injury analysis and index of suspicion even more important – Otherwise significant injuries may be missed

Question 27

Collision Questions

Answer 27

– How did the objects collide? – From which direction did they come? – At what speed were they travelling? – Were the object similarly or different sized? – Were there any secondary collisions or additional transfers of energy?

Question 28

Cause of Collision

Answer 28

– Did wet roads or poor visibility contribute to the crash? – Was alcohol involved? – Are ther skid marks? Was the driver prevented from braking?

Question 29

Auto Interior Question

Answer 29

– Does the windshield show evidence of an impact? –  Is the steering wheel deformed or collapsed? –  Is the dash indented where the knees or head hit it? – Has the impact extended into the passenger compartment?

Question 30

Motorcycle Collisions

Answer 30

``` •  OFen result in serious trauma even at low speed –  Driver absorbs most of impact •  Impacts –  Frontal –  Angular –  Sliding –  Ejection •  Initial Bike/Object Collision •  Rider/Object •  Rider/Ground ```

Question 31

Adult Pedestrian Accidents

Answer 31

– Adults turn away – Bumper strikes lower legs first – Victim rolls up and over and thrown

Question 32

Child pedestrian accident

Answer 32

– Children turn toward – Thrown in front of car – Femurs, pelvis oFen injured

Question 33

Recreational Vehicles

Answer 33

``` •  Lack structure and restraint system –  Little protection offered to occupants •  Types of Vehicles – Snowmobiles – Personal watercraft – ATV’s ```

Question 34

Blast Injuries

Answer 34

•  Causes: – Dust (e.g. grain elevator) – Fumes (e.g. gasoline or natural gas) – Explosive compounds •  Magnitude ranges from small fire cracker to a nuclear explosion •  May be accidental or an act ot terrorism

Question 35

Mechanisms of a Blast

Answer 35

*   Explosion *   Pressure wave *   Blast wind *   Projectiles *   Personnel displacement *   Confined space explosions and structural collapses *   Burns

Question 36

Blast Injury Phases

Answer 36

•  Primary – Caused by heat of explosion and pressure wave •  Secondary – Caused by blast projectiles •  Tertiary – Caused by personnel displacement and structural collapse

Question 37

Blast Injury Assessment

Answer 37

•  Survey and assess scene – Be aware of potential for secondary device – Secure further EMS operations •  Triage •  Establish Incident Command System if necessary •  Evaluate for secondary hazards

Question 38

Common Injuries Lungs

Answer 38

– Pressure wave rapidly compresses and distorts chest, lungs and alveoli – Ruptures alveolar walls – Fluid accumulation and hemorrhage – High risk of emboli formation

Question 39

Common injuries Abdomen

Answer 39

– Rapid compression and decompression – Bowel wall may hemorrhage or rupture – Release of bowel contents into abdomen

Question 40

Common Injuries ears

Answer 40

– Eustachian tube cannot equalize pressure – Stretching or rupture of tympanic membrane – Often fracture of small bones of hearing – Hearing loss may be temporary or permanent

Question 41

Common injuries penetrating wounds

Answer 41

– Care as any serious open wound or impaled object

Question 42

Common Injuries Burns

Answer 42

 Treatment consistent with traditional management

Question 43

Falls

Answer 43

•  Release of stored gravitational energy •  Potential for injury depends on: – Height – Stopping distance

Question 44

Fall Factors

Answer 44

•  Nature of impact surface contour – Stairway may focus force of impact , increasing seriousness of injury •  Area of contact and pathway of of energy transmission – Energy transmitied up skeletal structure •  Age related factors – Common problem in elderly

Question 45

Sports Injuries

Answer 45

•  Injuries most commonly produce by extreme exertion, fatigue or direct trauma – Variety of injury patterns – Often exchange of great kinetic forces producing serious injuries •  Alterations in patient LOC result in: – Exclusion from further activity – Follow up with a physician

Question 46

Protective Gear

Answer 46

•  Greatly reduces potential for injury – May also cause injuries e.g. cleats may cause torn ligaments as the foot is fixed while the knee is twisted •  Helmet –  If loose remove –  If tight, remove face mask and immobilize in place – Take helmet to hospital

Question 47

Kinetics

Answer 47

``` Branch of physics dealing with: – Forces affecting objects in motion – Energy exchanges that occur as objects collide Two basic principles: –  Law of inertia –  Law of conservation of energy ```

Question 48

Crush Injuries

Answer 48

•  Causes – Structural collapse, explosion, industrial; or agricultural •  Pathophysiology – 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