CHAPTER 24 Flashcards
What is the leading cause of death in the US among people younger than age 44?
Traumatic and unintentional injuries
Occur as a result of physical forces applied to the body
Trauma emergencies
Illnesses or conditions not caused by an outside force.
Medical emergencies
How can a traumatic injury be caused by an underlying medical condition?
A patient has a stroke while driving and veers of the road, striking a tree
How can a medical illness result from a recent traumatic injury?
Pneumonia develops in a patient a few days after a fall that fractures their ribs
Why is it important to evaluate the MOI for a trauma patient?
It will provide you with an index of suspicion for different types of serious and/or life threatening underlying injuries
How does a traumatic injury occur?
When the body’s tissues are exposed to energy levels beyond their tolerance.
The way in which traumatic injuries occur. It describes the force (or energy transmission) acting on the body that cause injury.
Mechanism of Injury (MOI)
What are 3 concepts of energy that are typically associated with injury (not including thermal energy, which causes burns)?
Potential energy, kinetic energy and the energy of work
Energy cannot not be created or destroyed but instead:
Converted or transformed
Who is it important to estimate the height from which a patient fell as well as the surface they landed on?
To fully appreciate the injury potential of the fall
Force acting over a distance
Work
Force x distance = work
What results in the work that causes injury?
Forces that bend, pull, or compress tissue beyond their inherent limits
The energy of a moving object and reflects the relationship between mass (weight) of the object and the velocity (speed) at which it is traveling
Kinetic energy
Kinetic energy = 1/2 mass x velocity2 or
KE 1/2m x v2
In the case of a motor vehicle crash, the kinetic energy of the speeding vehicle is:
Converted into the work of stopping the vehicle
The energy that is available to cause injury ________ when an object’s weight doubles but _________ when it’s speed doubles
Doubles, quadruples
What dictates the severity of an injury
The amount of kinetic energy that is converted to do work on the body
The product of mass (weight), force of gravity, and height and is mostly associated with the energy of falling objects
Potential energy
Newton’s First Law
Objects at rest tend to stay at rest and objects in motion tend to stay in motion unless acted on by some force
Newton’s Second Law
Force = mass x acceleration
F=m x a
Acceleration is the change in velocity (speed) that occurs over time
Newton’s Third Law
For every action, there is an equal and opposite reaction. Two forces are equal but occur in opposite directions.
What type of injury should you suspect if you notice a collapsed steering wheel during a scene size up?
Serious chest injuries
Why should you constantly and consistently reevaluate the MOI
To rule out the possibility that the patient has a more significant injury than initially suspected or identified during the initial phases of care provided at the scene
Examples of no significant injuries include:
Injury to an isolated body part or a fall without the loss of consciousness
Significant MOIs include injury to more than one body system such as falls from heights, motor vehicle and motorcycle crashes, car versus pedestrian (or bicycle or motorcycle), gunshot wounds, and stabbings
Multisystem trauma
What are two categories of traumatic injuries
Blunt trauma and penetrating trauma
Result of force (or energy transmission) to the body that causes injury without anything penetrating the soft tissues or internal organs and cavities
Blunt trauma
Results in injury by objects that pierce and penetrate the surface of the body and injure the underlying soft tissues, internal organs, and body cavities
Penetrating trauma
Be alert to signs of _________ or __________ because these may be the only signs of blunt trauma
Skin discoloration or reports of pain
Types of motor vehicle crash classifications:
Frontal (head on) Rear-end Lateral (T-bone) Rollovers Rotational spins The principal difference between these is the direction of the force of impact
The 3 collisions in a typical impact are:
- The collision of the cat against another car or object
- The collision of the passenger against the interior of the car
- The collision of the passengers internal organs against the solid structures of the body
Why is it important to note and inspect damage to the vehicle in patient care?
It provides information about the severity of the collision and, therefore, had an indirect effect on patient care.
The greater the damage done to a vehicle during collision, the greater the _____ that was involved and, therefore, the greater the potential to _______ to the patient
Energy, cause injury
Injuries sustained during a collision to the ______ may not be as obvious as external injuries but are often the most life threatening
Passengers internal organs
When a patients head hits the windshield, the brain continues to move forward until it comes to rest by striking the inside of the skull results in what?
Compression injury (Coup-contracoup injury)
A compression injury in which there is bruising to the anterior portion of the brain and stretching or tearing of the posterior portion of the brain.
Coup-contrecoup brain injury
What should you suspect if you see a contusion on the forehead and the windshield is starred and pushed out?
An injury to the brain and potential spinal injury
What should you do if you suspect an injury to the brain?
Contact medical control, hospital staff can prepare for the patient by being ready to perform a CT scan. You should always provide your input because without it, the physician might not have found the brain injury right away.
Significant mechanisms of injury are suggested by the following:
Death of an occupant in the vehicle
Severe deformity if the vehicle or intrusion into the vehicle
Severe deformities if the frontal part of the vehicle without intrusion into the passenger compartment
Moderate intrusions fro a lateral (t-bone) type of accident
Severe damage from the rear
Crashes in which rotation is involved (rollover and spins)
Ejection from the vehicle
If there has been a death in an accident how should you treat patients?
Treat life threatening injuries and provide rapid transport to a trauma. Digital photos of the scene may provide valuable information to the staff and treating physicians at the trauma center
According to the CDC, between 1975 and 2008 ___________ saved an estimated 255,000 lives
Seatbelts
The slowing of an object
Deceleration
Air bags decrease injury to the:
Chest, face and head
All children who are shorter than _______ should ride in the rear seat
4 feet 9 inches
If an air bag did not inflate during the accident, it may deploy during
Extrication - use extreme caution when extricating a patient in a vehicle when an airbag has not deployed
Seatbelts may also cause ______ injuries
Abdominal
How are seatbelts designed to be worn?
Over the iliac crests of the pelvis to distribute the force over the bony structure
What can happen if the seatbelt is worn too low? Too high?
Hip dislocations
Internal injuries/damage to abdominal organs or lumbar spine fractures
What kind of injuries do rear-end impacts capable of causing?
Whiplash
Cervical spine and surrounding areas
Head and neck (headrests decrease the extension of head and neck and help reduce injury)
What kind of injuries can lateral crashes cause?
Death - very common cause of death in motor vehicle crashes
Lateral whiplash injury
Cervical spine
Shoulder, thorax, upper extremities and skull against the doorpost or window
Lateral chest and abdomen injuries on the side of impact
Possible fractures of the lower extremities, pelvis and ribs
Organs within the abdomen are at risk
Lateral crashes cause approximately ___% of all severe injuries to the aorta and approximately ___% of all fatalities that occur in motor vehicle crashes
25, 30
What types of vehicles are more prone to roll over crashes due to their high center of gravity?
Large trucks and some sport utility vehicles
What is the most common life threatening event in a rollover?
Ejection or partial ejection
A passenger on the outboard side of a vehicle that rolls over is at high risk for what?
Injury because of the centrifual force
In a rotational crash, passengers experience not only the rotational motion, but also ______
a lateral impact
Car-versus-pedestrian crashes often result in patients who have _______
graphic and apparent injuries
