Forensic aspects of trauma and the multiply injured patient Flashcards
outline the mechanism of injury in terms of Intensity and the equation for kinetic energy
Intensity of the force obeys the usual laws of physics - Force varies directly with mass of the ‘weapon’ and directly with square of velocity of impact. Kinetic energy = ½ mass x velocitysquared
what does excessive machanical force cause?
compression, traction, torsion, shearing.
classification of injury - define different manners, natures and appearances of injuries.
app - abrasion, contusion, laceration, incised wounds, gunshot, burns. Manner - suicidal, accidental, homicidal. Nature - blunt force, sharp force, explosive.
name types of bruising
Tramline, fingertip.
what factors effect the prominence of bruising
skin pigmentation, age, depth and location, fat (more = easier to bruise), resilient areas, coagulative disorders (thrombocytopenia, Von Willebrand’s disease, haemophilia, liver disease (alcoholics), bone marrow disease)
what does thhe consequence of injury depend upon?
type of mechanism, nature of target tissue, forces involved, number of impacts.
in Head injuries what outcomes do different volumes of blood have? 35, 40, 80, 150+?
35 - symptomatic, 40 - clinical deterioration/ life threatening, 80- commonly fatal due to increased ICP and herniation, 150+ - Fatal.
outline a traumatic Subarachnoid haemorrhage…
Due to rapid rotational movement of head, usually as the result of a single punch to jaw/ upper part of neck or side of head
Sudden unexpected twisting movement
Causes traumatic rupture of vessels at base of brain – most frequently distal portion of intracranial vertebral arteries at point where they cross the dura
Possibly represents same twisting damage to brainstem
Immediately unconscious and in cardiac arrest
what does a diffuse axonal injury cause?
immediate and prolonged coma with no apparent mass lesion or metabolic abnormality
What information do you want to get from paramedics?
Mechanism of injury – speed/forces involved/deaths of others involved/ejected/damage to vehicle etc, Time of injury, suspected serious injuries, vital signs, interventions carried out.
outline the CABC Approach…
Catastrophic haemorrhage control
Airway and C spine control - speech, gurgling, stridor, visual signs. Airway Mx - adjuncts, suction, manoeuvres.
Breathing - Effort- RR, accessory muscles, wheeze, Efficacy – trachea, percussion, air entry, Effect – sats, cyanosis
Circulation - hr, bp, urine output, confusion, Hb, lactate, us, ct.
5 common sites for blood loss
floor, chest, abdomen, pelvis, long bones.
what is the Lethal Triad?
Coagulopathy, Acidosis and Hypothermia
how is each of the triad preventable?
coag- give blood products (platelets, FFP), Acidosis - correct hypoxia and severe hypotension, Hypothermia - cover up patient properly.
how is volume replacement monitored?
vital signs, urine output and lactate.
