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Trauma. Comprehensive Review. Time vs. Survival. Relationship of time to survival The “golden hour” Importance of an organized approach to trauma. Scene Size-up. Body substance isolation review Scene safety Total number of patients Essential equipment and resources needed on-scene

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Trauma

Trauma

Comprehensive Review


Time vs survival

Time vs. Survival

Relationship of time to survival

The “golden hour”

Importance of an organized approach to trauma


Scene size up

Scene Size-up

Body substance isolation review

Scene safety

Total number of patients

Essential equipment and resources needed on-scene

Mechanisms of injury


It is important to be aware of mechanisms of injury because

It is important to be aware of mechanisms of injury because…


Basic mechanisms of motion injury

Basic Mechanisms of Motion Injury

Blunt injuries

Rapid forward deceleration (collisions)

Rapid vertical deceleration (falls)

Energy transfer from blunt objects (bat, stick)

Penetrating injuries

Projectiles

Knives

Falls upon fixed objects


Clues to injury motor vehicle collision

Clues to Injury Motor Vehicle Collision

Vehicle damage

What forces were involved in the collision?

Intrusion > 12 in occupant compartment

Intrusion > 18 in anywhere else

Damage to interior structures

What did the patient hit?

Injury patterns on the patient

What anatomic areas were hit?


Newtons law

Newtons Law

  • Says what……….?

  • Link


3 impacts in each accident

3 “Impacts” in each Accident

  • Car vs Slower or stopped object

  • Person vs Car (e.g wheel)

  • Organs vs Boney cage (e.g brain vs inside of cranium)


History taking

History taking

  • Scene survey (use your knowledge of trauma kinetics to extract information from the scene)

  • Ask bystanders what they saw, heard and their initial assessment

  • Ask first responders their initial impressions

  • Ask patient some questions?

  • Keep in mind what the trauma team wants to know. 4 main questions

    • 1

    • 2

    • 3

    • 4

  • Time frame – actual vs perceived

  • History taking and “recreation” of the crash is the only thing that separates the real medic from the layperson who looks at the destruction and crash scene

  • What also does it do re: patient injuries and expectations?


Trauma

Rapid forward deceleration

Rapid vertical deceleration

Energy transfer from blunt instruments


Trauma

ITLS

  • See table 1-3 Mechanism of injury and potential injury patterns

  • Read Chapter 1


Different kinds of mvc s

Different Kinds of MVC’s

  • Fontal (head on)

  • T boned 0 side impact

  • Rollover

  • Rear ended


Head on

Head on


Patient trapped

Patient Trapped

  • “down and under”

    • Forces on upper legs to force them under the dashboard

    • Specific injuries occur


Head on crash

Head on Crash

  • Link


Lateral impact collision t bone

Lateral-impact Collision- T bone

Machine collision

Body collision

Organ collision

Courtesy of Bonnie Meneely, EMT-P


Rear impact collision

Rear-impact Collision

Machine collision

Body collision

Organ collision

Courtesy of Bonnie Meneely, EMT-P


Occupant restraint systems

Occupant Restraint Systems

Lap belts

Cross-chest lap belt

Air bags

Passive restraint system.

No hazardous materials are released.

Always “lift and look” under the air bag.

Deformity of wheel suggests impact.


Small vehicle crashes

Small Vehicle Crashes

Motorcycles

Mopeds

E Bikes

All-terrain vehicles

Personal watercraft

Snowmobiles


Car vs pedestrian

Car Vs Pedestrian


Pedestrian injuries

Pedestrian Injuries

Patient sustains high-energy transfer.

Even with low-speed collision

Patient may have “second impact” injuries.

Courtesy of Bonnie Meneely, EMT-P


Donor cycles

Donor Cycles


Trauma

Type of injuries expected?


Helmet

Helmet

  • Ensure you review helmet removal technique

  • Look at it carefully

  • Inspect for damage

  • Bring to ER with you

  • Helmet tells a story too!


Patients may not look as injured

Patients may not look as injured


Explosions

Explosions

  • Need to know the force involved

  • Patient thrown?

  • How far?

  • Contact surface?

  • Heat or fire involved?

  • Assume trauma and full c- spine support

  • Hazmat?

  • Three phases…


Blast injuries

Blast Injuries

Scene Size-up

Scene safety!

May involve multiple patients

Mechanism

Primary

Secondary

Tertiary

Courtesy of Bonnie Meneely, EMT-P


Falls

Falls


Falls injuries depend upon 3 factors

FALLSInjuries depend upon 3 factors:

Distance of fall

Elderly may fracture hip from “trivial” fall.

Anatomic area impacted

Patients landing on their feet may have injury to knees, hips, or lumbar spine.

Patients landing on their heads may have cervical spine injury.

Surface hit


Forces in falls

Forcesin falls

  • Something called Axial loading

    • Along the long axis of the body


Trauma

  • Case Study

    Classic 21 yr old dating

    A 14 year old. Parents

    Come home and “Don” jumps out 3rd story balcony!

    Fractures ankles and wrist ? Lumbar #


Tractor accidents

Tractor Accidents

Rear overturns (15%)

More likely to crush the driver

Side overturns (85%)

Mechanism

Crush injuries

Thermal & chemical burns

sy of Roy Alson, M.D.

Courtesy of Roy Alson, M.D.


Penetrating injuries knives other objects

Penetrating InjuriesKnives & Other Objects

Severity depends upon:

Site

Length of object

Angle of penetration

Below 4th intercostal space may involve chest and abdomen.

Do not remove impaled object.

Courtesy of Bonnie Meneely, EMT-P


Penetrating injuries gunshot wounds

Penetrating InjuriesGunshot Wounds

Remember scene safety!

Severity depends upon:

Anatomic area struck & tissue density

Missile velocity & size

Type of bullet (hollow point, shot shell, jacketed)

Preserve evidence if possible.

Courtesy of Bonnie Meneely, EMT-P


Collision summary

Collision Summary

Note type of collision.

Note evidence of high-energy transfer.

Maintain high index of suspicion.

Keep scene time to a minimum.

Relay observations to receiving physician.


More to come

More to come

  • Ensure you do the readings of ITLS and Bledsoe for trauma

  • Tomorrow TTG


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