Prehospital Trauma Life Support

Prehospital Trauma Life Support
Lesson
2
Copyright 2003, Elsevier Science (USA). All rights reserved.
Kinematics of Trauma
PROVIDER COURSE
Objectives
Discuss the laws of energy and motion Discuss trauma associated with blunt impact and penetrating injury Overview of the effects of energy distribution in MVCs Review the kinematics of blast and violent injuries Use kinematics to predict injury patterns
2-2
Kinetic Energy
KE =
mass (weight) x velocity (speed)2 2
or
KE = mv2
Kinetic energy is the energy of motion

2-3
Example of Kinetic Energy

The KE of a 150 lb (68 kg) person traveling at
30 mph (48 km/h) would be:
150 x 30 x 30
2 or 68 x 48 x 48 2
= 67,500 KE units
= 78,336 KE units
2-4
Velocity versus Mass

150 lb (68 kg) person traveling at 30 mph (48 km/h) = 67,500 (78,336) KE units 180 lb (82 kg) person traveling at 30 mph (48 km/h) = 81,000 (94,464) KE units
150 lb (68 kg) person traveling at 40 mph (64 km/h) = 120,000 (139,264) KE units
What is more important velocity or mass?
2-5
Velocity
2-6
Newtons First Law of Motion

A body at rest will stay at rest
A body in motion will remain in motion
Unless what?
2-7
Newtons First Law and Blunt Trauma

Vehicle strikes pole Driver continues moving forward
Anterior surface of body strikes steering wheel

Posterior body continues moving forward
Organs are compressed within body
2-8
Law of Conservation of Energy

Energy cannot be created or destroyed Energy can change forms and can be transferred
Can you give an example?
2-9
How does the law of conservation of energy pertain to trauma?
Can you give some examples?
2-10
Predicting Injury
Compression Injury
2-11
Predicting Injury
Shear Injury
2-12
Predicting Injury
In a 50 mph (80 km/h) MVC, what types of injuries would occur if the patient were to strike the windshield?
2-13
Head and Neck

Injuries to:
Bones
Ligaments
Soft tissues Brain Spinal cord
2-14
Torso
Injuries to:
Ribs
Heart and lungs
Abdominal organs
Major vessels
2-15
Extremities
Injuries to:
Bones
Ligaments
Soft tissues
Blood vessels
2-16
Types of Motor Vehicle Crashes

Frontal impact Rear impact Lateral impact Rotational impact Rollover
2-17
What type of injury patterns might you see in a frontal impact?

2-18
Frontal Impact
What injuries would you expect with an up-and-over pathway?

2-19
Injuries with Up-and-Over Pathway

Head injuries
Spine injuries
Chest injuries
Abdominal injuries
Fractured pelvis
2-20
Frontal Impact
What injuries would you expect with a down-and-under pathway?

2-21
Injuries with Down and Under Pathway

Pelvic/acetabular fractures Hip dislocations Femur fractures Posterior knee Lower extremity fractures
2-22
Injuries with Down and Under Pathway

Also the same injuries as up and over pathway Head injuries Spine injuries Chest injuries Abdominal injuries Fractured pelvis
2-23
Rear Impact
What types of injuries would you expect?
2-24
Lateral Impact
2-25
Lateral Impact Injuries

Neck/shoulder
Chest/abdomen
Pelvis
2-26
Rotational Impact
2-27
Rollover
What injury patterns might you see following this crash?

2-28
Restraint Devices
What types of injuries should you anticipate?
2-29
Restraint Devices
Shoulder harness only, lap belt not used
(Victim moves down and under)
Lap restraint only, shoulder harness not used

(Victim moves up and over)
What types of injuries should you anticipate?
2-30
Air Bag Deployment
What types of injuries would you expect to see? What if there were a second crash?
2-31
Air Bag Deployment

What concerns would you have about a:
Small patient?
Child in a car seat?
2-32
Motorcycle Crashes
Mandatory helmet laws have been associated with up to 300% fewer head injuries and deaths.
2-33
Frontal Impact/Ejection
How many impacts typically occur? What types of injuries would you expect to see?
2-34
Lateral Impact
How many impacts typically occur? What types of injuries would you expect to see?
2-35
Pedestrian versus Motor Vehicle
Sedan
SUV
What injuries would you expect?
2-36
Pedestrian versus Motor Vehicle
How are injury patterns different with a child?
2-37
Falls
Impact surface Height Deceleration forces cause both compression injury and shear injury Falls from a distance of more than three times the patients height may produce critical injuries
2-38
Landing Feet First

(Don Juan Syndrome)
Injury pattern:
Bilateral heel fractures Ankle fractures Distal tibia/fibula fractures Knee dislocations Femur fractures Hip injuries Spine compression fractures
2-39
Landing Arms/Hands First

Injury pattern:
Colles fractures of the wrist
Shoulder dislocations Fractures of the clavicles
2-40
Landing Head First

Injury pattern:
Spinal and spinal cord injuries Facial injuries Brain damage
2-41
Sports and Recreational Activity Mechanisms
What types of sport and recreational activities are common in your area?
2-42
Predicting Sports-related Injuries

Kinematics and forces involved Use of protective equipment
Can equipment contribute to injury?
2-43
Blast Injuries
Warfare/terrorism Industrial/residential
What types of explosions may occur in your area?
2-44
Blast-Related Injuries
Three injury patterns:

Primary Secondary Tertiary
2-45
Primary Blast Injuries

Cause: pressure/heat wave from blast Affected area: Gas-containing organs
Skin
2-46
Secondary Blast Injuries

Cause: flying debris Affected area:
Skin Internal organs Skeleton
2-47
Tertiary Blast Injuries

Cause: victim thrown against an object Affected area: Area of impact or referred energy What types of injuries would you expect?
2-48
Penetrating Trauma
Stab wounds Gunshot wounds Impaled objects
2-49
Stab Wounds
Low velocity Multiple wounds from a single weapon Cone of injury A knife, ice pick, and scissors are common weapons. Injuries are usually limited to depth and area of penetration.
Would a longer knife have a larger cone of injury?
2-50
Stab Wounds: Key Issues

Type of weapon Number of wounds Depth of penetration Anatomic structures along potential path
2-51
Gunshot Wounds
How do injuries differ when created by mediumor high-velocity weapons?
2-52
Projectiles: Key Issues

Profile Fragmentation Tumble/pathway Velocity
2-53
Gunshot Wounds: Cavitation
To what is cavitation related?
2-54
Gunshot Wounds
Entrance and exit wounds

2-55
Shotgun Wounds
The ultimate in fragmentation is created by shotgun wounds

2-56
Considerations for Penetrating Trauma

Scene safety is the top priority! Weapon type Anatomic structures along potential path Crime scene preservation
Patient care takes precedence
2-57
Summary
The cornerstone of assessment is early consideration of kinematics to predict hidden injury
2-58
Prehospital Trauma Life Support

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2-59

Prehospital Trauma Life Support

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Prehospital Trauma Life Support

mass (weight) x velocity (speed)2 2

Kinetic energy is the energy of motion

Example of Kinetic Energy

Velocity versus Mass

What is more important velocity or mass?

Newtons First Law of Motion

A body in motion will remain in motion

Newtons First Law and Blunt Trauma

Anterior surface of body strikes steering wheel

Organs are compressed within body

Law of Conservation of Energy

Can you give an example?

How does the law of conservation of energy pertain to trauma?

Can you give some examples?

Head and Neck

Copyright 2003, Elsevier Science (USA). All rights reserved.

Types of Motor Vehicle Crashes

What type of injury patterns might you see in a frontal impact?

What injuries would you expect with an up-and-over pathway?

Injuries with Up-and-Over Pathway

What injuries would you expect with a down-and-under pathway?

Injuries with Down and Under Pathway

Injuries with Down and Under Pathway

What types of injuries would you expect?

What types of injuries would you expect?

Lateral Impact Injuries

What types of injuries would you expect?

What injury patterns might you see following this crash?

What types of injuries should you anticipate?

Lap restraint only, shoulder harness not used

What types of injuries should you anticipate?

Air Bag Deployment

Air Bag Deployment

Pedestrian versus Motor Vehicle

What injuries would you expect?

Pedestrian versus Motor Vehicle

How are injury patterns different with a child?

Landing Feet First

Landing Arms/Hands First

Shoulder dislocations Fractures of the clavicles

Landing Head First

Sports and Recreational Activity Mechanisms

Predicting Sports-related Injuries

Can equipment contribute to injury?

What types of explosions may occur in your area?

Three injury patterns:

Primary Blast Injuries

What types of injuries would you expect?

Secondary Blast Injuries

What types of injuries would you expect?

Tertiary Blast Injuries

Would a longer knife have a larger cone of injury?

Stab Wounds: Key Issues

How do injuries differ when created by mediumor high-velocity weapons?

Projectiles: Key Issues

Gunshot Wounds: Cavitation

To what is cavitation related?

Entrance and exit wounds

The ultimate in fragmentation is created by shotgun wounds

Considerations for Penetrating Trauma

Prehospital Trauma Life Support

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