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cs of
Trauma
Kimberly Ann Holmes Kenney
RN, CNS-Rx, MS(N), MS
CCRN, CEN, CFRN, NREMT-P
Objectives
mv2
KE =
2
150 x 30 x 30
= 67,500 KE units
2
Velocity vs. Mass
150 lb. person traveling at 30 mph = 67,500 KE
units
Unless what?
Newton’s First Law and Blunt
Trauma
Car strikes pole.
Driver continues moving forward.
Anterior surface of body strikes
steering wheel.
Posterior body continues moving
forward.
Organs compressed within body.
w of Conservation of Energy
Energy cannot be created.
Energy cannot be destroyed.
Compression Injury
Deceleration and Acceleration
Shear Injury
Organ
Injury
Abdominal
organ damage.
Major vessel
damage.
Extremity Injury
Fractures.
Ligamentous
injury.
Soft tissue
injury.
ypes of Motor Vehicle Collisions
Frontal impact.
Lateral impact.
Rotational impact.
Rear impact.
Rollover.
What type of injury patterns might
you see in a frontal impact?
Frontal Impact - Occupant
Pathways
Fractured pelvis.
Frontal Impact - Occupant
Pathways
Femur fractures.
Pelvic/acetabular fractures.
Rear Impact
deaths.
Types of Impact:
Frontal/Ejection
Height.
(Greater height = greater injury.)
✔ Aorta.
✔ Spleen.
✔ Kidney.
Landing Feet
First
(Don Juan Syndrome)
Injuries seen in patients
landing feet first:
✔ Bilateral heel fractures.
✔ Ankle fractures.
✔ Distal tibia/fibula fractures.
✔ Knee dislocations.
✔ Femur fractures.
✔ Hip injuries.
✔ Spine compression fractures.
anding Arms/Hands First
Physical findings:
✔ Colles’ fractures of wrists.
✔ Shoulder dislocations.
✔ Fractures of the clavicles.
Landing Head-First
Physical
findings:
✔ C-spine
injuries.
✔ Facial injuries.
✔ CNS damage.
Sports &
Recreational Activity
Mechanisms
Acceleration
Deceleration
Hyperextension
Hyperflexion
Twisting What types of sporting or
Falling recreational injuries are
common to your area?
edicting Sports-Related Injurie
Kinematics & forces involved.
Equipment contributing to
injury.
Involvement of protective
equipment.
Nature of the sport.
Blast Injuries
Warfare.
Civilian areas.
✔ Mines.
✔ Shipyards.
✔ Chemical plants.
✔ Tank trucks.
✔ Refineries.
✔ Fireworks firms.
✔ Silos. Do you have any of
✔ LP gas tanks. these in your area?
Blast-Related Injuries
Three mechanisms of
injury:
✔ Primary.
✔ Secondary.
✔ Tertiary.
rimary Phase Injuries
Cause: pressure wave from blast.
Affected area: gas-containing organs.
Injuries:
✔ Pulmonary bleeding.
✔ Pneumothorax.
✔ Air emboli.
✔ Perforation of the GI tract.
✔ Burns.
Death may occur in absence of outward
signs.
econdary Phase Injuries
Cause: flying debris.
Affected area:
✔ Body surface.
✔ Skeletal system.
Injuries:
✔ Lacerations.
✔ Fractures.
✔ Burns.
ertiary Phase Injuries
Cause: victim thrown against
an object.
Weapon velocity.
Bullet design.
enetrating Trauma
Penetrating
Newton’s First Law and
ballistics:
✔ Bullet in brass cartridge is at rest.
✔ Bullet propelled by rapid
combustion of powder.
✔ Bullet leaves barrel of gun.
✔ Bullet strikes a body.
✔ Bullet transfers energy to victim.
Low-Energy Injuries
Low velocity.
Usually hand-driven
weapons.
Less secondary
trauma.
Multiple wounds
from a single
weapon.
Low-Energy Penetrating
Wounds
How does the length
of the weapon relate
to the cone of
damage?
sessment of Low-Energy Injurie
Type of weapon
involved.
Path of weapon.
Depth of penetration.
Number of wounds.
Underlying anatomy.
Medium-Energy Penetrating
Injuries
High-Energy Penetrating
Injuries
How do these weapons differ
from handguns and shotguns?
Permanent
cavity Compression
and crush
Gunshot Wounds
Some projectiles are designed to
tumble.
Tumbling creates greater tissue
damage and more tissue
Fragmentation