Veronica Bonales, M.D.    Whack-a-Mole:                CEP America                              Emergency Physicianaka Blu...
Blunt Force          TraumaVeronica Bonales, M.D.CEP America, Emergency PhysicianRedwood Memorial Hospital
Blunt Force Trauma
Blunt Force Trauma Types Sample Injuries byAnatomical Region Specific Syndromes
Blunt Force              Compression    Trauma
Blunt Force Trauma  Injury due to pressure force     Hit by moving object     Hit or fall against solid    object     Obje...
Blunt Force              Deceleration    Trauma
Blunt Force Trauma Injury because of suddenhalt    MVC most common    Acceleration factor  greatest in air travel Stretchi...
Blunt Force Trauma        Anatomical      Considerations
Blunt Force   Head and Spine    Trauma    Injuries
Blunt Force TraumaSkull 22 bones  8 CRANIAL, 14 FACIAL
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force TraumaBasilar SkullFracture  Battle’s  Sign  Raccoon  Eyes  CSF  Otorrhea or  rhinorrhea
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma         • Cranium          – Brain          – Attached by            meninges          – Surrounded by ...
Blunt Force TraumaCoup and contrecoup injuries
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma  Epidural hematoma
Blunt Force Trauma  Epidural hematoma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma  Subdural hematoma
Blunt Force Trauma  Subdural hematoma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma Subarachnoid hematoma
Blunt Force Trauma Subarachnoid hematoma
Blunt Force Trauma  Special Considerations
Blunt Force Trauma  Special Considerations
Blunt Force Trauma  Special Considerations
Blunt Force Trauma  Special Considerations
Blunt Force TraumaCervical Spine 7 vertebrae  Axis  Atlas Ligaments  Anterior  Posterior
Blunt Force Trauma  Axial Load Injuries
Blunt Force Trauma         Hyperextension        injuries         Hyperflexion        injuries
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma           Hangman’s Fracture            - Bilateral pedicle                    Fx           - Distracti...
Blunt Force Trauma
Blunt Force Trauma
Blunt Force TraumaC spine precautions placed when: – Any neck discomfort or numbness in   extremities – Not fully alert or...
Blunt Force TraumaC spine precautions placed when: – Any neck discomfort or numbness in   extremities – Not fully alert or...
Blunt Force TraumaRigid collars, such as the Philadelphia and the extrication collars, reduce flexion and extension to abo...
Blunt Force Traumabest immobilization method – secure patient to a hard board – place sandbags at either side of head – ri...
Blunt Force Trauma          Thoracic          Spine           12 vertebrae           Attached to           rib cage       ...
Blunt Force Trauma• Axial loading – Burst fracture – Nerve findings common
Blunt Force Trauma• Hyperextension injuries – Very unstable fracture
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma        • Lumbar Spine         –5 vertebrae         –Fractures          require          significant    ...
Blunt Force TraumaFlexion injuries Wedge compression fracture Requires a high energy process
Head and Spine Injuries         Look for motor or         sensory deficits         Deficit will point to         location ...
Blunt Force   Thoracic Injuries    Trauma
Blunt Force Trauma  Bony Injuries  Pulmonary injuries  Cardiac andvascular injuries Diaphragmaticinjuries
Blunt Force TraumaSternal Fracture  Indicates worse mechanism of injury  Not an indicator of cardiac injury
Blunt Force TraumaSternal Fracture  Indicates worse mechanism of injury  Not an indicator of cardiac injury
Blunt Force Trauma
Blunt Force TraumaRib Fractures   9 - 11 watch for intra-abdominal injuries
Blunt Force TraumaRib Fractures   9 - 11 watch for intra-abdominal injuries
Blunt Force TraumaRib Fractures   9 - 11 watch for intra-abdominal injuriesFlail Chest Three or more consecutive ribs Brok...
Blunt Force TraumaLung contusions More common in children Serious cause of morbidity  Elderly  COPD
Pneumothorax
1        2    345
1        2    345
Findings:Respiratory distress    Tachycardia    Hypotension         JVD Pulsus Paradoxus
12              Findings:        Respiratory distress            Tachycardia            Hypotension                 JVD   ...
12              Findings:        Respiratory distress            Tachycardia            Hypotension                 JVD   ...
Lateral chest!•Pleural Cavity can hold 4+ liters of blood•Not symptomatic until get about 250 ml•First 300 ml space
Lateral chest!•Pleural Cavity can hold 4+ liters of blood•Not symptomatic until get about 250 ml•First 300 ml space
Lateral chest!•Pleural Cavity can hold 4+ liters of blood•Not symptomatic until get about 250 ml•First 300 ml space
Lateral chest!•Pleural Cavity can hold 4+ liters of blood•Not symptomatic until get about 250 ml•First 300 ml space
1200900600300
Blunt Force Trauma
Blunt Force Trauma           Cardiac Injuries            life-threatening arrhythmias            anomalies of conduction s...
Blunt Force Trauma
Blunt Force Trauma Cardiac Injury  9 - 34% of thoracic injuries  Right atrium most susceptible to injury  Will lead to EKG...
Blunt ForceTrauma Thoracic AortaDisruption  2nd leading cause of death  93% at desc. Aorta  Widened mediastinum most commo...
Blunt ForceTrauma Thoracic AortaDisruption  2nd leading cause of death  93% at desc. Aorta  Widened mediastinum most commo...
Blunt ForceTrauma Thoracic AortaDisruption  2nd leading cause of death  93% at desc. Aorta  Widened mediastinum most commo...
Blunt Force Trauma           Pericardial           tamponade            Tachy 77%            JVD 76%             Dec. Hear...
Blunt Force Trauma           Pericardial           tamponade            Tachy 77%            JVD 76%             Dec. Hear...
Blunt Force Trauma           Pericardial           tamponade            Tachy 77%            JVD 76%             Dec. Hear...
Blunt Force Trauma
Blunt Force Trauma             Diaphragmatic            injury               Strong              compressive              ...
Token Gorymedical photo
Blunt Force   Abdominal Injuries    Trauma
Blunt Force TraumaMost common type   50 – 70%  Liver & spleen most commonly injured  may not manifest during initial asses...
Blunt Force Trauma         Compression injuries          Liver lacerations          and hematomas          Splenic lacerat...
Blunt Force Trauma Hollow organinjuries  Usually  secondary to  seatbelt  Compressive  forces increase  pressure  Decelera...
Blunt Force Trauma
Blunt Force Trauma           Spleen             Most commonly            injured solid            organ             Rich b...
Blunt Force Trauma
Blunt Force TraumaInjured from trauma to:  Eighth through twelfth ribs on right side of bodyUpper central part of abdomen ...
Blunt Force Trauma
Blunt Force TraumaKidney Firmly held in the retroperitoneum Severe compression or rib fractures Deceleration leads to shea...
Blunt Force Trauma            Pelvic Organ           Injuries              Most commonly             associated with      ...
Blunt Force Trauma            Focused            Abdominal            Sonography             for            Trauma
Blunt Force Trauma            Focused            Abdominal            Sonography             for            Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma
Blunt Force Trauma              Medial Malleolus
Blunt Force Trauma              Medial Malleolus
Blunt Force Trauma              Medial Malleolus
Blunt Force   Crush Syndromes    Trauma
Blunt Force Traumaoccurs when body part subjectedto high degree of force orpressure
Blunt Force Trauma Bleeding Bruising Fracture Laceration Compartment Syndrome
Blunt Force TraumaNot an acuteoccurrenceSymptoms: Pain out of proportion/passive motion Parasthesias/ Paralysis Pallor Pul...
Blunt Force TraumaCompartment PressuresNormal about zero; usually less than 10 mm HgCapillary blood flow compromised at >2...
Blunt Force TraumaTraumatic Asphyxia Syndrome Constrictive force to chest wall Can occur within two minutes Mechanism of i...
Blunt Force Trauma Vital signs  Tachycardia  Tachypnea  Signs of shock    Hypotension    Diaphoresis    Slow cap refill Me...
Luckiest Man Alive
Questions??
Questions??Thank You!!
References• ACS Surgery: Principles and Practice. Souba, et. al. Multiple chapters.• Emergency Medicine: A Comprehensive S...
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
FCA 0111 - Blunt Force Trauma
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FCA 0111 - Blunt Force Trauma

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Redwood Memorial Hospital, Pre-Hospital Care, Field Care Audit, Blunt Force Trauma Lecture on 01/19/11

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FCA 0111 - Blunt Force Trauma

  1. 1. Veronica Bonales, M.D. Whack-a-Mole: CEP America Emergency Physicianaka Blunt Force Trauma Redwood Memorial Hospital
  2. 2. Blunt Force TraumaVeronica Bonales, M.D.CEP America, Emergency PhysicianRedwood Memorial Hospital
  3. 3. Blunt Force Trauma
  4. 4. Blunt Force Trauma Types Sample Injuries byAnatomical Region Specific Syndromes
  5. 5. Blunt Force Compression Trauma
  6. 6. Blunt Force Trauma Injury due to pressure force Hit by moving object Hit or fall against solid object Object exerts pressure Tears and hematomas to solid organs
  7. 7. Blunt Force Deceleration Trauma
  8. 8. Blunt Force Trauma Injury because of suddenhalt MVC most common Acceleration factor greatest in air travel Stretching & linear shearingof fixed or free organs
  9. 9. Blunt Force Trauma Anatomical Considerations
  10. 10. Blunt Force Head and Spine Trauma Injuries
  11. 11. Blunt Force TraumaSkull 22 bones 8 CRANIAL, 14 FACIAL
  12. 12. Blunt Force Trauma
  13. 13. Blunt Force Trauma
  14. 14. Blunt Force Trauma
  15. 15. Blunt Force Trauma
  16. 16. Blunt Force Trauma
  17. 17. Blunt Force Trauma
  18. 18. Blunt Force Trauma
  19. 19. Blunt Force TraumaBasilar SkullFracture Battle’s Sign Raccoon Eyes CSF Otorrhea or rhinorrhea
  20. 20. Blunt Force Trauma
  21. 21. Blunt Force Trauma
  22. 22. Blunt Force Trauma
  23. 23. Blunt Force Trauma
  24. 24. Blunt Force Trauma
  25. 25. Blunt Force Trauma • Cranium – Brain – Attached by meninges – Surrounded by fluid – Surface blood vessels
  26. 26. Blunt Force TraumaCoup and contrecoup injuries
  27. 27. Blunt Force Trauma
  28. 28. Blunt Force Trauma
  29. 29. Blunt Force Trauma
  30. 30. Blunt Force Trauma
  31. 31. Blunt Force Trauma
  32. 32. Blunt Force Trauma
  33. 33. Blunt Force Trauma
  34. 34. Blunt Force Trauma
  35. 35. Blunt Force Trauma Epidural hematoma
  36. 36. Blunt Force Trauma Epidural hematoma
  37. 37. Blunt Force Trauma
  38. 38. Blunt Force Trauma
  39. 39. Blunt Force Trauma
  40. 40. Blunt Force Trauma
  41. 41. Blunt Force Trauma Subdural hematoma
  42. 42. Blunt Force Trauma Subdural hematoma
  43. 43. Blunt Force Trauma
  44. 44. Blunt Force Trauma
  45. 45. Blunt Force Trauma
  46. 46. Blunt Force Trauma
  47. 47. Blunt Force Trauma Subarachnoid hematoma
  48. 48. Blunt Force Trauma Subarachnoid hematoma
  49. 49. Blunt Force Trauma Special Considerations
  50. 50. Blunt Force Trauma Special Considerations
  51. 51. Blunt Force Trauma Special Considerations
  52. 52. Blunt Force Trauma Special Considerations
  53. 53. Blunt Force TraumaCervical Spine 7 vertebrae Axis Atlas Ligaments Anterior Posterior
  54. 54. Blunt Force Trauma Axial Load Injuries
  55. 55. Blunt Force Trauma Hyperextension injuries Hyperflexion injuries
  56. 56. Blunt Force Trauma
  57. 57. Blunt Force Trauma
  58. 58. Blunt Force Trauma
  59. 59. Blunt Force Trauma Hangman’s Fracture - Bilateral pedicle Fx - Distraction C2-C3 - Due to complete disruption
  60. 60. Blunt Force Trauma
  61. 61. Blunt Force Trauma
  62. 62. Blunt Force TraumaC spine precautions placed when: – Any neck discomfort or numbness in extremities – Not fully alert or AMS – Other painful injuries
  63. 63. Blunt Force TraumaC spine precautions placed when: – Any neck discomfort or numbness in extremities – Not fully alert or AMS – Other painful injuries
  64. 64. Blunt Force TraumaRigid collars, such as the Philadelphia and the extrication collars, reduce flexion and extension to about 30% normal and rotation and lateral movement to about 50%.
  65. 65. Blunt Force Traumabest immobilization method – secure patient to a hard board – place sandbags at either side of head – rigid collar around the neck – decreases movement to about 5% of normal.
  66. 66. Blunt Force Trauma Thoracic Spine 12 vertebrae Attached to rib cage Ligaments Anterior Posterior
  67. 67. Blunt Force Trauma• Axial loading – Burst fracture – Nerve findings common
  68. 68. Blunt Force Trauma• Hyperextension injuries – Very unstable fracture
  69. 69. Blunt Force Trauma
  70. 70. Blunt Force Trauma
  71. 71. Blunt Force Trauma • Lumbar Spine –5 vertebrae –Fractures require significant mechanism
  72. 72. Blunt Force TraumaFlexion injuries Wedge compression fracture Requires a high energy process
  73. 73. Head and Spine Injuries Look for motor or sensory deficits Deficit will point to location of injury Remember dual innervation of cervical cape Log roll & keep spine in neutral position
  74. 74. Blunt Force Thoracic Injuries Trauma
  75. 75. Blunt Force Trauma Bony Injuries Pulmonary injuries Cardiac andvascular injuries Diaphragmaticinjuries
  76. 76. Blunt Force TraumaSternal Fracture Indicates worse mechanism of injury Not an indicator of cardiac injury
  77. 77. Blunt Force TraumaSternal Fracture Indicates worse mechanism of injury Not an indicator of cardiac injury
  78. 78. Blunt Force Trauma
  79. 79. Blunt Force TraumaRib Fractures 9 - 11 watch for intra-abdominal injuries
  80. 80. Blunt Force TraumaRib Fractures 9 - 11 watch for intra-abdominal injuries
  81. 81. Blunt Force TraumaRib Fractures 9 - 11 watch for intra-abdominal injuriesFlail Chest Three or more consecutive ribs Broken in 2 or more places Same side of chest Paradoxical Chest Movement
  82. 82. Blunt Force TraumaLung contusions More common in children Serious cause of morbidity Elderly COPD
  83. 83. Pneumothorax
  84. 84. 1 2 345
  85. 85. 1 2 345
  86. 86. Findings:Respiratory distress Tachycardia Hypotension JVD Pulsus Paradoxus
  87. 87. 12 Findings: Respiratory distress Tachycardia Hypotension JVD Pulsus Paradoxus
  88. 88. 12 Findings: Respiratory distress Tachycardia Hypotension JVD Pulsus Paradoxus
  89. 89. Lateral chest!•Pleural Cavity can hold 4+ liters of blood•Not symptomatic until get about 250 ml•First 300 ml space
  90. 90. Lateral chest!•Pleural Cavity can hold 4+ liters of blood•Not symptomatic until get about 250 ml•First 300 ml space
  91. 91. Lateral chest!•Pleural Cavity can hold 4+ liters of blood•Not symptomatic until get about 250 ml•First 300 ml space
  92. 92. Lateral chest!•Pleural Cavity can hold 4+ liters of blood•Not symptomatic until get about 250 ml•First 300 ml space
  93. 93. 1200900600300
  94. 94. Blunt Force Trauma
  95. 95. Blunt Force Trauma Cardiac Injuries life-threatening arrhythmias anomalies of conduction system congestive heart failure cardiogenic shock hemopericardium pericardial tamponade cardiac rupture valvular rupture intraventricular thrombus thromboemboli air emboli coronary artery occlusion ventricular aneurysm constrictive pericarditis
  96. 96. Blunt Force Trauma
  97. 97. Blunt Force Trauma Cardiac Injury 9 - 34% of thoracic injuries Right atrium most susceptible to injury Will lead to EKG changes and Troponin elevations Contusio cordis vs commotio cordis
  98. 98. Blunt ForceTrauma Thoracic AortaDisruption 2nd leading cause of death 93% at desc. Aorta Widened mediastinum most common finding 85%
  99. 99. Blunt ForceTrauma Thoracic AortaDisruption 2nd leading cause of death 93% at desc. Aorta Widened mediastinum most common finding 85%
  100. 100. Blunt ForceTrauma Thoracic AortaDisruption 2nd leading cause of death 93% at desc. Aorta Widened mediastinum most common finding 85%
  101. 101. Blunt Force Trauma Pericardial tamponade Tachy 77% JVD 76% Dec. Heart Sounds 28% Hypotension 26%
  102. 102. Blunt Force Trauma Pericardial tamponade Tachy 77% JVD 76% Dec. Heart Sounds 28% Hypotension 26%
  103. 103. Blunt Force Trauma Pericardial tamponade Tachy 77% JVD 76% Dec. Heart Sounds 28% Hypotension 26%
  104. 104. Blunt Force Trauma
  105. 105. Blunt Force Trauma Diaphragmatic injury Strong compressive forces Intrusion by abdominal viscera Injury mostly occurs on right Bowel sounds in the chest
  106. 106. Token Gorymedical photo
  107. 107. Blunt Force Abdominal Injuries Trauma
  108. 108. Blunt Force TraumaMost common type 50 – 70% Liver & spleen most commonly injured may not manifest during initial assessment & treatment period 1.5L before distention appears
  109. 109. Blunt Force Trauma Compression injuries Liver lacerations and hematomas Splenic lacerations and sequestration Deceleration injuries Kidney Bowel injuries Vascular injuries
  110. 110. Blunt Force Trauma Hollow organinjuries Usually secondary to seatbelt Compressive forces increase pressure Deceleration disrupts blood supply from mesenteric vessels
  111. 111. Blunt Force Trauma
  112. 112. Blunt Force Trauma Spleen Most commonly injured solid organ Rich blood supply Pain in LUQ with left shoulder pain
  113. 113. Blunt Force Trauma
  114. 114. Blunt Force TraumaInjured from trauma to: Eighth through twelfth ribs on right side of bodyUpper central part of abdomen Tear at falciform or direct injuryBlood and bile will leak intoabdominal cavity Shock Peritoneal irritation
  115. 115. Blunt Force Trauma
  116. 116. Blunt Force TraumaKidney Firmly held in the retroperitoneum Severe compression or rib fractures Deceleration leads to shearing of arteries Spillage of blood and urine into retroperitoneum
  117. 117. Blunt Force Trauma Pelvic Organ Injuries Most commonly associated with pelvic fractures Urinary rupture if compressive force on full bladder
  118. 118. Blunt Force Trauma Focused Abdominal Sonography for Trauma
  119. 119. Blunt Force Trauma Focused Abdominal Sonography for Trauma
  120. 120. Blunt Force Trauma
  121. 121. Blunt Force Trauma
  122. 122. Blunt Force Trauma
  123. 123. Blunt Force Trauma Medial Malleolus
  124. 124. Blunt Force Trauma Medial Malleolus
  125. 125. Blunt Force Trauma Medial Malleolus
  126. 126. Blunt Force Crush Syndromes Trauma
  127. 127. Blunt Force Traumaoccurs when body part subjectedto high degree of force orpressure
  128. 128. Blunt Force Trauma Bleeding Bruising Fracture Laceration Compartment Syndrome
  129. 129. Blunt Force TraumaNot an acuteoccurrenceSymptoms: Pain out of proportion/passive motion Parasthesias/ Paralysis Pallor Pulselessness Poiklothermia
  130. 130. Blunt Force TraumaCompartment PressuresNormal about zero; usually less than 10 mm HgCapillary blood flow compromised at >20 mm HgMuscles/nerves at risk for ischemic necrosis>30 to 40 mm Hg.Nerve is most sensitive, followed by muscletissue.
  131. 131. Blunt Force TraumaTraumatic Asphyxia Syndrome Constrictive force to chest wall Can occur within two minutes Mechanism of injury - profound venous hypertension Cerebral hypoperfusion
  132. 132. Blunt Force Trauma Vital signs Tachycardia Tachypnea Signs of shock Hypotension Diaphoresis Slow cap refill Mental Status Neurodeficits Young will handle better than old
  133. 133. Luckiest Man Alive
  134. 134. Questions??
  135. 135. Questions??Thank You!!
  136. 136. References• ACS Surgery: Principles and Practice. Souba, et. al. Multiple chapters.• Emergency Medicine: A Comprehensive Study Guide. Tintinalli, et. al. Multiple chapters.• Howard-Nuss’ Clinical Practice of Emergency Medicine. Wolfson, et. al. Multiple chapters.• Manual of Forensic Emergency Medicine. Riviello. Chapter 10: Blunt Force Trauma• Mastery of Surgery, Vol. 1. Fischer and Bland. Part V: Breast, Chest and Mediastinum. Chapter 49 Thoracic Truama.

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