Blunt Trauma Markus Forsythe, MD
Introduction to Blunt Trauma <ul><li>Most common cause of trauma death and disability </li></ul><ul><li>Energy exchange be...
Kinetics of Blunt Trauma <ul><li>Inertia </li></ul><ul><ul><li>“ A body in motion will remain in motion unless acted upon ...
Kinetics of Blunt Trauma <ul><li>Kinetic Energy </li></ul><ul><ul><li>Energy in Motion </li></ul></ul><ul><ul><li>Double W...
Kinetics of Blunt Trauma <ul><li>Force </li></ul><ul><ul><li>Emphasizes the importance of rate at which an object changes ...
Blunt Trauma: Automobile Crashes <ul><li>44,000 people die each year on US highways </li></ul><ul><li>Events of Impact </l...
Blunt Trauma: Automobile Crashes <ul><li>Restraints </li></ul><ul><ul><li>Seatbelts </li></ul></ul><ul><ul><ul><li>Occupan...
Blunt Trauma: Automobile Crashes <ul><li>Types of Impact </li></ul><ul><ul><li>Frontal:  32% </li></ul></ul><ul><ul><li>La...
Blunt Trauma: Automobile Crashes <ul><li>Frontal Impact </li></ul><ul><ul><li>Down-and-Under </li></ul></ul><ul><ul><ul><l...
Blunt Trauma: Automobile Crashes <ul><li>Lateral Impact </li></ul><ul><ul><li>15% of MVC’s but 22% of deaths </li></ul></u...
Blunt Trauma: Automobile Crashes <ul><li>Rotational </li></ul><ul><ul><li>Vehicle struck at oblique angle </li></ul></ul><...
Blunt Trauma: Automobile Crashes <ul><li>Vehicle Crash Analysis </li></ul><ul><ul><li>Hazards </li></ul></ul><ul><ul><li>C...
Blunt Trauma: Automobile Crashes <ul><li>Vehicular Mortality </li></ul><ul><ul><li>Head:  48% </li></ul></ul><ul><ul><li>I...
Blunt Trauma: Automobile Crashes Crash Evaluation <ul><li>Collision Questions </li></ul><ul><ul><li>How did collision occu...
Blunt Trauma:  Motorcycle Crashes <ul><li>Serious injuries can occur with high and low speed collision. </li></ul><ul><li>...
Copyright © 2003 E.Faubion
Blunt Trauma:  Pedestrian Accidents <ul><li>Adults </li></ul><ul><ul><li>Adults turn away </li></ul></ul><ul><ul><li>Bumpe...
Blunt Trauma: Recreational Vehicle  Accidents <ul><li>Lack structure and restraint system </li></ul><ul><li>Types of Vehic...
Blunt Trauma:  Blast Injuries <ul><li>Blast Injuries </li></ul><ul><ul><li>Dust, Fumes, Explosive Compounds </li></ul></ul...
Explosion <ul><li>Pressure Wave </li></ul><ul><ul><li>Structural Collapse </li></ul></ul><ul><ul><li>Blast Wind </li></ul>...
Explosion <ul><li>Blast Injury Assessment </li></ul><ul><ul><li>Be alert for secondary device </li></ul></ul><ul><ul><li>I...
Explosion <ul><li>Blast Injury Care </li></ul><ul><ul><li>Lungs </li></ul></ul><ul><ul><ul><li>Forceful compression and di...
Explosion <ul><li>Blast Injury Care </li></ul><ul><ul><li>Ears </li></ul></ul><ul><ul><ul><li>Initial Hearing Loss </li></...
Other Types of Blunt Trauma <ul><li>Falls </li></ul><ul><ul><li>Stairs, Force, Surface </li></ul></ul><ul><ul><li>Landing ...
Other Types of Blunt Trauma <ul><li>Sports Injuries </li></ul><ul><ul><li>Various Injury Patterns </li></ul></ul><ul><ul><...
Other Types of Blunt Trauma <ul><li>Crush Injuries </li></ul><ul><ul><li>Cause </li></ul></ul><ul><ul><ul><li>Structural c...
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Blunt trauma

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Blunt trauma

  1. 1. Blunt Trauma Markus Forsythe, MD
  2. 2. Introduction to Blunt Trauma <ul><li>Most common cause of trauma death and disability </li></ul><ul><li>Energy exchange between an object and the human body, without intrusion through the skin </li></ul>
  3. 3. Kinetics of Blunt Trauma <ul><li>Inertia </li></ul><ul><ul><li>“ A body in motion will remain in motion unless acted upon by an outside force.” </li></ul></ul><ul><ul><li>“ A body at rest will remain at rest unless acted upon by an outside force.” </li></ul></ul><ul><li>Conservation of Energy </li></ul><ul><ul><li>“ Energy can neither be created nor destroyed. It is only changed from one form to another.” </li></ul></ul><ul><li>Kinetic versus Potential Energy </li></ul>
  4. 4. Kinetics of Blunt Trauma <ul><li>Kinetic Energy </li></ul><ul><ul><li>Energy in Motion </li></ul></ul><ul><ul><li>Double Weight = Double Energy </li></ul></ul><ul><ul><li>Double Speed = Quadruple Energy </li></ul></ul><ul><ul><li>SPEED IS THE GREATEST DETERMINANT </li></ul></ul>
  5. 5. Kinetics of Blunt Trauma <ul><li>Force </li></ul><ul><ul><li>Emphasizes the importance of rate at which an object changes speed (acceleration or deceleration) </li></ul></ul>
  6. 6. Blunt Trauma: Automobile Crashes <ul><li>44,000 people die each year on US highways </li></ul><ul><li>Events of Impact </li></ul><ul><ul><li>Vehicle Collision </li></ul></ul><ul><ul><li>Body Collision </li></ul></ul><ul><ul><li>Organ Collision </li></ul></ul><ul><ul><li>Secondary Collisions </li></ul></ul><ul><ul><ul><li>Objects inside vehicle strike occupant </li></ul></ul></ul><ul><ul><li>Additional Injuries </li></ul></ul><ul><ul><ul><li>Vehicle receives a second impact </li></ul></ul></ul>
  7. 7. Blunt Trauma: Automobile Crashes <ul><li>Restraints </li></ul><ul><ul><li>Seatbelts </li></ul></ul><ul><ul><ul><li>Occupant slows with the vehicle </li></ul></ul></ul><ul><ul><ul><li>Shoulder and Lap belts MUST be worn together </li></ul></ul></ul><ul><ul><ul><ul><li>Injuries if worn separately </li></ul></ul></ul></ul><ul><ul><li>Airbags (SRS) </li></ul></ul><ul><ul><ul><li>Reduce blunt chest trauma </li></ul></ul></ul><ul><ul><ul><li>Cause: Hand, Forearm, & Facial Injury </li></ul></ul></ul><ul><ul><ul><li>Check for steering wheel deformity </li></ul></ul></ul><ul><ul><ul><li>Side Airbags </li></ul></ul></ul><ul><ul><li>Child Safety Seats </li></ul></ul><ul><ul><ul><li>Infants and Small Children: Rear facing </li></ul></ul></ul><ul><ul><ul><li>Older Child: Forward facing </li></ul></ul></ul>
  8. 8. Blunt Trauma: Automobile Crashes <ul><li>Types of Impact </li></ul><ul><ul><li>Frontal: 32% </li></ul></ul><ul><ul><li>Lateral: 15% </li></ul></ul><ul><ul><li>Rotational: 38% </li></ul></ul><ul><ul><ul><li>Left & Right – Front & Rear </li></ul></ul></ul><ul><ul><li>Rear-end: 9% </li></ul></ul><ul><ul><li>Rollover: 6% </li></ul></ul>
  9. 9. Blunt Trauma: Automobile Crashes <ul><li>Frontal Impact </li></ul><ul><ul><li>Down-and-Under </li></ul></ul><ul><ul><ul><li>Knee, femur, and hip fracture </li></ul></ul></ul><ul><ul><ul><li>Chest trauma-Steering Wheel </li></ul></ul></ul><ul><ul><ul><ul><li>Paper Bag Syndrome </li></ul></ul></ul></ul><ul><ul><li>Up-and-Over </li></ul></ul><ul><ul><ul><li>Tenses legs = Bilateral femur fracture </li></ul></ul></ul><ul><ul><ul><li>Hollow organ rupture and liver laceration </li></ul></ul></ul><ul><ul><ul><li>Similar chest trauma </li></ul></ul></ul><ul><ul><ul><li>Axial Loading </li></ul></ul></ul><ul><ul><li>Ejection </li></ul></ul><ul><ul><ul><li>Due to up-and-over pathway </li></ul></ul></ul><ul><ul><ul><li>Contact with the vehicle & external object </li></ul></ul></ul>
  10. 10. Blunt Trauma: Automobile Crashes <ul><li>Lateral Impact </li></ul><ul><ul><li>15% of MVC’s but 22% of deaths </li></ul></ul><ul><ul><li>Upper extremity injury </li></ul></ul><ul><ul><li>Rib, clavicle, humerus, pelvis, femur fracture </li></ul></ul><ul><ul><li>Lateral compression </li></ul></ul><ul><ul><ul><li>Ruptured diaphragm, Spleen fracture, Aortic injury </li></ul></ul></ul>
  11. 11. Blunt Trauma: Automobile Crashes <ul><li>Rotational </li></ul><ul><ul><li>Vehicle struck at oblique angle </li></ul></ul><ul><ul><li>Less serious injuries unless strike a secondary object </li></ul></ul><ul><li>Rear-end </li></ul><ul><ul><li>Seat propels the occupant forward </li></ul></ul><ul><ul><li>Head is forced backwards </li></ul></ul><ul><ul><ul><li>Stretching of neck muscles and ligaments </li></ul></ul></ul><ul><ul><ul><li>Hyperextension & hyperflexion </li></ul></ul></ul><ul><li>Rollover </li></ul><ul><ul><li>Multiple points of impact </li></ul></ul><ul><ul><li>Ejection or partial ejection </li></ul></ul><ul><ul><li>Less injury with restraints </li></ul></ul>www.safetyforum.com
  12. 12. Blunt Trauma: Automobile Crashes <ul><li>Vehicle Crash Analysis </li></ul><ul><ul><li>Hazards </li></ul></ul><ul><ul><li>Crumple Zones </li></ul></ul><ul><ul><li>Intrusion </li></ul></ul><ul><ul><li>Deformity of Vehicle </li></ul></ul><ul><ul><li>Use of Restraints </li></ul></ul><ul><li>Intoxication </li></ul><ul><ul><li>Fatal Accidents: >50% involved ETOH </li></ul></ul><ul><ul><li>Recreational Accidents </li></ul></ul>Copyright © 2003 E.Faubion Copyright © 2003 E.Faubion
  13. 13. Blunt Trauma: Automobile Crashes <ul><li>Vehicular Mortality </li></ul><ul><ul><li>Head: 48% </li></ul></ul><ul><ul><li>Internal (Torso): 37% </li></ul></ul><ul><ul><li>Spinal & Chest fracture: 8% </li></ul></ul><ul><ul><li>Extremity fracture: 2% </li></ul></ul><ul><ul><li>All Other: 5% </li></ul></ul>
  14. 14. Blunt Trauma: Automobile Crashes Crash Evaluation <ul><li>Collision Questions </li></ul><ul><ul><li>How did collision occur? </li></ul></ul><ul><ul><li>Direction? </li></ul></ul><ul><ul><li>Speed? </li></ul></ul><ul><ul><li>Similar/Different sized? </li></ul></ul><ul><ul><li>Secondary collisions? </li></ul></ul><ul><li>Cause of Crash </li></ul><ul><ul><li>Weather & visibility? </li></ul></ul><ul><ul><li>Alcohol involved? </li></ul></ul><ul><ul><li>Skid marks? </li></ul></ul><ul><li>Auto Interior </li></ul><ul><ul><li>Starring of windshield? </li></ul></ul><ul><ul><li>Steering wheel deformity? </li></ul></ul><ul><ul><li>Dash deformity? </li></ul></ul><ul><ul><li>Intrusion? </li></ul></ul>
  15. 15. Blunt Trauma: Motorcycle Crashes <ul><li>Serious injuries can occur with high and low speed collision. </li></ul><ul><li>Types of Impact </li></ul><ul><ul><li>Frontal </li></ul></ul><ul><ul><li>Angular </li></ul></ul><ul><ul><li>Sliding </li></ul></ul><ul><ul><li>Ejection </li></ul></ul><ul><ul><ul><li>Initial Bike/Object Collision </li></ul></ul></ul><ul><ul><ul><li>Rider/Object </li></ul></ul></ul><ul><ul><ul><li>Rider/Ground </li></ul></ul></ul>Copyright © 2003 E.Faubion Copyright © 2003 E.Faubion
  16. 16. Copyright © 2003 E.Faubion
  17. 17. Blunt Trauma: Pedestrian Accidents <ul><li>Adults </li></ul><ul><ul><li>Adults turn away </li></ul></ul><ul><ul><li>Bumper strikes lower legs first </li></ul></ul><ul><ul><li>Victim rolls up and over and thrown </li></ul></ul><ul><li>Children </li></ul><ul><ul><li>Children turn toward </li></ul></ul><ul><ul><li>Femurs, Pelvis often injured </li></ul></ul><ul><ul><li>Thrown away or run over </li></ul></ul>
  18. 18. Blunt Trauma: Recreational Vehicle Accidents <ul><li>Lack structure and restraint system </li></ul><ul><li>Types of Vehicles </li></ul><ul><ul><li>Snowmobiles </li></ul></ul><ul><ul><li>Personal watercraft </li></ul></ul><ul><ul><li>ATV’s </li></ul></ul>
  19. 19. Blunt Trauma: Blast Injuries <ul><li>Blast Injuries </li></ul><ul><ul><li>Dust, Fumes, Explosive Compounds </li></ul></ul><ul><li>Explosion </li></ul><ul><ul><li>Fuel + Oxidant combine instantaneously </li></ul></ul><ul><ul><li>Heat & Pressure Wave </li></ul></ul>
  20. 20. Explosion <ul><li>Pressure Wave </li></ul><ul><ul><li>Structural Collapse </li></ul></ul><ul><ul><li>Blast Wind </li></ul></ul><ul><li>Burns </li></ul><ul><li>Projectiles </li></ul><ul><li>Personnel Displacement </li></ul><ul><li>Blast Injury Phases </li></ul><ul><ul><li>Primary: Heat of the explosion </li></ul></ul><ul><ul><li>Secondary: Trauma caused by projectiles </li></ul></ul><ul><ul><li>Tertiary: Personnel displacement and structural collapse </li></ul></ul>
  21. 21. Explosion <ul><li>Blast Injury Assessment </li></ul><ul><ul><li>Be alert for secondary device </li></ul></ul><ul><ul><li>Initial scene size-up important </li></ul></ul><ul><ul><li>Establish Incident Command System (ICS) </li></ul></ul><ul><ul><li>Evaluate for secondary hazards </li></ul></ul><ul><ul><li>Injury Patterns </li></ul></ul><ul><ul><ul><li>Rupture of Air or Fluid Filled Organs </li></ul></ul></ul><ul><ul><ul><ul><li>Lung: Late manifestation (heat & pressure) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hearing loss </li></ul></ul></ul></ul>
  22. 22. Explosion <ul><li>Blast Injury Care </li></ul><ul><ul><li>Lungs </li></ul></ul><ul><ul><ul><li>Forceful compression and distortion of chest cavity </li></ul></ul></ul><ul><ul><ul><ul><li>Compression and decompression </li></ul></ul></ul></ul><ul><ul><ul><li>Pulmonary Embolism, Dyspnea, Hemoptysis, Pneumothorax </li></ul></ul></ul><ul><ul><li>Abdomen </li></ul></ul><ul><ul><ul><li>Compression & Decompression </li></ul></ul></ul><ul><ul><ul><li>Release of bowel contents </li></ul></ul></ul><ul><ul><ul><li>Diaphragm rupture from pushing of organs up into thorax area </li></ul></ul></ul>
  23. 23. Explosion <ul><li>Blast Injury Care </li></ul><ul><ul><li>Ears </li></ul></ul><ul><ul><ul><li>Initial Hearing Loss </li></ul></ul></ul><ul><ul><ul><li>Injury improves over time </li></ul></ul></ul><ul><ul><li>Penetrating Wounds </li></ul></ul><ul><ul><ul><li>Care as any serious open wound or impaled object </li></ul></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><ul><li>Treatment consistent with traditional management. </li></ul></ul></ul>
  24. 24. Other Types of Blunt Trauma <ul><li>Falls </li></ul><ul><ul><li>Stairs, Force, Surface </li></ul></ul><ul><ul><li>Landing Area </li></ul></ul><ul><ul><ul><li>Surface Type </li></ul></ul></ul><ul><ul><ul><li>Body Part </li></ul></ul></ul><ul><ul><li>Height of Fall </li></ul></ul><ul><ul><li>Elderly </li></ul></ul>
  25. 25. Other Types of Blunt Trauma <ul><li>Sports Injuries </li></ul><ul><ul><li>Various Injury Patterns </li></ul></ul><ul><ul><ul><li>Produced by extreme exertion, fatigue or direct trauma </li></ul></ul></ul><ul><ul><ul><ul><li>Acceleration, deceleration, compression, rotation, hyperextension, or hyperflexion </li></ul></ul></ul></ul><ul><ul><ul><li>Unconsciousness, neurological defect or decreased mental status require physician follow-up </li></ul></ul></ul><ul><ul><li>Protective Gear reduces injury pattern </li></ul></ul><ul><ul><ul><li>Helmet Removal </li></ul></ul></ul><ul><ul><ul><ul><li>If loose remove </li></ul></ul></ul></ul><ul><ul><ul><ul><li>If tight, remove face mask and immobilize in place </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Take helmet to hospital </li></ul></ul></ul></ul>
  26. 26. Other Types of Blunt Trauma <ul><li>Crush Injuries </li></ul><ul><ul><li>Cause </li></ul></ul><ul><ul><ul><li>Structural collapse, explosion, industrial; or agricultural </li></ul></ul></ul><ul><ul><li>Great force to soft tissue and bones </li></ul></ul><ul><ul><ul><li>Tissue stretching and compression </li></ul></ul></ul><ul><ul><ul><li>Extended pressure results in anaerobic metabolism distal to compression </li></ul></ul></ul><ul><ul><ul><li>Return of blood flow, toxins to entire body </li></ul></ul></ul><ul><ul><ul><li>Severe hemorrhage due to severe damaged blood vessels </li></ul></ul></ul><ul><ul><li>Care </li></ul></ul><ul><ul><ul><li>Prolonged crush Medications </li></ul></ul></ul><ul><ul><ul><ul><li>Sodium Bicarbonate: Reduce Acidosis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Dopamine: Improve Kidney Function </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Morphine: Pain management </li></ul></ul></ul></ul>
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