djorgenmorris

1. Paramedic Care:
Principles & Practice
Volume 5
Trauma Emergencies

2. Chapter 2
Blunt Trauma

4. Introduction to Blunt Trauma
 Blunt trauma is the most common cause of trauma-
related death and disability.
 True nature of the injury is often hidden.

5. Physics 101

6. Kinetics
 Kinetics is a branch of physics dealing with objects in
motion and the energy exchanges that occur as objects
collide.
 Deals with motion and energy exchanges

7. Kinetics of Impact
 Two basic principles of kinetics:
 Laws of inertia
 Energy conservation

9. Law of Inertia
 Newton’s first law:
 “A body in motion will remain in motion unless acted upon
by an outside force.”
 “A body at rest will remain at rest unless acted upon by an
outside force.”

11. Energy Conservation
 Law of Energy Conservation
 “Energy can neither be created nor destroyed. It can only
be changed from one form to another.”
 All the energy of motion converts to other energy forms.

12. Types of Energy
 Potential
 Kinetic

14. Kinetic Energy
 Kinetic energy of an object while in motion is
measured by the following formula:
KE = mass (weight) x velocity (speed)2
2

15. Kinetic Energy
 When you double an object’s weight, you double its
kinetic energy.
 As speed (velocity) increases, there is a larger
(squared) increase in kinetic energy.
 Releasing energy slowly, as occurs with braking,
results in a tolerable transfer of energy while stopping.

16. Force
 Newton’s second law of motion explains the forces at
work during a collision:
Force = Mass (Weight) X Acceleration (or Deceleration)

17. Force
 The formula emphasizes the importance of the rate at
which an object changes speed.
 Gradual changes in speed are usually uneventful.
 When significant kinetic energy is applied to human
anatomy, we call it trauma.

18. Biomechanics of Trauma

19. Biomechanics of Trauma
 Describes the actual injury process.
 Bound by the laws of physics:
 Inertia, energy conservation, and force
 Trauma is divided into two general categories:
 Blunt
 Penetrating

20. Blunt Trauma
 The Force enters the
body, not the object.

21. What Causes the Injury?
 Compression (opposite of stretching)
 Stretching (opposite of compression)
 Shearing

22. Skin
 Resistant to compression and stretching (hides injuries)

23. Bone
 Very strong but will fx with shearing forces

24. Lung
 Compression is bad

25. Hollow Organs
 Tolerant unless filled with fluid or air

26. Biomechanics of Trauma
 Blunt
 Closed injury
 Indirect injury to
underlying structures
 Transmission of energy
into the body

27. Biomechanics of Trauma
 Penetrating
 Open injury
 Direct injury to
underlying structures

28. Automobile Collisions
 44,000 people die each year on U.S. highways.
 Events of Impact:
 Vehicle collision
 Body collision
 Organ collision
 Secondary collisions
 Additional injuries
 Vehicle receives a second impact

29. Automobile Collisions

30. Automobile Collisions
 Restraints
 Seatbelts
 Airbags (SRS)
 Reduce blunt chest
trauma
 Cause: hand, forearm,
and facial injury
 Check for steering
wheel deformity
 Side airbags
 Child Safety Seats

31. Automobile Collisions
 Types of Impact
 Frontal
 Lateral
 Rotational
 Rear-end
 Rollover

32. Frontal Impact
 Up-and-Over
 Tenses legs = bilateral femur fracture
 Hollow organ rupture and liver laceration
 Similar chest trauma
 Axial loading
 Down-and-Under
 Knee, femur, and hip fracture
 Chest trauma – steering wheel
 Paper bag syndrome
 Ejection

33. Lateral Impact
 15% of MVCs but 22% of
deaths
 Upper extremity injury
 Rib, clavicle, humerus,
pelvis, femur fracture
 Lateral compression
 Ruptured diaphragm
 Spleen fracture
 Aortic injury

34. Rotational Impact
 Vehicle struck at oblique
angle
 Less serious injuries
unless strike a
secondary object
© Mark C. Ide

35. Rear-End Collisions
 Rear-end
 Seat propels the occupant
forward
 Head is forced backward
 Stretching of neck muscles and
ligaments
 Hyperextension and
hyperflexion
© Mark C. Ide

36. Rollover
 Rollover
 Multiple points of impact
 Ejection or partial ejection
 Less injury with restraints
© Mark C. Ide

37. What kind of car do you see?

38. Vehicle Collision Analysis
 Hazards
 Crumple zones
 Intrusion
 Deformity of vehicle
 Use of restraints
 Undeployed airbags should be deactivated by trained
fire/extrication personnel
 Intoxication
 Fatal collisions: >50% involve legal intoxication
 Recreational accidents

39. Automobile Collision
Evaluation
© Ray Kemp/911 Imaging

44. Automobile Collisions
 Vehicular Mortality
 Head: 48%
 Internal (torso): 37%
 Spinal and chest fracture: 8%
 Extremity fracture: 2%
 All other: 5%

45. Automobile Collision
Evaluation
 Collision Questions
 How did collision occur?
 Direction?
 Speed?
 Similar/different sized?
 Secondary collisions?
 Cause of Collision
 Weather and visibility?
 Alcohol involved?
 Skid marks?
 Auto Interior
 Starring of windshield?
 Steering wheel deformity?
 Dash deformity?
 Intrusion?

46. Motorcycle Collisions
 Serious injuries can occur with high- and low-speed
collision
 Types of Impact
 Frontal
 Angular
 Sliding
 Ejection
 Initial bike/object collision
 Rider/object
 Rider/ground

48. Pedestrian Collisions
 Adults
 Adults turn away
 Bumper strikes lower
legs first
 Victim rolls up and over
and thrown

49. Pedestrian Collisions
 Children
 Children turn toward
 Femurs, pelvis often
injured
 Thrown away or run
over

50. Recreational Vehicle
Collisions
 Lack structure and restraint system
 Types of Vehicles
 Snowmobiles
 Personal watercraft
 ATVs
 Often see injuries in children due to lack of skills and training

51. Blast Injuries
 Explosion
 Pressure Wave
 Blast Wind
 Victim Displacement
© Joshua Menzies

52. Blast Injuries

53. Explosion
 Pressure Wave
 Structural collapse
 Blast wind
 Burns
 Projectiles
 Terrorist devices may contain nails, screws, or other
materials meant to cause additional injury and
destruction.
 Personnel Displacement

54. Explosion
 Blast Injury Phases
 Primary: Heat of the explosion
 Secondary: Trauma caused by projectiles
 Tertiary: Personnel displacement and structural collapse

55. Explosion
 Blast Injury Assessment
 Be alert for secondary device
 Initial scene size-up important
 Establish Incident Command System (ICS)
 Evaluate for secondary hazards
 Injury Patterns:
 Rupture of air- or fluid-filled organs
 Lung: Late manifestation (heat and pressure)
 Hearing loss

56. Explosion
 Lungs
 Forceful compression and distortion of chest cavity
 Compression and decompression
 Pulmonary embolism, dyspnea, hemoptysis,
pneumothorax
 Abdomen
 Compression and decompression
 Release of bowel contents
 Diaphragm rupture from pushing of organs up into thorax
area

57. Explosion
 Ears
 Initial hearing loss
 Injury improves over time
 Penetrating Wounds
 Care as any serious open wound or impaled object
 Burns
 Treatment consistent with traditional management

58. Other Types of Blunt Trauma
 Falls
 The initial impact may
involve other body
surfaces with the forces of
deceleration
 Evaluating a fall
 Determine the point of
impact
 The fall height
 The impact surface
 The transmission pathway
of forces along the skeleton

59. Other Types of Blunt Trauma
 Sports Injuries
 Sports injuries are most commonly produced by extreme
exertion, fatigue, or by direct trauma forces.
 Injuries can be secondary to acceleration, deceleration,
compression, rotation, hyperextension, or hyperflexion.

60. Other Types of Blunt Trauma
 Crush Injury
 Cause
 Structural collapse, explosion, MVC, industrial, or agricultural
 Great force to soft tissue and bones
 Tissue stretching and compression
 Extended pressure results in anaerobic metabolism distal to
compression
 Return of blood flow, toxins to entire body
 Severe hemorrhage due to severe damaged blood vessels

64. Questions?