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Pedestrian Vehicle Accidents 'Common Injuries Patterns'

A presentation focusing on the common injury patterns seen in pedestrian vehicle accidents. By Dr. Nic Sparrow - Medical Director of phcworld.org

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Pedestrian Vehicle Accidents 'Common Injuries Patterns'

  1. 1. Pedestrian Vehicle Accidents ‘Common Injury Patterns’<br />By Dr. Nic Sparrow MBBS, BSc, MRCGP<br />Medical Director – Pre-Hospital Care World<br />www.phcworld.org<br />
  2. 2. Overview / Aims<br />To discuss some the common injuries patterns in Pedestrian Vehicle Accidents (PVA’s) <br />To explore and review key medical literature surrounding this topic<br />Conclude with a summary of useful things to remember when attending PVA’s <br />
  3. 3. Background<br />1 Pedestrian is killed by a motor vehicle every 113 minutes and injured every 8 minutes in the USA<br />PVA’s account for a significant number of trauma admissions and deaths in urban areas<br />Patients can have multiple injuries & be difficult to evaluate initially<br />Pedestrians Injured by Automobiles: Relationship of Age to Injury Type and Severity; DemetriosDemetriades et al: J Am CollSurg: V0l. 199, No. 3, September 2004<br />
  4. 4. Key Research Paper<br />Demetriades D et al. Pedestrians Injured by Automobiles: Relationship to Age to Injury Type and Severity. <br /> J AM CollSurg Vol. 199 No.3 Sept 2004<br />Trauma Registry-based study in Los Angeles included all trauma admission for PVA’s by automobiles over a 10 year + 4 month period<br />From 1993 to 2003 = 5838 patient involved in this study<br /> ≤ 14 yrs – 19.4% (1136)<br />15-55 yrs – 64.1% (3741)<br />56 -65 yrs – 7.2% (420)<br />&gt; 65 yrs – 9.3% (541)<br />
  5. 5. Continuation <br />There were 972 patients (16.6%) with at least one body area with severe injuries, defined as an abbreviated injury score &gt; 3<br /> Head = 620 (10.6%) Most common area<br /> Chest = 156 (2.7%)<br /> Abdomen = 125 (2.1%)<br /> Extremities = 71 (1.2%)<br />
  6. 6. Factors Affecting Injury Severity<br />Age of the patient<br />The speed and type of vehicle<br />Objects carried at time of impact<br />The main point of contact with the vehicle<br />Hit at 65 km/hr - 80% chance of death <br />Hit at 50 km/hr - 80% chance of survival<br />
  7. 7. The ‘CALL – OUT’<br />Parking defensively protecting the scene<br />Watch for traffic !<br />Assess & Approach <br /> ‘Read the wreck’<br />THINK SAFETY<br />SELF, Scene, Survivor <br />
  8. 8. Management of PVA’s<br />First Responder / EMS Provider<br />Think Spinal Control... <br />Airway<br />Breathing<br />Circulation<br />Disability<br />Exposure <br />Ask yourself<br />1) Head injury ?<br />2) Does this patient need intubating ?<br />3) Does this patient have a pelvic injury ?<br />
  9. 9. Head Injuries<br />Incidence of severe head trauma (AIS &gt; 3) increased significantly with age:-<br /> 7.4% of the children ≤14 yrs <br /> 23.7% of the adults &gt; 65 yrs<br />Subdural and subarachnoid haemorrhages also increased significantly with age<br />Spine Control <br />Palpate the Skull<br />Look in Eyes & ENT<br />GCS &lt; 9 consider intubation<br />
  10. 10. Spinal Injuries<br />Rapid Assessment of the Airway / C-Spine is required<br />The overall incidence of Spinal Injuries was 5.1% (295 patients)<br />No difference between the occurrences of C-spine / Thoracic/ Lumbar Spine injuries<br />C-SPINE 3 POINT IMMOBILISATION<br />
  11. 11. Spinal Injuries - Continuation<br />Spinal Injuries increase dramatically with age<br />Factors such as osteoarthritis and osteoporosis contribute to injuries<br />Risk of spinal injury is x21 greater in &gt; 65yrs (8.5% occurrence) compared with children (0.4%) <br />
  12. 12. Upper Extremity Injuries<br />Male 30 yrs - Hit by car on highway <br />GCS 3/15, # L Humerus / Radius + Ulnar<br />CT Head Normal<br />IV access & BP monitoring impossible on L arm <br />
  13. 13. Chest Injuries<br />A Pneumo or haemothoraxwas present in 247 pts (4.2%) and rose steadily through the ages<br />Incidence was 2.1% in children ≤ 14 yrs<br />Incidence was 8.5% inpatients &gt;65 yrs<br />Thoracic aortic injury occurred in 16 patients (0.3%) – x7 times more likely in the over 65yrs, none occurred in the ≤ 14 yrs<br />
  14. 14. Fractures of the first x3 ribs, or ≥ 3 rib #’s <br />&gt; 10% mortality<br />
  15. 15. Abdominal Trauma<br />Liver injuries occurred in 141 pts (2.4%)<br />Splenic injuries occurred in 102 pts (1.7%)<br />Renal injuries occurred in 44 pts (0.8%)<br />Gastro injuries occurred in 237 (4.1%)<br />There was no statistically significance difference across the age groups<br />
  16. 16. Pelvic Injuries<br />Requires massive energy transfer<br />Occurred in 748 patients (12.8%)<br />X3.5 likely in the &gt;65yrs (22.6%) compared with children under 14 yrs (6.3%)<br />Patient may complain of severe back pain, abdominal or suprapubicpain<br />
  17. 17. Patient may become rapidly hypotensive<br />&gt; 3L of blood loss from pelvic #’s <br />Widened Symphysis Pubis<br />Sheet used to compress the pelvis <br />
  18. 18. Upto 1.5L blood loss from femoral #’s<br />Overall Mortality<br /><ul><li> Closed fractures ~ 3.0%
  19. 19. Compound pelvic fractures up to 40%</li></li></ul><li>Lower Extremity Injuries<br />Tibia fractures were the most common injury accounting for 1512 cases (25.9%)<br />Children ≤ 14yrs were ~50% less likely to suffer tibial fractures than those older<br />However, children were x1.8 more likely to sustain femoral fractures <br />
  20. 20. Lower Extremity Injuries<br />Stop overt bleeding<br />Check for peripheral pulses<br />In the absence of pulses, exclude a pelvic fracture, provide analgesia & reduce<br />Wrap in dressing + splint<br />~ 1000mls<br />
  21. 21. Fatalities<br />The overall mortality from PVA’s was 7.7% (449 deaths)<br />This increased significantly with age<br />3.2% in the pediatric group<br />25.1% in the &gt; 65 yr group<br />
  22. 22. Points to remember (1)<br />Tibial #’s are the most common injury ~ 25%<br />Head injury increases significantly with age 7.4% in the ≤14 yrs to 23.7% in &gt; 65 yrs<br />Look out for pelvic fractures. Occurs in ~12% of patients (22.6% incidence in &gt; 65yrs)<br />
  23. 23. Points to remember (2)<br />Spinal injuries occurred in 5.1% of pts; the elderly were x21 more likely to suffer spinal trauma<br />Haemo / Pneumothorax occur in ~ 4% <br />Mortality rate in &gt;65 yrs = ~25%<br />The older the patient the greater the risk of serious injury<br />
  24. 24. THE END<br />Visit www.phcworld.org <br />for more information<br />

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