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. Veronica Bonales, M.D. Whack-a-Mole: CEP America Emergency Physician aka Blunt Force Trauma Redwood Memorial Hospital
- 4. Blunt Force Trauma Veronica Bonales, M.D. CEP America, Emergency Physician Redwood Memorial Hospital
- 8. Blunt Force Trauma Types Sample Injuries by Anatomical Region Specific Syndromes
- 9. Blunt Force Compression Trauma
- 10. 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
- 13. Blunt Force Deceleration Trauma
- 14. Blunt Force Trauma Injury because of sudden halt MVC most common Acceleration factor greatest in air travel Stretching & linear shearing of fixed or free organs
- 17. Blunt Force Trauma Anatomical Considerations
- 18. Blunt Force Head and Spine Trauma Injuries
- 21. Blunt Force Trauma Skull 22 bones 8 CRANIAL, 14 FACIAL
- 29. Blunt Force Trauma Basilar Skull Fracture Battle’s Sign Raccoon Eyes CSF Otorrhea or rhinorrhea
- 35. Blunt Force Trauma • Cranium – Brain – Attached by meninges – Surrounded by fluid – Surface blood vessels
- 36. Blunt Force Trauma Coup and contrecoup injuries
- 45. Blunt Force Trauma Epidural hematoma
- 46. Blunt Force Trauma Epidural hematoma
- 51. Blunt Force Trauma Subdural hematoma
- 52. Blunt Force Trauma Subdural hematoma
- 57. Blunt Force Trauma Subarachnoid hematoma
- 58. Blunt Force Trauma Subarachnoid hematoma
- 59. Blunt Force Trauma Special Considerations
- 60. Blunt Force Trauma Special Considerations
- 61. Blunt Force Trauma Special Considerations
- 62. Blunt Force Trauma Special Considerations
- 63. Blunt Force Trauma Cervical Spine 7 vertebrae Axis Atlas Ligaments Anterior Posterior
- 64. Blunt Force Trauma Axial Load Injuries
- 65. Blunt Force Trauma Hyperextension injuries Hyperflexion injuries
- 69. Blunt Force Trauma Hangman’s Fracture - Bilateral pedicle Fx - Distraction C2-C3 - Due to complete disruption
- 72. Blunt Force Trauma C spine precautions placed when: – Any neck discomfort or numbness in extremities – Not fully alert or AMS – Other painful injuries
- 73. Blunt Force Trauma C spine precautions placed when: – Any neck discomfort or numbness in extremities – Not fully alert or AMS – Other painful injuries
- 74. Blunt Force Trauma Rigid 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%.
- 75. Blunt Force Trauma best 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.
- 76. Blunt Force Trauma Thoracic Spine 12 vertebrae Attached to rib cage Ligaments Anterior Posterior
- 77. Blunt Force Trauma • Axial loading – Burst fracture – Nerve findings common
- 78. Blunt Force Trauma • Hyperextension injuries – Very unstable fracture
- 81. Blunt Force Trauma • Lumbar Spine –5 vertebrae –Fractures require significant mechanism
- 82. Blunt Force Trauma Flexion injuries Wedge compression fracture Requires a high energy process
- 83. 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
- 84. Blunt Force Thoracic Injuries Trauma
- 85. Blunt Force Trauma Bony Injuries Pulmonary injuries Cardiac and vascular injuries Diaphragmatic injuries
- 86. Blunt Force Trauma Sternal Fracture Indicates worse mechanism of injury Not an indicator of cardiac injury
- 87. Blunt Force Trauma Sternal Fracture Indicates worse mechanism of injury Not an indicator of cardiac injury
- 89. Blunt Force Trauma Rib Fractures 9 - 11 watch for intra-abdominal injuries
- 90. Blunt Force Trauma Rib Fractures 9 - 11 watch for intra-abdominal injuries
- 91. Blunt Force Trauma Rib Fractures 9 - 11 watch for intra-abdominal injuries Flail Chest Three or more consecutive ribs Broken in 2 or more places Same side of chest Paradoxical Chest Movement
- 92. Blunt Force Trauma Lung contusions More common in children Serious cause of morbidity Elderly COPD
- 94. Pneumothorax
- 98. 1 2 3 4 5
- 99. 1 2 3 4 5
- 101. Findings: Respiratory distress Tachycardia Hypotension JVD Pulsus Paradoxus
- 102. 1 2 Findings: Respiratory distress Tachycardia Hypotension JVD Pulsus Paradoxus
- 103. 1 2 Findings: Respiratory distress Tachycardia Hypotension JVD Pulsus Paradoxus
- 107. Lateral chest! •Pleural Cavity can hold 4+ liters of blood •Not symptomatic until get about 250 ml •First 300 ml space
- 108. Lateral chest! •Pleural Cavity can hold 4+ liters of blood •Not symptomatic until get about 250 ml •First 300 ml space
- 109. Lateral chest! •Pleural Cavity can hold 4+ liters of blood •Not symptomatic until get about 250 ml •First 300 ml space
- 110. Lateral chest! •Pleural Cavity can hold 4+ liters of blood •Not symptomatic until get about 250 ml •First 300 ml space
- 115. 1200 900 600 300
- 118. Blunt Force Trauma
- 119. 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
- 120. Blunt Force Trauma
- 121. 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
- 122. Blunt Force Trauma Thoracic Aorta Disruption 2nd leading cause of death 93% at desc. Aorta Widened mediastinum most common finding 85%
- 123. Blunt Force Trauma Thoracic Aorta Disruption 2nd leading cause of death 93% at desc. Aorta Widened mediastinum most common finding 85%
- 124. Blunt Force Trauma Thoracic Aorta Disruption 2nd leading cause of death 93% at desc. Aorta Widened mediastinum most common finding 85%
- 125. Blunt Force Trauma Pericardial tamponade Tachy 77% JVD 76% Dec. Heart Sounds 28% Hypotension 26%
- 126. Blunt Force Trauma Pericardial tamponade Tachy 77% JVD 76% Dec. Heart Sounds 28% Hypotension 26%
- 127. Blunt Force Trauma Pericardial tamponade Tachy 77% JVD 76% Dec. Heart Sounds 28% Hypotension 26%
- 128. Blunt Force Trauma
- 129. Blunt Force Trauma Diaphragmatic injury Strong compressive forces Intrusion by abdominal viscera Injury mostly occurs on right Bowel sounds in the chest
- 133. Blunt Force Abdominal Injuries Trauma
- 134. Blunt Force Trauma Most common type 50 – 70% Liver & spleen most commonly injured may not manifest during initial assessment & treatment period 1.5L before distention appears
- 135. Blunt Force Trauma Compression injuries Liver lacerations and hematomas Splenic lacerations and sequestration Deceleration injuries Kidney Bowel injuries Vascular injuries
- 136. Blunt Force Trauma Hollow organ injuries Usually secondary to seatbelt Compressive forces increase pressure Deceleration disrupts blood supply from mesenteric vessels
- 137. Blunt Force Trauma
- 138. Blunt Force Trauma Spleen Most commonly injured solid organ Rich blood supply Pain in LUQ with left shoulder pain
- 139. Blunt Force Trauma
- 140. Blunt Force Trauma Injured from trauma to: Eighth through twelfth ribs on right side of body Upper central part of abdomen Tear at falciform or direct injury Blood and bile will leak into abdominal cavity Shock Peritoneal irritation
- 141. Blunt Force Trauma
- 142. Blunt Force Trauma Kidney Firmly held in the retroperitoneum Severe compression or rib fractures Deceleration leads to shearing of arteries Spillage of blood and urine into retroperitoneum
- 143. Blunt Force Trauma Pelvic Organ Injuries Most commonly associated with pelvic fractures Urinary rupture if compressive force on full bladder
- 144. Blunt Force Trauma Focused Abdominal Sonography for Trauma
- 145. Blunt Force Trauma Focused Abdominal Sonography for Trauma
- 146. Blunt Force Trauma
- 147. Blunt Force Trauma
- 148. Blunt Force Trauma
- 149. Blunt Force Trauma Medial Malleolus
- 150. Blunt Force Trauma Medial Malleolus
- 151. Blunt Force Trauma Medial Malleolus
- 152. Blunt Force Crush Syndromes Trauma
- 153. Blunt Force Trauma occurs when body part subjected to high degree of force or pressure
- 154. Blunt Force Trauma Bleeding Bruising Fracture Laceration Compartment Syndrome
- 155. Blunt Force Trauma Not an acute occurrence Symptoms: Pain out of proportion/passive motion Parasthesias/ Paralysis Pallor Pulselessness Poiklothermia
- 156. Blunt Force Trauma Compartment Pressures Normal about zero; usually less than 10 mm Hg Capillary blood flow compromised at >20 mm Hg Muscles/nerves at risk for ischemic necrosis >30 to 40 mm Hg. Nerve is most sensitive, followed by muscle tissue.
- 157. Blunt Force Trauma Traumatic Asphyxia Syndrome Constrictive force to chest wall Can occur within two minutes Mechanism of injury - profound venous hypertension Cerebral hypoperfusion
- 158. Blunt Force Trauma Vital signs Tachycardia Tachypnea Signs of shock Hypotension Diaphoresis Slow cap refill Mental Status Neurodeficits Young will handle better than old
- 159. Luckiest Man Alive
- 160. Questions??
- 162. 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.