Kinematics

Question 1

What is it/Why is it Important?

Answer 1

• Force of acceleration/deceleration of car is equal to the speed of person
• Assessment and management of trauma patients MUST consider the kinematics/mechanism of injury as this can inform you as to potential injury patterns
• Need to assess where each person was before the crash

Question 2

Common Causes of Blunt Trauma

Answer 2

• Low level falls
• RTCs
• Falls from height
• Crushes
• Sporting accidents

Question 3

Factors Affecting Severity of Blunt Trauma

Answer 3

• Decelerating fast eg car to tree
• Objects projected in car
• Direction of impact
• Parts of body which absorb the energy
• Velocity at impact
• Protective eqipment

Question 4

Different Vehicle Mechanism’s

Answer 4

• Rollover
• Frontal Impact (Down and Under, Up and Over)
• Lateral Impact
• Motorcycle Mechanism
• Car vs Pedestrian
• Rear Impact

Question 5

Mechanisms that happen during a Rollover

Answer 5

• Roof intrusion
• Complete ejection
• Partial ejection
• Projection into objects
  (5 fold increase of mortality if ejected)

Question 6

Evidence in Car seen in a Frontal Impact

Answer 6

• Bent steering wheel
• Knee Imprint on dashboard
• Bull’s eye fracture, windscreen

Question 7

Suspected Injury Pattern from Frontal Impact

Answer 7

• Cervical spine fracture
• Anterior flail chest
• Myocardial contusion
• Pneumothorax
• Traumatic aortic distruption
• Fractured spleen or liver
• Posterior fracture/dislocation of hip, knee

Question 8

What happens in the Down and Under Mechanism?

Answer 8

• Force is transmitted to lower extremeties
• Upper body rotates forward and hits dash/steering wheel

Question 9

What happens in an Up and Over Mechanism?

Answer 9

• Happens when person not wearing seatbelt in a frontal impact
• Compression on the C-Spine
• Compression of hollow/solid organs
• Chest/abdominal steering wheel
• Sheering wounds (occur when forces are applied to body tissues or parts that cause these tissues to move in opposite directions)

Question 10

In a Lateral Impact, where are the 3 point of Impact?

Answer 10

Ribs, clavicle, humerus/arm

Question 11

Suspected Injury Pattern from a Lateral Impact

Answer 11

• Contralateral neck sprain
• Cervical spine fracture
• Lateral flail chest
• Pneumothorax
• Traumatic aortic disruption
• Diaphragmatic rupture
• Fractured ribs assc w/ spleen/liver depending on side of impact
• Fractured pelvis or acetabulum

Question 12

What happen in a Motorcycle Mechanism

Answer 12

• During a sudden stop, the person is most likely to go over the bar
• Riders will hit their pelvis on the fuel tank causing trauma
• The centre of gravity is behind and above the front axle
• Riders can get primary and secondary injuries

Question 13

Common Motorcycle Injuries

Answer 13

• Bilateral wrist fractures common injury, also femur injury
• Can cause decompression of c spine, can cause sheering injuries
• Secondary injuries (head, road rash)

Question 14

Car Vs Pedestrian; What happens to Adults compared to Children

Answer 14

• Type of vehicle will depend on mechanism of patient eg bounce off, up and over, side across (see image on slide)
• Child - will bounce off vehicle or get dragged underneath the car depending on height compared to car (check)

Question 15

Car vs Pedestrian Injury Pattern

Answer 15

• Head injury
• Traumatic aortic distruption
• Abdominal visceral injuries
• Fractured lower extremities/pelvis

Question 16

Rear Impact Injury Pattern

Answer 16

• Cervical spine injury
• Soft tissue injury to neck

Question 17

Mechanism fo Fall from Height

Answer 17

• Velocity increases with height
• Landing surface affects deceleration Eg sand vs concrete
• Compression of c spine
• If patient lands feet first energy will travel from the ground up causing injuries; ankle fractures, mid shaft femur fracture, pelvic fractures and injuries sustained from secondary impact
• If patient falls flat, injuries will be dissipated and more likely to have massive internal haemorrhage

Question 18

Primary Blast Injury

Answer 18

Blast Wave - blast lung, perforated ear drum, organ rupture, eye rupture, traumatic brain injury (causes a lot of very quick death)

Question 19

Secondary Blast Injury

Answer 19

Penetrating - ballistic or fragmentation from bomb carrying secondary objects

Question 20

Tertiary Blast Injury

Answer 20

Blast Wind - blunt force injuries from being thrown

Question 21

Quaternary Blast Injury

Answer 21

Heat/Fumes - Flash burns, inhalation injuries

Question 22

Quinary Blast Injuries

Answer 22

Dirty Bombs - bacteria, radiation, chemicals

Question 23

Low Velocity Mechanism

Answer 23

• If the there’s a larger frontal area = more tissue dmg
• Think about fragmentation
• Tumble
• Profile of projectile

Question 24

High Velocity Mechanism

Answer 24

• Can create temporary cavities internally then permanent cavaties
• Can fragment, slowing the bullet down
• Severity related to the damage caused by the path of the bullet and the amount of kinetic energy that is transferred from the round to the tissues
• Bullets are designed to cause death by haemorrhage

Question 25

District General Hospital Capabilities

Answer 25

Might take basic trauma, easy fractures (must check local guidlines)

Question 26

Trauma Unit Capabilities

Answer 26

All truama except sever major trauma. Can go here to stabalise a pt before going to MTC. No vacular/neuro capabilities

Question 27

Major Trauma Centre

Answer 27

Neuro ect. everything you would need. Some are specifically paeds MTCs. Brighton = adult. Southampton/London = paeds

Question 28

ATMIST Handover

Answer 28

A ge and sex
T time of arrival and incident
M OI - kinematics eg head on collision/rollover, stabbing
I injuries suspected or seen
S igns - obs
T treatment given