Product of mass, gravity, and height that is converted into kinetic energy
Energy of a moving object
Product of force times distance
Energy from motion and is subdivided into kinetic energy and potential energy.
The energy available to cause injury ____ when an object’s weight doubles, but ____ when its speed doubles.
Significant MOI for adults
Multisystem trauma Ejection from vehicle Death of passenger in the same vehicle Fall from a height >20 feet Unrestrained vehicle rollover High-speed (>40 mph) vehicle crash Vehicle-pedestrian collision Motorcycle crash of >20 mph AMS Penetrating trauma to head, chest, or abd
Significant MOI for children
Ejection from vehicle
Death of passenger in same vehicle
Fall >10 feet or two-three times child’s height
Fall of <10 feet w/ LOC
Medium-to-high-speed vehicle crash (=>25 mph)
Penetrating trauma to the head, chest, or abd
Force to the body that causes injury w/o penetrating the soft tissue or internal organs and cavities
Injury by objects that pierce and penetrate the surface of the body and injury the soft tissues, internal organs, and body cavities.
Top five causes of death from unintentional injury in the US:
Poisonings (OD), MVCs, falls, choking and suffocation, and drowning.
MVCs consist of three collisions :
Collision of the car against another car, tree, or some other object.
Collision of the passenger against the interior of the car.
Collisions of the passenger’s internal organs against the solid structures of the body.
Coup-countercoup brain injury
Compression injury to the anterior portion of the brain and stretching or tearing of the posterior portion of the brain.
What signs of vehicle deformity should you have a high suspicion of significant MOIs?
Severe deformities of the frontal portion, w/ or w/o intrusion into the passenger compartment.
Moderate intrusions of lateral collision.
Severe damage to the rear.
Rotational collision - rollovers and spins.
What are body clues would you suspect to see when the front end of a vehicle is deformed and the windshield is cracked? What are the potential injuries?
Body clues : bruises or lacerations to head and/or face
Potential injuries : brain injury; scalp, facial cutes; c-spine injuries; tracheal injuries
What are body clues would you suspect to see when the steering column is deformed? What are the potential injuries?
Body clues : Bruised neck and/or chest
Potential injuries : sternal or rib fx, flail chest; myocardial contusion’ pericardial tamponade; pneumothorax or hemothorax; exsanguination from aortic tear
What are body clues would you suspect to see when the dashboard is deformed? What are the potential injuries?
Body clues : bruised abdomen; bruised knee, dislocated patella
Potential injuries : ruptured spleen, liver, bowel, diaphragm; patella fx; dislocated knee; femoral fx; dislocated hip
What are body clues would you suspect to see when the vehicle is deformed on one side? What are the potential injuries?
Body clues : bruised shoulder
Potential injuries : clavicle fx; humerus fx; multiple rib fx
What are body clues would you suspect to see when the door of a vehicle is smashed in? What are the potential injuries?
Body clues : bruised shoulder or pelvic
Potential injuries : hip fx; iliac wing fx; clavicle or ribs fx
What are body clues would you suspect to see when the “B” pillar is deformed? What are the potential injuries?
Body clues : Bruised temple
Potential injuries : brain injury; c-spine fx
What are body clues would you suspect to see when the door or window handles are broken? What are the potential injuries?
Body clues : bruised or deformed arms
Potential injuries : contusions
What are body clues would you suspect to see when the window is broken in a vehicle? What are the potential injuries?
Body clues : dicing lacerations
Potential injuries : multiple lacerations
What are body clues would you suspect to see when posterior deformity of the vehicle? What are the potential injuries?
Body clues : secondary anterior injuries, especially if unrestrained
Potential injuries : whiplash; deceleration injuries of a head-on impact
What are body clues would you suspect to see when headrest is not adjusted? What are the potential injuries?
Body clues : none
Potential injuries : bleeding, bruising, or tearing inside skull
What type of injuries would you suspect from a seatbelt?
Abdominal injuries, especially in peds
Lumbar spine fx, especially in elderly
What type of injuries would you suspect from an airbag deployment?
Injuries to face, neck, chest, and abdomen including internal organs.
Up-and-over pathway injuries from a frontal collision.
Chest injuries - rib fx, flailed chest, pneumothorax, hemothorax, contusions, great vessel injury
Abdominal injuries - solid organs, hollow organs, diaphragm
Down-and-under pathway injuries from frontal collision.
Posterior knee and hip dislocations
Pelvic and acetabular fx
Potential injuries and s/s of a blunt or penetrating trauma to the neck?
Potential injuries : Airway obstruction from bleeding, secretions, or FB in upper or lower airway
s/s : noisy or labored respirations; swelling of face or neck
Potential injuries and s/s of a substantial chest wall blunt or penetrating trauma?
Potential injuries : breathing problems, cardiac or pulmonary contusion, pneumothorax or hemothorax, broken ribs
s/s : substantial chest pain, SOB, asymmetrical chest wall movement, penetrating trauma to chest
Potential injuries and s/s of a substantial blunt or penetrating trauma to chest, abdomen, or groin?
Potential injuries : hidden blood loss, damage to major vessels
s/s : bruising, redness, abrasions, or obvious trauma to the abdomen or pelvis; abdominal distention or rigidity; ttp of pelvis
Potential injuries and s/s of a blunt force trauma to the head?
Potential injuries : brain injury
s/s : LOC, AMS, amnesia, combative, or changes in speech patterns; difficulty moving extremities; severe HA w/ associated n/v
Potential injuries and s/s of a blunt force trauma, penetrating trauma, or fall from a substantial height?
Potential injury : spinal injury
s/s : severe neck or back pain, difficulty moving or feeling extremities, loss of sensation or tingling in the extremities
Which three factors should you take into account with a fall MOI?
Height of the fall
Type of surface struck
Part of the body that hit first, followed by the path of energy displacement
Penetrating trauma can be classified as :
Primary blast injuries
Injuries from blast wave itself :
Disruption of major blood vessels
Rupture ear drums and major organs
Possible amputation of limbs
Secondary blast injuries
Injuries due to missiles being propelled by blast force.
Tertiary blast injruies
Injuries due to impact with another object.
Quaternary blast injuries
Collateral injuries such as :
Burns from hot gases or fires
Respiratory injury from inhaling toxic gases
Crush injuries from collapsed building
Contamination of wounds from environmental, chemical, or toxic substances
Mental health emergencies
Pulmonary blast injuries
Pulmonary trauma consisting of contusions and hemorrhages.
s/s of pulmonary blast injuries
Chest pain Hemoptysis Tachypnea Respiratory distress Subcutaneous emphysema
Trauma lethal triad
Hypothermia + acidosis + coagulopathy = death
What treatments should you administer to prevent death secondary to the trauma lethal triad?
Aggressively control bleeding
Minimize the volume of acidic IV fluid (nl saline)
Warm IV fluids
Monitor end-tidal CO and ventilate to prevent respiratory acidosis
ALS back up for administration of tranexamic acid (TXA)
Criteria for use of emergency air services for trauma patients :
Extended period to access or extricate a remote or trapped patient.
Trauma center is greater than 20-25 miles.
Needs medical care and stabilization at ALS, and there is no ground ALS unit available.
Traffic conditions or hospital availability prevents transportation in an ideal trim.
Prevent overwhelming trauma centers w/ multiple patients
What is the phenomenon that results from the rapid changes in tissue and fluid pressure that occur with the passage of the projectile resulting in serious injury to internal organs distant to the actual path of the bullet?