What is trauma?

Question 1

What do we mean by trauma

Answer 1

Trauma is the acute physiological and structural change (injury) that occurs in a patient’s body when an external source of energy transfers to the body faster than the body’s ability to sustain and dissipate it” (Pilbery and Caroline, 2013 quoted by Pilbery and Lethbridge, 2016)

“Major trauma describes serious and often multiple injuries where there is a strong possibility of death or disability” (NAO, 2010 quoted by Pilbery and Lethbridge, 2016)

Question 2

Mechanism of Injury

Answer 2

‘the physical circumstances causing an injury event’ Trauma Care, 2009

‘Kinematics is the study of how matter moves and interacts in collisions, whether this is a person in a car, a person against a floor or the thoracic contents striking the inside of the rib cage.’ ATACC, 2014
The body can only withstand a limited range of stress
Injury is sustained when the energy delivered exceeds the tolerance of the tissue

Question 3

Mechanism of Injury

Energy can be delivered by

Answer 3

Kinetic energy 
Thermal energy 
Electrical energy
Chemical energy
Nuclear energy
Kinetic energy is the energy that is most commonly associated with trauma

Question 4

Blunt Trauma

Answer 4

Majority of trauma we attend

Two forces involved – shear & compression

Examine vehicle in RTC’s to determine potential energy exchanged

Question 5

Frontal Impact

Answer 5

Speed of impact?
Driver position?
Airbag activation?
Seatbelt worn?
Occupant will either be up and                               over or down and under

Question 6

Pedestrians truma

Answer 6

Who is the casualty 
	– adult, elderly or child
What sort of vehicle?
What anatomical structures                                         could be involved?
Is the patient compensating?

Question 7

Penetrating Trauma

Answer 7

What is the objects initial size
Ice pick
Axe
Bullet – has it tumbled causing greater internal damage
GSW – think about fragmentation
Classify the weapon according to their energy capacity – low, medium, high

Low energy – knife, ice pick

Medium & High - firearms

Question 8

Falls

Answer 8

Consider
Distance of fall
Anatomy impacted
Surface struck

Question 9

Elderly

Answer 9

More likely to sustain more serious injuries
Higher mortality
More likely to require admission, spend longer in hospital
>75 falls are leading cause of death
Ageing attenuates compensatory mechanisms
Despite chit

Question 10

Triage

Answer 10

it is the process of sorting patients according to priority in order to establish an order for treatment and evacuation’ Trauma Care, 2009

Question 11

Triage think

Answer 11

Are there enough resources for all patients
Treat life threatening first
Ensure survival of the greatest number of casualties
Do the most, for the most!!

Question 12

Triage Sieve

Answer 12

Takes place where the casualty is found
Fast, physiological assessment
Based on mobility
Followed by simple ABC 
Paediatrics – triage tape

Question 13

Triage Sort

Answer 13

Second stage, more in depth
Takes place casualty clearing station
Usually adopts TRTS (RR, SBP, GCS)
Score gives the casualty’s priority level

Question 14

Reporting and Handover

Answer 14

Describe mechanism
Photographic evidence?

Why is sharing information with the MTC important?

ATMIST