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Trauma

Trauma. Comprehensive Review. Time vs. Survival. Relationship of time to survival The “golden hour” Importance of an organized approach to trauma. Scene Size-up. Body substance isolation review Scene safety Total number of patients Essential equipment and resources needed on-scene

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Trauma

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  1. Trauma Comprehensive Review

  2. Time vs. Survival Relationship of time to survival The “golden hour” Importance of an organized approach to trauma

  3. Scene Size-up Body substance isolation review Scene safety Total number of patients Essential equipment and resources needed on-scene Mechanisms of injury

  4. It is important to be aware of mechanisms of injury because…

  5. Basic Mechanisms of Motion Injury Blunt injuries Rapid forward deceleration (collisions) Rapid vertical deceleration (falls) Energy transfer from blunt objects (bat, stick) Penetrating injuries Projectiles Knives Falls upon fixed objects

  6. Clues to Injury Motor Vehicle Collision Vehicle damage What forces were involved in the collision? Intrusion > 12 in occupant compartment Intrusion > 18 in anywhere else Damage to interior structures What did the patient hit? Injury patterns on the patient What anatomic areas were hit?

  7. Newtons Law • Says what……….? • Link

  8. 3 “Impacts” in each Accident • Car vs Slower or stopped object • Person vs Car (e.g wheel) • Organs vs Boney cage (e.g brain vs inside of cranium)

  9. History taking • Scene survey (use your knowledge of trauma kinetics to extract information from the scene) • Ask bystanders what they saw, heard and their initial assessment • Ask first responders their initial impressions • Ask patient some questions? • Keep in mind what the trauma team wants to know. 4 main questions • 1 • 2 • 3 • 4 • Time frame – actual vs perceived • History taking and “recreation” of the crash is the only thing that separates the real medic from the layperson who looks at the destruction and crash scene • What also does it do re: patient injuries and expectations?

  10. Rapid forward deceleration Rapid vertical deceleration Energy transfer from blunt instruments

  11. ITLS • See table 1-3 Mechanism of injury and potential injury patterns • Read Chapter 1

  12. Different Kinds of MVC’s • Fontal (head on) • T boned 0 side impact • Rollover • Rear ended

  13. Head on

  14. Patient Trapped • “down and under” • Forces on upper legs to force them under the dashboard • Specific injuries occur

  15. Head on Crash • Link

  16. Lateral-impact Collision- T bone Machine collision Body collision Organ collision Courtesy of Bonnie Meneely, EMT-P

  17. Rear-impact Collision Machine collision Body collision Organ collision Courtesy of Bonnie Meneely, EMT-P

  18. Occupant Restraint Systems Lap belts Cross-chest lap belt Air bags Passive restraint system. No hazardous materials are released. Always “lift and look” under the air bag. Deformity of wheel suggests impact.

  19. Small Vehicle Crashes Motorcycles Mopeds E Bikes All-terrain vehicles Personal watercraft Snowmobiles

  20. Car Vs Pedestrian

  21. Pedestrian Injuries Patient sustains high-energy transfer. Even with low-speed collision Patient may have “second impact” injuries. Courtesy of Bonnie Meneely, EMT-P

  22. Donor Cycles

  23. Type of injuries expected?

  24. Helmet • Ensure you review helmet removal technique • Look at it carefully • Inspect for damage • Bring to ER with you • Helmet tells a story too!

  25. Patients may not look as injured

  26. Explosions • Need to know the force involved • Patient thrown? • How far? • Contact surface? • Heat or fire involved? • Assume trauma and full c- spine support • Hazmat? • Three phases…

  27. Blast Injuries Scene Size-up Scene safety! May involve multiple patients Mechanism Primary Secondary Tertiary Courtesy of Bonnie Meneely, EMT-P

  28. Falls

  29. FALLSInjuries depend upon 3 factors: Distance of fall Elderly may fracture hip from “trivial” fall. Anatomic area impacted Patients landing on their feet may have injury to knees, hips, or lumbar spine. Patients landing on their heads may have cervical spine injury. Surface hit

  30. Forces in falls • Something called Axial loading • Along the long axis of the body

  31. Case Study Classic 21 yr old dating A 14 year old. Parents Come home and “Don” jumps out 3rd story balcony! Fractures ankles and wrist ? Lumbar #

  32. Tractor Accidents Rear overturns (15%) More likely to crush the driver Side overturns (85%) Mechanism Crush injuries Thermal & chemical burns sy of Roy Alson, M.D. Courtesy of Roy Alson, M.D.

  33. Penetrating InjuriesKnives & Other Objects Severity depends upon: Site Length of object Angle of penetration Below 4th intercostal space may involve chest and abdomen. Do not remove impaled object. Courtesy of Bonnie Meneely, EMT-P

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