Quantum Physics and the Time-Space Continuum

1. Quantum Physics and the Time-Space Continuum An in depth and highly detailed analysis of the physical universe and it’s relevance to the pre-hospital emergency medical practicum.

2. TRAUMA KINEMATICS An Introduction to the Physics of Trauma

3. Trauma Statistics • Over 150,000 trauma deaths/year • Over 40, 000 are auto related • Leading cause of death for ages 1-40 • One-third are preventable • Cost exceeds $220 billion (2001) • Unnecessary deaths are often caused by injuries missed because of low index of suspicion

4. Kinematics • Physics of Trauma • Understanding kinematics allows prediction of injuries based on forces and motion involved in an injury event.

5. Basic Principles • Conservation of Energy Law • Newton’s First Law of Motion • Newton’s Second Law of Motion • Kinetic Energy

6. Newton’s First Law • Body in motion stays in motion unless acted on by outside force • Body at rest stays at rest unless acted on by outside force

7. Newton’s Second Law • Force of an object = mass (weight) x acceleration or deceleration (change in velocity) • Major factor is velocity • “Speed Kills”

8. Law of Conservation of Energy • For every action there is an opposite and equal reaction • Energy cannot be created or destroyed • Energy can only change from one form to another

9. Kinetic Energy • Energy of Motion • Kinetic energy = ½ mass of an object X (velocity)2 • Injury doubles when weight doubles but quadruples when velocity doubles

10. So… When a moving body is acted on by an outside force and changes its motion, then kinetic energy must change to some other form of energy. If the moving body is a human being and the energy transfer occurs too rapidly, then trauma results.

11. Blunt Force Trauma • Force without penetration • “Unseen injuries” • Cavitation towards or away from the injury

12. Penetrating Trauma • Piercing or penetration of body with damage to soft tissues and organs • Depth of injury

13. Mechanism of Injury Profiles

14. Motor Vehicle Collisions • Five major types of motor vehicle collisions: • Head-on • Rear-end • Lateral • Rotational • Roll-over

15. Motor Vehicle Collisions • In each collision, three impacts occur: • Vehicle • Occupants • Occupant organs

16. Head-On Collision

17. Head-on Collision • Vehicle stops • Occupants continue forward • Two pathways • Down and under • Up and over

18. Frontal Collision • Down and under pathway • Knees impact dash, causing knee dislocation/patella fracture • Force fractures femur, hip, posterior rim of acetabulum (hip socket) • Pelvic injuries kill!

19. Frontal Collision • Down and under pathway • Upper body hits steering wheel • Broken ribs • Flail chest • Pulmonary/myocardial contusion • Ruptured liver/spleen

20. Frontal Collision • Down and under pathway • Paper bag pneumothorax • Aortic tear from deceleration • Head thrown forward • C-spine injury • Tracheal injury

21. Frontal Collision • Up and over pathway • Chest/abdomen hit steering wheel • Rib fractures/flail chest • Cardiac/pulmonary contusions/aortic tears • Abdominal organ rupture • Diaphragm rupture • Liver/mesenteric lacerations

22. Frontal Collision • Up and over pathway • Head impacts windshield • Scalp lacerations • Skull fractures • Cerebral contusions/hemorrhages • C-spine fracture

23. Rear-end Collision

24. Rear-end Collision • Car (and everything touching it) moves forward • Body moves, head does not, causing whiplash • Vehicle may strike other object causing frontal impact • Worst patients in vehicles with two impacts

25. Lateral Collision

26. Lateral Collision • Car appears to move from under patient • Patient moves toward point of impact • Increased potential for “shearing” injuries • Increased cervical spine injury

27. Lateral Collision • Chest hits door • Lateral rib fractures • Lateral flail chest • Pulmonary contusion • Abdominal solid organ rupture • Suspect upper extremity fractures and dislocations

28. Lateral Collision • Hip hits door • Head of femur driven through acetabulum • Pelvic fractures • C-spine injury • Head injury

29. Rotational Collision

30. Rotational Collision • Off-center impact • Car rotates around impact point • Patients thrown toward impact point • Injuries combination of head-on, lateral • Point of greatest damage = point of greatest deceleration = worst patients

31. Rollover

32. Roll-Over • Multiple impacts each time vehicle rolls • Injuries unpredictable • Assume presence of severe injury • Justification for Transport to Level I or II Trauma Center

33. Restrained vs Unrestrained Patients • Ejection causes 27% of motor vehicle collision deaths • 1 in 13 suffers a spinal injury • Probability of death increases six-fold

34. Restrained with Improper Positioning • Seatbelts Above Iliac Crest • Compression injuries to abdominal organs • T12 - L2 compression fractures • Seatbelts Too Low • Hip dislocations

35. Restrained with Improper Positioning • Seatbelts Alone • Head, C-Spine, Maxillofacial injuries • Shoulder Straps Alone • Neck injuries • Decapitation

36. Motorcycle Collisions • Rider impacts motorcycle parts • Rider ejected over motorcycle or trapped between motorcycle and vehicle • No protection from effects of deceleration • Limited protection from gear

37. Pedestrian vs. Vehicle • Child • Faces oncoming vehicle • Waddell’s Triad • Bumper Femur fracture • Hood Chest injuries • Ground Head injuries

38. Pedestrian vs. Vehicle • Adult • Turns from oncoming vehicle • O’Donohue’s Triad • Bumper Tib-fib fracture Knee injuries • Hood Femur/pelvic

39. Falls • Critical Factor • Height • Increased height + Increased injury • Surface • Type of impact surface increases injury • Objects struck during fall • Body part of first impact • Feet • Head Buttocks • Parallel

40. Falls • Assess body part that impacts first, usually sustains the bulk of injury • Think about the path of energy through body and what other organs/systems could be impacted (index of suspicion)

41. Falls onto Head/Spine • Injuries may not be obvious • C-spine precautions! • Watch for delayed head injury S/S

42. Falls onto Hands • Bilateral colles fractures • Potential for radial/ulna fractures and dislocations

43. Fall onto Buttocks • Pelvic fracture • Coccygeal (tail bone) fracture • Lumbar compression fracture

44. Fall onto Feet* • Don Juan Syndrome • Bilateral heel fractures • Compression fractures of vertebrae • Bilateral Colles’ fractures

45. Index of Suspicion

46. Stab Wounds • Damage confined to wound track • Four-inch object can produce nine-inch track • Gender of attacker • Males stab up; Females stab down • Evaluate for multiple wounds • Check back, flanks, buttocks

47. Stab Wounds • Chest/abdomen overlap • Chest below 4th ICS = Abdomen until proven otherwise • Abdomen above iliac crests = Chest until proven otherwise

48. Stabbings • Always maintain high degree of suspicion with stab wounds • Remember: small stab wounds do NOT mean small damage

49. Gunshot Wounds • Damage CANNOT be determined by location of entrance/exit wounds • Missiles tumble • Secondary missiles from bone impacts • Remote damage from • Blast effect • Cavitation

50. Gunshot Wounds • Severity cannot be evaluated in the field or Emergency Department • Severity can only be evaluated in OR