Download - Kinematics of Trauma-B
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Motorcycle Collisions
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Mandatory helmet laws
have been associated
with up to 300% fewerhead injuries and
deaths.
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Types of Impact: Frontal/Ejection
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How many impacts did this collision involve?
What types of injuries would you expect to see?
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Types of Impact: Lateral
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How many impacts did this collision involve?
What types of injuries would you expect to see?
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Pedestrian vs. Motor Vehicle
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How would the injury patterns differ
between the adultand the child?
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Falls
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Impact surface.(Harder surface = greater injury.)
Height.(Greater height = greater injury.)
Falls from a distance of more than
three times the patients heightproduce critical injuries.
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Falls
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Deceleration injuries.
Liver.
Aorta.
Spleen.
Kidney.
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Landing Feet First
(Don Juan Syndrome)
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Injuries seen in patients landingfeet first: Bilateral heel fractures. Ankle fractures. Distal tibia/fibula fractures.
Knee dislocations. Femur fractures. Hip injuries. Spine compression fractures.
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Landing Arms/Hands First
Physical findings:
Colles fractures of wrists.
Shoulder dislocations.
Fractures of the clavicles.
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Landing Head-First
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Physicalfindings:
C-spineinjuries.
Facial injuries.
CNS damage.
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Acceleration
Deceleration
Hyperextension
Hyperflexion
Twisting Falling
Sports & Recreational
Activity Mechanisms
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What types of sporting or
recreational injuries are
common to your area?
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Kinematics & forces involved.
Equipment contributing to injury.
Involvement of protective equipment.
Nature of the sport.
Predicting Sports-Related Injuries
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Blast Injuries
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Warfare.
Civilian areas.
Mines. Shipyards. Chemical plants. Tank trucks.
Refineries. Fireworks firms. Silos. LP gas tanks.
Do you have any of
these in your area?
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Blast-Related Injuries
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Three mechanisms of injury: Primary.
Secondary.
Tertiary.
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Primary Phase Injuries
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Cause: pressure wave from blast.
Affected area: gas-containing organs.
Injuries: Pulmonary bleeding. Pneumothorax. Air emboli.
Perforation of the GI tract. Burns.
Death may occur in absence of outward signs.
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Secondary Phase Injuries
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Cause: flying debris.
Affected area:
Body surface. Skeletal system.
Injuries:
Lacerations. Fractures. Burns.
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Cause: victim thrown against anobject.
Affected area: area of impact orreferred energy.
Injuries: similar to those sustainedin a vehicle ejection.
Tertiary Phase Injuries
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Physics.
Weapon velocity.
Bullet design.
Penetrating Trauma
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Penetrating Trauma
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Newtons First Law and ballistics:
Bullet in brass cartridge is at rest.
Bullet propelled by rapidcombustion of powder.
Bullet leaves barrel of gun.
Bullet strikes a body.
Bullet transfers energy to victim.
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Low-Energy Injuries
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Low velocity.
Usually hand-drivenweapons.
Less secondary trauma.
Multiple wounds from a
single weapon.
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Low-Energy Penetrating Wounds
How does the lengthof the weapon relate
to the cone of
damage?
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Type of weapon involved.
Path of weapon.
Depth of penetration.
Number of wounds.
Underlying anatomy.
Assessment of Low-Energy Injuries
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Medium-Energy Penetrating Injuries
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High-Energy Penetrating Injuries
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How do these weapons differfrom handguns and shotguns?
How do the woundsdiffer internally and
externally?
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The larger the frontal area of theprojectile, the greater the damage.
The larger the cavitation and thegreater the damage, the greater theexit wound.
Projectile - Frontal Area
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Gunshot Wounds - Cavitation
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Reformation by
elastic tissueTemporarycavity
Compression
and crush
Permanent
cavity
Direction of travel Bullet
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Gunshot Wounds
Describe the difference between
entrance and exit wounds. 2-58
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Tumbling Projectiles
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Some projectiles are designed to tumble.
Tumbling creates greater tissue damageand more tissue destruction.
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Fragmentation
The shotgun round is the ultimate
in fragmentation.
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Scene safety.
Patient care is the priority!
Weapon type. Range at which weapon was fired.
Number of entrance and exit wounds.
Underlying anatomy and track.
Crime scene preservation.
Considerations for Penetrating Trauma
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Kinematics Summary
The cornerstone of assessment
is early consideration of
kinematics to predict hidden
injury.
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