kinematics of trauma-b

7/27/2019 Kinematics of Trauma-B

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Motorcycle Collisions

2-33

Mandatory helmet laws

have been associated

with up to 300% fewerhead injuries and

deaths.


2/30

Types of Impact: Frontal/Ejection

2-34

How many impacts did this collision involve?

What types of injuries would you expect to see?


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Types of Impact: Lateral

2-35

How many impacts did this collision involve?

What types of injuries would you expect to see?


4/30

Pedestrian vs. Motor Vehicle

2-36

How would the injury patterns differ

between the adultand the child?


5/30

Falls

2-37

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

2-38

Deceleration injuries.

Liver.

Aorta.

Spleen.

Kidney.


7/30

Landing Feet First

(Don Juan Syndrome)

2-39

Injuries seen in patients landingfeet first: Bilateral heel fractures. Ankle fractures. Distal tibia/fibula fractures.

Knee dislocations. Femur fractures. Hip injuries. Spine compression fractures.


8/30

Landing Arms/Hands First

Physical findings:

Colles fractures of wrists.

Shoulder dislocations.

Fractures of the clavicles.

2-40


9/30

Landing Head-First

2-41

Physicalfindings:

C-spineinjuries.

Facial injuries.

CNS damage.


10/30

Acceleration

Deceleration

Hyperextension

Hyperflexion

Twisting Falling

Sports & Recreational

Activity Mechanisms

2-42

What types of sporting or

recreational injuries are

common to your area?


11/30

Kinematics & forces involved.

Equipment contributing to injury.

Involvement of protective equipment.

Nature of the sport.

Predicting Sports-Related Injuries

2-43


12/30

Blast Injuries

2-44

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?


13/30

Blast-Related Injuries

2-45

Three mechanisms of injury: Primary.

Secondary.

Tertiary.


14/30

Primary Phase Injuries

2-46

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.


15/30

Secondary Phase Injuries

2-47

Cause: flying debris.

Affected area:

Body surface. Skeletal system.

Injuries:

Lacerations. Fractures. Burns.


16/30

Cause: victim thrown against anobject.

Affected area: area of impact orreferred energy.

Injuries: similar to those sustainedin a vehicle ejection.

Tertiary Phase Injuries

2-48


17/30

Physics.

Weapon velocity.

Bullet design.

Penetrating Trauma

2-49


18/30

Penetrating Trauma

2-50

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.


19/30

Low-Energy Injuries

2-51

Low velocity.

Usually hand-drivenweapons.

Less secondary trauma.

Multiple wounds from a

single weapon.


20/30

Low-Energy Penetrating Wounds

How does the lengthof the weapon relate

to the cone of

damage?

2-52


21/30

Type of weapon involved.

Path of weapon.

Depth of penetration.

Number of wounds.

Underlying anatomy.

Assessment of Low-Energy Injuries

2-53


22/30

Medium-Energy Penetrating Injuries

2-54


23/30

High-Energy Penetrating Injuries

2-55

How do these weapons differfrom handguns and shotguns?

How do the woundsdiffer internally and

externally?


24/30

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

2-56


25/30

Gunshot Wounds - Cavitation

2-57

Reformation by

elastic tissueTemporarycavity

Compression

and crush

Permanent

cavity

Direction of travel Bullet


26/30

Gunshot Wounds

Describe the difference between

entrance and exit wounds. 2-58


27/30

Tumbling Projectiles

2-59

Some projectiles are designed to tumble.

Tumbling creates greater tissue damageand more tissue destruction.


28/30

Fragmentation

The shotgun round is the ultimate

in fragmentation.

2-60


29/30

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

2-61


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Kinematics Summary

The cornerstone of assessment

is early consideration of

kinematics to predict hidden

injury.

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kinematics of trauma-b

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