quantum physics and the time- space continuum an in depth and highly detailed analysis of the...
TRANSCRIPT
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.
TRAUMA KINEMATICS
An Introduction to the Physics of Trauma
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
Kinematics
• Physics of Trauma
• Understanding kinematics allows prediction of injuries based on forces and motion involved in
an injury event.
Basic Principles
• Conservation of Energy Law• Newton’s First Law of Motion• Newton’s Second Law of Motion
• Kinetic Energy
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
Newton’s Second Law
• Force of an object = mass (weight) x acceleration or deceleration (change in
velocity)• Major factor is velocity
• “Speed Kills”
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
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
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.
Blunt Force Trauma
• Force withoutpenetration• “Unseen
injuries”• Cavitation
towards or away from the
injury
Penetrating Trauma
• Piercing or penetration of body with damage to soft tissues and organs
• Depth of injury
Mechanism of Injury Profiles
Motor Vehicle Collisions
• Five major types of motor vehicle collisions:–Head-on–Rear-end– Lateral–Rotational–Roll-over
Motor Vehicle Collisions
• In each collision, three impacts occur:–Vehicle–Occupants
–Occupant organs
Head-On Collision
Head-on Collision
• Vehicle stops• Occupants continue forward• Two pathways–Down and under–Up and over
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!
Frontal Collision
• Down and under pathway–Upper body hits steering wheel• Broken ribs• Flail chest• Pulmonary/myocardial contusion• Ruptured liver/spleen
Frontal Collision
• Down and under pathway–Paper bag pneumothorax–Aortic tear from deceleration–Head thrown forward• C-spine injury• Tracheal injury
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
Frontal Collision
• Up and over pathway–Head impacts windshield• Scalp lacerations• Skull fractures• Cerebral contusions/hemorrhages
–C-spine fracture
Rear-end Collision
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
Lateral Collision
Lateral Collision
• Car appears to move from under patient• Patient moves toward point of impact
• Increased potential for “shearing” injuries• Increased cervical spine injury
Lateral Collision
• Chest hits door– Lateral rib fractures– Lateral flail chest–Pulmonary contusion–Abdominal solid organ rupture
• Suspect upper extremity fractures and dislocations
Lateral Collision
• Hip hits door–Head of femur driven through acetabulum–Pelvic fractures
• C-spine injury• Head injury
Rotational Collision
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
Rollover
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
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
Restrained with Improper Positioning
• Seatbelts Above Iliac Crest–Compression injuries to abdominal
organs– T12 - L2 compression fractures
• Seatbelts Too Low–Hip dislocations
Restrained with Improper Positioning
• Seatbelts Alone–Head, C-Spine, Maxillofacial injuries
• Shoulder Straps Alone–Neck injuries–Decapitation
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
Pedestrian vs. Vehicle
• Child– Faces oncoming vehicle–Waddell’s Triad• Bumper Femur fracture• Hood Chest injuries• Ground Head injuries
Pedestrian vs. Vehicle
• Adult– Turns from oncoming vehicle–O’Donohue’s Triad• Bumper Tib-fib fracture
Knee injuries• Hood Femur/pelvic
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
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)
Falls onto Head/Spine
• Injuries may not be obvious
• C-spine precautions!
• Watch for delayed head injury S/S
Falls onto Hands
• Bilateral colles fractures
• Potential for radial/ulna fractures and dislocations
Fall onto Buttocks
• Pelvic fracture• Coccygeal (tail
bone) fracture• Lumbar
compression fracture
Fall onto Feet*• Don Juan
Syndrome– Bilateral heel
fractures– Compression
fractures of vertebrae
– Bilateral Colles’ fractures
Index of Suspicion
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
Stab Wounds
• Chest/abdomen overlap–Chest below 4th ICS = Abdomen until
proven otherwise–Abdomen above iliac crests = Chest
until proven otherwise
Stabbings• Always maintain
high degree of suspicion with stab wounds
• Remember: small stab wounds do NOT mean small damage
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
Gunshot Wounds
• Severity cannot be evaluated in the field or Emergency Department
• Severity can only be evaluated in OR
Significant ALS MOI
• Multi-system trauma• Fractures in more than one location• MVA – death in same vehicle, high speed or
significant vehicle damage• Falls > 2 X body height• Thrown > 10 – 15 feet• Penetrating trauma to the “box”• Age co-factors: < 6 or > 60• “Lucky Victim”
Conclusion
• Think about mechanisms of injury• Always maintain an increased index of
suspicion• Doing YOUR job as an EMT will lead to:
– Fewer missed injuries– Increased patient survival