Blunt trauma

1. Blunt TraumaBlunt Trauma
Markus Forsythe, MDMarkus Forsythe, MD

2. Introduction to Blunt TraumaIntroduction to Blunt Trauma
Most common cause of trauma death and Most common cause of trauma death and
disabilitydisability
Energy exchange between an object and Energy exchange between an object and
the human body, without intrusion through the human body, without intrusion through
the skinthe skin

3. Kinetics of Blunt TraumaKinetics of Blunt Trauma
InertiaInertia
““A body in motion will remain in motion unless A body in motion will remain in motion unless
acted upon by an outside force.”acted upon by an outside force.”
““A body at rest will remain at rest unless acted A body at rest will remain at rest unless acted
upon by an outside force.”upon by an outside force.”
Conservation of EnergyConservation of Energy
““Energy can neither be created nor destroyed. Energy can neither be created nor destroyed.
It is only changed from one form to another.” It is only changed from one form to another.”
Kinetic versus Potential EnergyKinetic versus Potential Energy

4. Kinetics of Blunt TraumaKinetics of Blunt Trauma
Kinetic EnergyKinetic Energy
Energy in MotionEnergy in Motion
Double Weight = Double EnergyDouble Weight = Double Energy
Double Speed = Quadruple EnergyDouble Speed = Quadruple Energy
SPEED IS THE GREATESTSPEED IS THE GREATEST
DETERMINANTDETERMINANT
2
)()(
2
speedVelocityweightMass
KE
´
=

5. Kinetics of Blunt TraumaKinetics of Blunt Trauma
ForceForce
Emphasizes the importance of rate at which Emphasizes the importance of rate at which
an object changes speed (acceleration or an object changes speed (acceleration or
deceleration)deceleration)
onAcceleratiMassForce ´=

6. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
44,000 people die each year on US highways44,000 people die each year on US highways
Events of ImpactEvents of Impact
Vehicle CollisionVehicle Collision
Body CollisionBody Collision
Organ CollisionOrgan Collision
Secondary CollisionsSecondary Collisions
Objects inside vehicle strike occupantObjects inside vehicle strike occupant
Additional InjuriesAdditional Injuries
Vehicle receives a second impactVehicle receives a second impact

7. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
RestraintsRestraints
SeatbeltsSeatbelts
Occupant slows with the vehicleOccupant slows with the vehicle
Shoulder and Lap belts MUST be worn togetherShoulder and Lap belts MUST be worn together
Injuries if worn separatelyInjuries if worn separately
Airbags (SRS)Airbags (SRS)
Reduce blunt chest traumaReduce blunt chest trauma
Cause: Hand, Forearm, & Facial InjuryCause: Hand, Forearm, & Facial Injury
Check for steering wheel deformityCheck for steering wheel deformity
Side AirbagsSide Airbags
Child Safety SeatsChild Safety Seats
Infants and Small Children: Rear facingInfants and Small Children: Rear facing
Older Child: Forward facingOlder Child: Forward facing

8. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
Types of ImpactTypes of Impact
Frontal: 32%Frontal: 32%
Lateral: 15%Lateral: 15%
Rotational: 38%Rotational: 38%
Left & Right – Front & Left & Right – Front &
RearRear
Rear-end: 9%Rear-end: 9%
Rollover: 6%Rollover: 6%

9. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
Frontal ImpactFrontal Impact
Down-and-UnderDown-and-Under
Knee, femur, and hip fractureKnee, femur, and hip fracture
Chest trauma-Steering WheelChest trauma-Steering Wheel
Paper Bag SyndromePaper Bag Syndrome
Up-and-OverUp-and-Over
Tenses legs = Bilateral femur fractureTenses legs = Bilateral femur fracture
Hollow organ rupture and liver lacerationHollow organ rupture and liver laceration
Similar chest traumaSimilar chest trauma
Axial LoadingAxial Loading
EjectionEjection
Due to up-and-over pathwayDue to up-and-over pathway
Contact with the vehicle & external objectContact with the vehicle & external object

10. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
Lateral ImpactLateral Impact
15% of MVC’s but 22% of deaths15% of MVC’s but 22% of deaths
Upper extremity injuryUpper extremity injury
Rib, clavicle, humerus, pelvis, femur fractureRib, clavicle, humerus, pelvis, femur fracture
Lateral compressionLateral compression
Ruptured diaphragm, Spleen fracture, Aortic injuryRuptured diaphragm, Spleen fracture, Aortic injury

11. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
RotationalRotational
Vehicle struck at oblique angleVehicle struck at oblique angle
Less serious injuries unless Less serious injuries unless
strike a secondary objectstrike a secondary object
Rear-endRear-end
Seat propels the occupant Seat propels the occupant
forwardforward
Head is forced backwardsHead is forced backwards
Stretching of neck muscles Stretching of neck muscles
and ligamentsand ligaments
Hyperextension & Hyperextension &
hyperflexionhyperflexion
RolloverRollover
Multiple points of impactMultiple points of impact
Ejection or partial ejectionEjection or partial ejection
Less injury with restraintsLess injury with restraints
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12. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
Vehicle Crash AnalysisVehicle Crash Analysis
HazardsHazards
Crumple ZonesCrumple Zones
IntrusionIntrusion
Deformity of VehicleDeformity of Vehicle
Use of RestraintsUse of Restraints
IntoxicationIntoxication
Fatal Accidents: >50% involved ETOHFatal Accidents: >50% involved ETOH
Recreational AccidentsRecreational Accidents
Copyright © 2003 E.Faubion
Copyright © 2003 E.Faubion

13. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
Vehicular MortalityVehicular Mortality
Head: 48%Head: 48%
Internal (Torso): 37%Internal (Torso): 37%
Spinal & Chest fracture: 8%Spinal & Chest fracture: 8%
Extremity fracture: 2%Extremity fracture: 2%
All Other: 5%All Other: 5%

14. Blunt Trauma: Automobile CrashesBlunt Trauma: Automobile Crashes
Crash EvaluationCrash Evaluation
Collision QuestionsCollision Questions
How did collision How did collision
occur?occur?
Direction?Direction?
Speed?Speed?
Similar/Different Similar/Different
sized?sized?
Secondary collisions?Secondary collisions?
Cause of CrashCause of Crash
Weather & visibility?Weather & visibility?
Alcohol involved?Alcohol involved?
Skid marks?Skid marks?
Auto InteriorAuto Interior
Starring of windshield?Starring of windshield?
Steering wheel deformity?Steering wheel deformity?
Dash deformity?Dash deformity?
Intrusion?Intrusion?

15. Blunt Trauma: Motorcycle CrashesBlunt Trauma: Motorcycle Crashes
Serious injuries can Serious injuries can
occur with high and occur with high and
low speed collision.low speed collision.
Types of ImpactTypes of Impact
FrontalFrontal
AngularAngular
SlidingSliding
EjectionEjection
Initial Bike/Object Initial Bike/Object
CollisionCollision
Rider/ObjectRider/Object
Rider/GroundRider/Ground
Copyright © 2003 E.Faubion
Copyright © 2003 E.Faubion

16. Copyright © 2003 E.Faubion

17. Blunt Trauma: Blunt Trauma:
Pedestrian AccidentsPedestrian Accidents
AdultsAdults
Adults turn awayAdults turn away
Bumper strikes lower legs firstBumper strikes lower legs first
Victim rolls up and over and thrownVictim rolls up and over and thrown
ChildrenChildren
Children turn towardChildren turn toward
Femurs, Pelvis often injuredFemurs, Pelvis often injured
Thrown away or run overThrown away or run over

18. Blunt Trauma: Recreational Vehicle Blunt Trauma: Recreational Vehicle
AccidentsAccidents
Lack structure and restraint systemLack structure and restraint system
Types of VehiclesTypes of Vehicles
SnowmobilesSnowmobiles
Personal watercraftPersonal watercraft
ATV’sATV’s

19. Blunt Trauma: Blast InjuriesBlunt Trauma: Blast Injuries
Blast InjuriesBlast Injuries
Dust, Fumes, Dust, Fumes,
Explosive CompoundsExplosive Compounds
ExplosionExplosion
Fuel + Oxidant Fuel + Oxidant
combine combine
instantaneouslyinstantaneously
Heat & Pressure WaveHeat & Pressure Wave

20. ExplosionExplosion
Pressure WavePressure Wave
Structural CollapseStructural Collapse
Blast WindBlast Wind
BurnsBurns
ProjectilesProjectiles
Personnel DisplacementPersonnel Displacement
Blast Injury PhasesBlast Injury Phases
Primary: Heat of the Primary: Heat of the
explosionexplosion
Secondary: Trauma caused Secondary: Trauma caused
by projectilesby projectiles
Tertiary: Personnel Tertiary: Personnel
displacement and structural displacement and structural
collapsecollapse

21. ExplosionExplosion
Blast Injury AssessmentBlast Injury Assessment
Be alert for secondary deviceBe alert for secondary device
Initial scene size-up importantInitial scene size-up important
Establish Incident Command System (ICS)Establish Incident Command System (ICS)
Evaluate for secondary hazardsEvaluate for secondary hazards
Injury PatternsInjury Patterns
Rupture of Air or Fluid Filled OrgansRupture of Air or Fluid Filled Organs
Lung: Late manifestation (heat & pressure)Lung: Late manifestation (heat & pressure)
Hearing lossHearing loss

22. ExplosionExplosion
Blast Injury CareBlast Injury Care
LungsLungs
Forceful compression and distortion of chest cavityForceful compression and distortion of chest cavity
Compression and decompressionCompression and decompression
Pulmonary Embolism, Dyspnea, Hemoptysis, Pulmonary Embolism, Dyspnea, Hemoptysis,
PneumothoraxPneumothorax
AbdomenAbdomen
Compression & DecompressionCompression & Decompression
Release of bowel contentsRelease of bowel contents
Diaphragm rupture from pushing of organs up into Diaphragm rupture from pushing of organs up into
thorax areathorax area

23. ExplosionExplosion
Blast Injury CareBlast Injury Care
EarsEars
Initial Hearing LossInitial Hearing Loss
Injury improves over timeInjury improves over time
Penetrating WoundsPenetrating Wounds
Care as any serious open wound or impaled objectCare as any serious open wound or impaled object
BurnsBurns
Treatment consistent with traditional management.Treatment consistent with traditional management.

24. Other Types of Blunt TraumaOther Types of Blunt Trauma
FallsFalls
Stairs, Force, SurfaceStairs, Force, Surface
Landing AreaLanding Area
Surface TypeSurface Type
Body PartBody Part
Height of FallHeight of Fall
ElderlyElderly

25. Other Types of Blunt TraumaOther Types of Blunt Trauma
Sports InjuriesSports Injuries
Various Injury PatternsVarious Injury Patterns
Produced by extreme exertion, fatigue or direct traumaProduced by extreme exertion, fatigue or direct trauma
Acceleration, deceleration, compression, rotation, Acceleration, deceleration, compression, rotation,
hyperextension, or hyperflexionhyperextension, or hyperflexion
Unconsciousness, neurological defect or decreased Unconsciousness, neurological defect or decreased
mental status require physician follow-upmental status require physician follow-up
Protective Gear reduces injury patternProtective Gear reduces injury pattern
Helmet RemovalHelmet Removal
If loose removeIf loose remove
If tight, remove face mask and immobilize in placeIf tight, remove face mask and immobilize in place
Take helmet to hospitalTake helmet to hospital

26. Other Types of Blunt TraumaOther Types of Blunt Trauma
Crush InjuriesCrush Injuries
CauseCause
Structural collapse, explosion, industrial; or agriculturalStructural collapse, explosion, industrial; or agricultural
Great force to soft tissue and bonesGreat force to soft tissue and bones
Tissue stretching and compressionTissue stretching and compression
Extended pressure results in anaerobic metabolism distal to Extended pressure results in anaerobic metabolism distal to
compressioncompression
Return of blood flow, toxins to entire bodyReturn of blood flow, toxins to entire body
Severe hemorrhage due to severe damaged blood vesselsSevere hemorrhage due to severe damaged blood vessels
CareCare
Prolonged crush MedicationsProlonged crush Medications
Sodium Bicarbonate: Reduce AcidosisSodium Bicarbonate: Reduce Acidosis
Dopamine: Improve Kidney FunctionDopamine: Improve Kidney Function
Morphine: Pain managementMorphine: Pain management