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Kinemati

cs of
Trauma
Kimberly Ann Holmes Kenney
RN, CNS-Rx, MS(N), MS
CCRN, CEN, CFRN, NREMT-P
Objectives

 Discuss the laws of energy and


motion.
 Discuss trauma associated with
blunt impact and penetrating injury.
 Overview of the effects of energy
distribution in MVCs.
 Review the kinematics of blast and
violent injuries.
 Use kinematics to predict injury
Kinetic Energy

mass (weight) x velocity


KE =
(speed)2
2
or

mv2
KE =
2

Kinetic energy is the energy of


motion.
Example of Kinetic
Energy
The KE of a 150-lb. person
traveling at 30 mph would be:

150 x 30 x 30
= 67,500 KE units
2
Velocity vs. Mass

 150 lb. person traveling at 30 mph = 67,500 KE
units

 180 lb. person traveling at 30 mph = 81,000 KE


units

 150 lb. person traveling at 40 mph = 120,000 KE


units What is more
important: velocity
or mass?
Velocity
ewton’s First Law of Motion

 A body at rest will stay at
rest.

A body in motion will


remain
in motion.

Unless what?
Newton’s First Law and Blunt
Trauma

 Car strikes pole.
Driver continues moving forward.
Anterior surface of body strikes
steering wheel.
Posterior body continues moving
forward.
Organs compressed within body.
w of Conservation of Energy

 Energy cannot be created.
Energy cannot be destroyed.

But, energy can


0
change forms and
can be transferred.

Can you give


an example?
How does the
Law of Conservation of
Energy pertain to
trauma?
Can you give some examples?
Deceleration and Acceleration

Compression Injury
Deceleration and Acceleration

Shear Injury
Organ
Injury

In a 50 mph MVC, what types injuries would


occur if the patient were to strike the windshield?
Head Injury

 Fractures.

 Ligamentous
injuries.
Soft tissue injury.
Brain injury.
Cord damage.
Torso Injury

 Rib fractures.

Heart & lung


damage.

Abdominal
organ damage.

Major vessel
damage.
Extremity Injury
Fractures.
Ligamentous
injury.
Soft tissue
injury.
ypes of Motor Vehicle Collisions

 Frontal impact.
Lateral impact.
Rotational impact.
Rear impact.
Rollover.
What type of injury patterns might
you see in a frontal impact?
Frontal Impact - Occupant
Pathways

What injuries would you expect with an


up and over pathway?
juries with Up & Over Pathway
continued...

 Head injuries.
Spine injuries.
Chest injuries.
✔ Fractures.
✔ Pneumothorax.
✔ Hemothorax.
✔ Contusions.
✔ Great vessel injury.
juries with Up & Over Pathway
continued...
Abdominal injuries.
✔ Solid organs.
✔ Hollow organs.
✔ Diaphragm.

Fractured pelvis.
Frontal Impact - Occupant
Pathways

What injuries would you expect with


a down and under pathway?
uries with Down & Under Pathwa

 Posterior knee/hip
dislocations.

Femur fractures.

Lower extremity fractures.

Pelvic/acetabular fractures.
Rear Impact

What types of injuries would you expect?


Lateral Impact

What types of injuries would you expect?


Body Motion during Lateral
Impacts

 Neck
Chest
Pelvis
Rotational Impact

What types of injuries would you expect?


Rollover

What injury patterns might you see


following this collision?
ap Restraint Device
Properly positioned lap
restraint.
Improperly positioned lap
restraint.
What types of injuries
should you anticipate?
ap & Shoulder Restraint Syste
Shoulder harness only; lap belt not
used.
(Victim moves down and under).
Lap restraint only; shoulder
harness not used. (Victim moves up
and over) What types of injuries
should you anticipate?
Airbag Deployment

 What types of injuries
would you expect to see?

What injuries would occur


in a second collision?
Airbag Deployment
What concerns would you
have about a:
✔ Small patient?
✔ Child in a car seat?
Motorcycle Collisions
Mandatory helmet laws

have been associated

with up to 300% fewer

head injuries and

deaths.
Types of Impact:
Frontal/Ejection

How many impacts did this collision involve?


What types of injuries would you expect to see?
Types of Impact: Lateral

How many impacts did this collision involve?


What types of injuries would you expect to see?
Pedestrian vs. Motor
Vehicle

How would the injury patterns differ


between the adult and the child?
Falls
Impact surface.
(Harder surface = greater injury.)

Height.
(Greater height = greater injury.)

Falls from a distance of more


than three times the patient’s
height produce critical injuries.
Falls
Deceleration injuries.
✔ Liver.

✔ Aorta.

✔ Spleen.

✔ Kidney.
Landing Feet
First
(Don Juan Syndrome)

 Injuries seen in patients
landing feet first:
✔ Bilateral heel fractures.
✔ Ankle fractures.
✔ Distal tibia/fibula fractures.
✔ Knee dislocations.
✔ Femur fractures.
✔ Hip injuries.
✔ Spine compression fractures.
anding Arms/Hands First
Physical findings:
✔ Colles’ fractures of wrists.
✔ Shoulder dislocations.
✔ Fractures of the clavicles.
Landing Head-First


 Physical
findings:
✔ C-spine
injuries.
✔ Facial injuries.
✔ CNS damage.
Sports &
Recreational Activity
Mechanisms
Acceleration
Deceleration
Hyperextension
Hyperflexion
Twisting What types of sporting or
Falling recreational injuries are
common to your area?
edicting Sports-Related Injurie
Kinematics & forces involved.
Equipment contributing to
injury.
Involvement of protective
equipment.
Nature of the sport.
Blast Injuries
Warfare.
Civilian areas.
✔ Mines.
✔ Shipyards.
✔ Chemical plants.
✔ Tank trucks.
✔ Refineries.
✔ Fireworks firms.
✔ Silos. Do you have any of
✔ LP gas tanks. these in your area?
Blast-Related Injuries
Three mechanisms of
injury:
✔ Primary.
✔ Secondary.
✔ Tertiary.
rimary Phase Injuries

 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.
econdary Phase Injuries
Cause: flying debris.
Affected area:
✔ Body surface.
✔ Skeletal system.

Injuries:
✔ Lacerations.
✔ Fractures.
✔ Burns.
ertiary Phase Injuries
Cause: victim thrown against
an object.

Affected area: area of impact


or referred energy.

Injuries: similar to those


sustained in a vehicle ejection.
enetrating Trauma
Penetrating
Physics.

Weapon velocity.

Bullet design.
enetrating Trauma
Penetrating
Newton’s First Law and
ballistics:
✔ Bullet in brass cartridge is at rest.
✔ Bullet propelled by rapid
combustion of powder.
✔ Bullet leaves barrel of gun.
✔ Bullet strikes a body.
✔ Bullet transfers energy to victim.
Low-Energy Injuries
Low velocity.
Usually hand-driven
weapons.
Less secondary
trauma.
Multiple wounds
from a single
weapon.
Low-Energy Penetrating
Wounds
How does the length
of the weapon relate
to the cone of
damage?
sessment of Low-Energy Injurie

 Type of weapon
involved.
Path of weapon.
Depth of penetration.
Number of wounds.
Underlying anatomy.
Medium-Energy Penetrating
Injuries
High-Energy Penetrating
Injuries
How do these weapons differ
from handguns and shotguns?

How do the wounds


differ internally and
externally?
rojectile - Frontal Area
The larger the frontal area of
the projectile, the greater the
damage.

The larger the cavitation and


the greater the damage, the
greater the exit wound.
Gunshot Wounds -
Cavitation
Reformation by Temporary
elastic tissue cavity

Direction of travel Bullet

Permanent
cavity Compression
and crush
Gunshot Wounds

Describe the difference between


entrance and exit wounds.
Tumbling Projectiles


 Some projectiles are designed to
tumble.
Tumbling creates greater tissue
damage and more tissue
Fragmentation

The shotgun round is the ultimate


in fragmentation.
nsiderations for Penetrating Traum

 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.
Kinematics
Summary
The cornerstone of
assessment is early
consideration of
kinematics to predict
hidden injury.

Related Interests