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Falls from height
30-40% associated with suicidal intent Remainder accidental Seasonal variation in accidental falls Suicidal attempts show no such seasonal variation Also associated with drugs, alcohol and psychiatric disease
Volume 46(6). above which major trauma is considered total of 166 cases. June 1999. Mean height fallen was 3.Can the Distance Fallen Predict Serious Injury after a Fall from a Height? J Trauma. 141 males and 25 females.1055-1058 Impact (v) is related to the Height fallen (h) and acceleration due to Gravity (g. 9.2 meters .1M): a clinically important risk. Height of fall: 1 to 20 meters.8m·sec-2) ATLS Fall >20 feet(6.
6 feet) is at significant risk of serious injury. . The height of fall should not be used as a sole criterion for trauma triage decision-making. height of fall is a poor predictor of major injury Sensitivity is inadequate to rule out major injury Positive predictive value of the test is poor The relative risk of serious injury increases with age Those who landed on heads had an increased relative risk Conclusions Any trauma victim who has fallen more than 2 meters (6.Can the Distance Fallen Predict Serious Injury after a Fall from a Height? As a sole criterion.
5 floors . and the body part first touching the ground are independent prognostic factors in victims of falls from height Out-ofhospital mortality comprised 70% of the total mortality. including 56% of the patients who died immediately on site A strong correlation between height of fall and mortality. circumstances of fall. The median height of fall in patients who died: 15 m.Prognostic factors in victims of falls from height Crit Care Med 2005. height of fall. 33:1239-1242 Patient age.
deceleration force is around 6 G. and deceleration estimated at 191 G on a beach WWII. pilot jumped from plane at 7320 m and landed in pine forest and snow: the survivor of the most extraordinary free fall ever reported Falls from height into water: Impact of feet on the water. with a 28 m·sec-1 velocity at contact. this force reaches 40 G . In cases of lateral impact.Prognostic factors in victims of falls from height The nature of the impact surface Survival after fall from 96 m.
body orientation at the time of the impact was a theoretical prognostic factor Impact on the feet results in lower extremity trauma which is not life threatening in most cases. children are particularly predisposed to cranial trauma. 23% after dorsal impact Because of the head weight. In contrast. injuries after impact on the head are clearly life threatening. .Prognostic factors in victims of falls from height On a solid impact surface. Mortality rate: 57% in ventral impact.
followed by the chest. and neck Primary cause of death was craniocerebral trauma and that the vast majority of skull injuries associated with falls down stairs were found above the ³hat brim line. extremities.´ Aortic lacerations and vertebral compression fractures were also frequent. . abdomen.Postmortem Analysis of Fatal Falls The head is the most frequently injured body region (70%).
The Physics of Falling Falls are examples of vertical deceleration injuries (VDI) Patterns of injury differ from horizontal deceleration injuries (HDI) associated with motor vehicle accidents Fractures and retro-peritoneal injuries are more common in VDIs Intra-abdominal injuries are more common in HDIs .
Age of patient 4.The Physics of Falling Factors influencing magnitude of injury: 1. Orientation of body on impact 5. Objects encountered during fall (associated with upper limb fractures) . Impact velocity 2. Rate of deceleration Impact surface Body habitus 3.
. Scalea et al. and they therefore recommended transportation to the angiography suite rather than the operating room for fall victims with evidence of continuous blood loss. J. Trauma 26:706.Patterns of Injury in Victims of Urban FreeFalls Major damage to parenchymal organs of the abdominal and thoracic cavity is the predominant cause of death after falls from extreme heights. 1981 Mechanisms sufficient to cause serious damage to intra-abdominal organs are severe enough to cause other injuries resulting in immediate death. Retroperitoneum is the most likely source of hemodynamic instability.
Peripheral vascular injuries are rare but should not be overlooked. The popliteal artery is most commonly involved. .Patterns of Injury in Victims of Urban FreeFalls ARDS may occur owing to direct transmission of shear forces to the alveoli after acute vertical deceleration. Usually consist of intimal tears or pseudoaneurysms Always associated with falls of more than 30 feet and fractures of the corresponding extremity.
The height of the fall is a good predictor of injury severity and ultimate outcome. .Patterns of Injury in Victims of Urban FreeFalls Survival is rare after urban free-falls from heights > 40 feet Spinal injuries may occur after falls from any height and a low threshold for aggressive evaluation of the whole spine should be adopted. Major vascular injuries are rare in survivors from urban falls but should be suspected and treated promptly for optimal results. especially in the presence of associated lower extremity fractures. Intraabdominal organ injuries are not uncommon and should be prioritized before retroperitoneal trauma in the differential diagnosis of the hemodynamically unstable fall victim.
All patients with spine fractures in whom the GCS was 14 or 15 had positive physical findings of their spinal fracture: pain.Patterns of Injury in Victims of Urban FreeFalls The ³battleship fracture´²simultaneous fracture of the lumbar spine and a tarsal or metatarsal bone. palpation tenderness. or neurologic deficits. Bypass extensive spinal radiographs in patients who clearly are awake and alert and have a negative physical examination. Two-thirds of patients with a fracture in the foot also had a lumbar spine fracture. .
Head-First Falls: Hyperextension of the head. lower spine and pelvic injuries are also common. Chest. Compression of the cervical spine. .
. Thrown backwards look for injuries to head.Feet-First Falls Compression travels up the spinal column. and pelvis. Foreword falls look for Colles or silver fork fractures of the wrist. back. possible affect on internal organs. Falls greater than 20ft.
Calcaneal fractures Diagnosis Bohler¶s salient angle < 20 degrees suggests fracture 7 common fracture patterns Treatment Need CT to assess involvement of sub-talar joint Can be surgically reconstructed or managed conservatively .
has been shown to increased in frequency with increasing height of fall All types of pelvic fractures described .Pelvic Fractures Common in buttock and feet first landings Occur in 20-30% of all falls from height As with other fractures.
Thoraco-lumbar fractures Commonest skeletal fracture associated with falls with an incidence of 80% Thoracolumbar junction is area most often involved L1 > L2 > T12 Stability depends upon column theory CT useful in determining stability .
Cervical Spine Fractures Rare in falls Can be seen with feet first landings with flexion of the neck at impact Flexion type cervical spine fractures: Anterior subluxation Bilateral facet joint dislocation Wedge / compression fracture Clay-shoveler fracture .
Pediatric Falls from Height .
000.000/yr) .Pediatric Falls from Height How common are falls ? Roughly half < 1yr fall from height Frequent source of ED Visits (§1/100/yr) Frequent source of hospitalization (§ 1/1000/yr) Infrequent cause of death (§ 4/1.
Body Orientation on Impact Determines the pattern of injuries sustained Determines mortality rate Head first 50% mortality from 1 floor Feet first 50% mortality from 5 floors Horizontal landing Associated with chest and abdominal injuries .
Feet First Landing Commonest orientation on landing Associated with typical fracture distribution: Calcaneus and subtalar joint Tibial plateau and fibula Femur Pelvis Lumbar spine Thoracic and cervical spine .
thoracic. the history is incorrect. 29:12731275.Free Falls & Fatality Deaths from falls in children: how far is fatal? J Trauma. . 5-9ft 0/65. 1-4ft 7/100 When children incur fatal injuries in falls of < 4ft. 3ft 18 Minor falls can be lethal.one should suspect abuse. or non-skull fractures in children who fall from < 3 floors. Fatalities: 10-45ft 1/118. we have found (as others) that it is extremely rare to have visceral. especially in a toddler. --if these injuries are found. Fatalities: 50ft 8. 31:1353-1355. Additionally. The mortality of childhood falls. J Trauma. 1991. 4-40ft 18. 1989.
they dissipate the energy transferred by the fall. and lacerations. Children <3 yrs are much less likely to have serious injuries than older children who fall the same distance. such as contusions. abrasions. It is thought that because younger children have more fat and cartilage and less muscle mass than older children. Young children who fell from <3 m sustained only minor injuries. .Free Falls & Fatality The nature of injuries associated with free falls in children is considerably different from that in adults.
Children with low-level falls had a similar risk for intracranial and abdominal injury as those who fell from greater heights. Mortality rate increased in falls from 6 m. and the radius.Free Falls & Fatality Fractures were the most common of their serious injuries. ulna and femur were the most frequent sites. 58. .000 fall-related hospitalizations and the 130 deaths below the age of 15 are most often associated with falls >10 m.
and the circumstances of injury should always be investigated for inflicted trauma. especially in children <5 yrs). because of an injury-prone situation permitted by older building codes . 98 children were injured during a 3-yr period from 1997 to 1999 in Dallas. Accidental falls decreased by 96% in 4 yrs.Free Falls & Fatality Nearly 3/4 of falls from heights in children are unintentional. ³Children Can¶t Fly´ program Legally requiring window guards in all family houses with children <10 yrs old.
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