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MECHANISM OF INJURY

Sherwyn U. Hatab

MECHANISM OF INJURY
The mechanism of injury refers to the way damage to skin, muscles, organs and bones happen. Healthcare providers use mechanism of injury to help determine how likely it is that a serious injury has occurred.

RAPID FORWARD DECELERATION


BASIC LAW OF MOTION: "A body in motion, remains in motion unless acted upon by an outside force." MVA are the most common form of rapid forward deceleration

MOTOR VEHICULAR ACCIDENT (MVA)


MOTOR VEHICLE ACCIDENTS (MVAs) can be broken down into 3 separate impacts. For example, if a car is traveling 160 kmh and hits a tree head on.

MVA IMPACTS
Vehicle impact, will occur when the car hits the tree Body impact, will occur when the occupant hits some structure inside the car (eg., windshield, steering wheel) Organ impact, will occur within the body of the occupant, when movable organs (i.e., brain, heart, liver, spleen, or intestines) impact with the supporting structures i.e., the skull, sternum, ribs, spine, or pelvis)

MVA HEAD-ON COLLISION

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When arriving on scene, the EMT should look for the following clues: Vehicle Impactextent of front end damage Body Impact: windshield damage steering wheel damage dashboard damage

Organ Impact obvious soft tissue injury (lacerations abrasions, bruising, and contusions) or fractures to the head, neck, chest and abdomen

WINDSHIELD DAMAGE

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2.

Major indication that victim was unrestrained and that the skull has impacted the windshield Injuries may include: head injury - soft tissue injury, fractures, coup and contercoup injury to the brain scalp, face, or neck injury

STEERING WHEEL DAMAGE

Major indication that victim was unrestrained and the body has impacted with the steering wheel

STEERING WHEEL DAMAGE

Note any obvious bruising to area of impact; a primary consideration should be the deeper structures and organs that are susceptible to shearing and compression forces generated by this type of impact.

STEERING WHEEL DAMAGE

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2. 3. 4. 5. 6. 7. 8. 9.

Injuries may include: Neck injuries including the C-spine larynx and tracheal injuries fractured sternum myocardial contusion pericardial tamponade pneumothorax hemothorax flail chest Intraabdominal injuries (ruptured spleen, liver or bowel)

DASHBOARD DAMAGE
Major indication that victim was unrestrained and the body has impacted with the dashboard Injuries may include: 1. knee injuries 2. femur, hip, or pelvis injuries (if energy is transferred proximally from the knee) 3. head, face, and C-spine injuries

LATERAL IMPACT OR T BONE COLLISION

LATERAL IMPACT OR T BONE COLLISION


When arriving on scene, the EMT should look for the following clues: Vehicle Impactdamage to the driver's or passenger's side Body Impactintrusion of the door, arm rests, window, or other parts of the car into the victim's space

LATERAL IMPACT OR T BONE COLLISION

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3. 4.

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Organ Impact head injury C-spine injury (the combination of the flexion and rotation of the spine that occurs with lateral impact produces more frequent and severe cervical injuries) chest and abdominal injuries to the side of impact upper arm, shoulder and clavicle injuries on the side of impact pelvic, hip, or femur injuries on the side of impact

REAR IMPACT COLLISION

Most common type of rear-end collision is when a stationary car is hit from behind by another car

REAR IMPACT COLLISION


Injuries occur as the torso and seat shoot forward; if the headrest is too low, the neck will end up hyperextended over the top of the headrest (this is how strains, torn ligaments, and more serious cervical injuries often occur) The vehicle may be involved in double impacts front and rear; the EMT should be looking for two sets of injuries

ROLLOVER COLLISION

ROLLOVER COLLISION
Occupant can be tossed around and injured from all directions Difficult to predict all the injuries that could result, however, the EMT should be prepared to perform a thorough primary and secondary survey Greater chance of occupants being ejected from the vehicle

VICTIMS EJECTED FROM VEHICLE


25 times more likely to be killed Injuries that result after the second impact when the body hits the ground outside the car are even more severe than the initial impact Distance between the victim and the vehicle usually indicates how fast the car was traveling and, therefore, how much energy was absorbed by the patient One out of 13 ejected victims sustain spinal injuries

SEAT BELT
Should be worn correctly (should be positioned across the pelvis above the femur and should be pulled tight enough to remain in this position) Purpose 1. Protect the occupants from impacting with the inside of the car 2. Prevent occupants from being ejected from the vehicle

SEATBELT WORN IMPROPERLY


If worn too high Compression injuries to abdominal organs Burst injuries to the small intestine and colon Rupture of the diaphragm due to increased intrabdominal pressure Compression fractures to the lumbar spine

SEATBELT WORN IMPROPERLY


If the lap belt is worn alone, Severe trauma to the head, face, and neck (since there is no shoulder strap to stop the forward momentum of the upper body) If the shoulder belt is worn alone, Severe C-spine injuries Decapitation

MOTORCYCLE ACCIDENTS
75% of motorcycle deaths are due to severe head trauma Helmets help to prevent head trauma, but do not protect against spinal injury Injuries are similar to victims that are ejected from vehicles; high frequency of head, neck, and extremity trauma

AUTO VS PEDESTRIAN COLLISION


Two common injury patterns occur, one for the adult and another for the child; because of the difference in height, they will contact the vehicle at different levels of the body. With an adult, the first impact is made by the bumper to the lower extremities; in children contact is usually to the upper legs or pelvis

AUTO VS PEDESTRIAN COLLISION

As the victim folds forward, the second impact occurs when the adult's upper legs and trunk hit the hood of the car; for the child, it is usually the abdomen and thorax (if the victim continues forward, their head may strike the hood or the windshield of the car)

AUTO VS PEDESTRIAN COLLISION


Finally, the third impact occurs when the victim falls off the car and hits the pavement usually head first Multi-system trauma should be assumed, even if they are asymptomatic initially.

RAPID VERTICAL DECELERATION

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Injury pattern that results with this mechanism is dependent upon three factors: distance of the fallfalling from greater heights increases the incidence of trauma because velocity increases as they fall body part that impacts first type of landing surfaceif the landing surface is more resilient, thereby increasing the stopping distance, the kinetic energy will be absorbed by the surface instead of the victim's body

RAPID VERTICAL DECELERATION

Injury pattern for children Associated with head injury, since their head is the heaviest part of their body and usually impacts first For adult Feet or leg fractures Hip or pelvic fractures Lumbar/sacral spine fractures Wrists fractures

PENETRATING TRAUMA (STAB WOUND)

1. 2. 3.

Severity of wound depends on the following: location penetrated blade length angle of penetration

PENETRATING TRAUMA (STAB WOUND)


Location: stab wounds that have entered the upper abdomen may have reached organs in the thoracic cavity Stab wounds that have entered the chest wall below the 4th intercostal space may have injured abdominal organs, since this is the highest level of the diaphragm. Do not underestimate the internal damage of simple entrance wounds, since the attacker may have moved the blade around inside after stabbing his victim, causing extensive internal injury.

FIREARMS

FIREARMS Severity of injury affected by the following factors: type of weaponlow velocity weapons are less destructive than high velocity weapons Caliber or size of bulletlarger bullets cause more resistance and therefore a larger area of damage

FIREARMS Distance from which the weapon was firedwith increased distance, the bullet will decrease in velocity by the time it reaches the victim Bullet deformityhollow point and soft nose bullets flatten out when they impact the victim, so the area damaged is greater

Tumble and yaw of bullet: as the bullet travels forward, it can tumble and oscillate vertically or horizontally about its axis, resulting in a larger surface area meeting the surface of the body

FIREARMS WOUND
Consist of three parts: Entrance woundmay be round or oval; shots from close range may have burns or smoke marks on the skin Exit woundif present, is larger and may be linear or stellate in appearance; not all entrance wounds will have an exit

FIREARMS WOUND
Internal wound damage to the tissue in the direct path of the bullet will cause a permanent cavity tissue on either side of the bullet's path will also be injured due to pressure from energy exerted outward from the path of the bullet which results in a temporary cavity (this temporary cavity is usually 3 to 6 times the size of the front surface area of the bullet)

FIREARMS WOUND

85 - 95% of wounds caused by firearms will require surgical intervention; only 30% of knife wounds will need to be explored