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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.

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

When arriving on scene. the EMT should look for the following clues: Vehicle Impact—extent of front end damage Body Impact: windshield damage steering wheel damage dashboard damage . 3. 2.MVA HEAD-ON COLLISION    1.

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

face. coup and contercoup injury to the brain scalp. Major indication that victim was unrestrained and that the skull has impacted the windshield Injuries may include: head injury .soft tissue injury.WINDSHIELD DAMAGE   1. fractures. or neck injury . 2.

STEERING WHEEL DAMAGE  Major indication that victim was unrestrained and the body has impacted with the steering wheel .

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  Note any obvious bruising to area of impact. .

4. 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. 2. 3. 5. 7. 9. liver or bowel) . 8.STEERING WHEEL DAMAGE  1. 6.

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

LATERAL IMPACT OR T BONE COLLISION .

LATERAL IMPACT OR T BONE COLLISION When arriving on scene. arm rests. or other parts of the car into the victim's space . window. the EMT should look for the following clues:  Vehicle Impact—damage to the driver's or passenger's side  Body Impact—intrusion of the door.

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. 3.LATERAL IMPACT OR T BONE COLLISION  1. or femur injuries on the side of impact . 2. shoulder and clavicle injuries on the side of impact pelvic. 4. hip. 5.

REAR IMPACT COLLISION  Most common type of rear-end collision is when a stationary car is hit from behind by another car .

if the headrest is too low. 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  .REAR IMPACT COLLISION Injuries occur as the torso and seat shoot forward. the neck will end up hyperextended over the top of the headrest (this is how strains. torn ligaments.

ROLLOVER COLLISION .

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

how much energy was absorbed by the patient  One out of 13 ejected victims sustain spinal injuries  .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.

Prevent occupants from being ejected from the vehicle  .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.

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 .

 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.SEATBELT WORN IMPROPERLY If the lap belt is worn alone.  Severe C-spine injuries  Decapitation .

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

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

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

even if they are asymptomatic initially.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.  .

Injury pattern that results with this mechanism is dependent upon three factors: distance of the fall—falling from greater heights increases the incidence of trauma because velocity increases as they fall body part that impacts first type of landing surface—if the landing surface is more resilient. 2. the kinetic energy will be absorbed by the surface instead of the victim's body . 3. thereby increasing the stopping distance.RAPID VERTICAL DECELERATION  1.

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 .RAPID VERTICAL DECELERATION        Injury pattern for children Associated with head injury.

PENETRATING TRAUMA (STAB WOUND)  1. 2. 3. Severity of wound depends on the following: location penetrated blade length angle of penetration .

since this is the highest level of the diaphragm.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.  Do not underestimate the internal damage of simple entrance wounds. causing extensive internal injury. . since the attacker may have moved the blade around inside after stabbing his victim.

FIREARMS .

FIREARMS Severity of injury affected by the following factors:  type of weapon—low velocity weapons are less destructive than high velocity weapons  Caliber or size of bullet—larger bullets cause more resistance and therefore a larger area of damage  .

so the area damaged is greater  .FIREARMS Distance from which the weapon was fired—with increased distance. the bullet will decrease in velocity by the time it reaches the victim  Bullet deformity—hollow point and soft nose bullets flatten out when they impact the victim.

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

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

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)  .

95% of wounds caused by firearms will require surgical intervention. only 30% of knife wounds will need to be explored .FIREARMS WOUND  85 .

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