IMMEDIATE (seconds- minutes)
these patient die before EMS can really fix it often even before arriving
IMMEDIATE (seconds- minutes)
usually form instant failure of a vital organ system
Types of energy transfers
1.kinetic
2.chemical
3.electric
4. Barometric
5. Thermal
What are the 3 mechanisms of blunt trauma?
1.direct contact -pt into object or object into pt
2.curshing force -body between two fixed points
3.acceleration/ decleraiton forces- differential movment in adjacent structures. result in shear
What is permeant cavitation?
-tissue deformity / displacement form direct damage from contact w/ object as object passed through tissue it cuts and forms a cavity
temporary/ secondary cavitation
-high velocity projectiles (bullet): creates pressure wave which forces nearby tissues out of the any; creates cavity much larger than the object itself
-stretching and damage to tissues
-once bullet gone cavity collapse down
What are high order explosives
-high pressure gases, rapidly expand, compressing surrounding medium, and procuring supersonic, overpressurization blast wave
-examples: TNt, ammonia nitrate fuel oil, dynamite
-categorized as primary, secondary, tertiary, quaternary
What are low order explosives
-subsonic explosion lacking an overpressurization blast wave
-under go deflagraiton rather then detonation relase energy slowly compared with high order explosives
-rarely casues pulmoanry and CSN damage due to primary blast
-ex: propellants, fireworks
what is a concussion?
-mild tBI
-hyper excitability ion shifts, changes energy metabolism, and decreased cerebral blood flow
-may lead to diffuse axonal injury
What can repeated concussions lead to
-structural remodeling/ Alzheimer’s, behavioural changes, cognitive decline
How does a bleed occur in the subdural space?
-rupture of the venous sinuses or small bridging veins due to torsion forces
Subarachnoid space
Arterial rupture
Primary spinal cord injury
-due to structural damage
Secondary spinal cord injury
-cascade of events from several hours to months after the injury which progressive deterioration beyond primary
Reparation phase of spinal cord injury
-cystic cavity formation, fluid , connective tissues, WBC -> barrier of neuronal regeneration (difficult to regrow)
-glial scars- protection form the infeciton and further damage
What is spinal shock?
-swelling around the Spinal cord develops secondary to trauma
-causes cord compression and transient neuro dysfunction, resembling cord injury/ transaction
Neurogenic shock
-disruptive shock state resulting disruption of autonomic flow secondary to high level spinal cord injury
-ANS dysfunction results below the injury resulting in vasodialtion lack of sympathic tone
-bradycardia secondary to unposed vagal tone (vagus nerve takes over )
-warm flush skin below injury
Autonomic dysreflexia
-spinal cord injury at T6 or higher
-triggered by sustained stimuli
-usually do to restrictive clothing, UTI, pressure areas
-this is post neurogenic shock
Above the injury in autonomic dysreflexia
-vasodailiton
-flushed face
-increased BP
-headache
-distended neck veins
-decreased HR
-increased sweating
Below the injury of autonomic dysreflexia
-vasoconstricton
-cold
-pale
-no sweating
COMMOTIDO cordis
-sudden CA because of blunt trauma
-physical stimuls must occur when ventricular are repolarization (physical force mediation R on T phenomenon)
-stimulus casue rapid VF
open book pelvis fracture
-pelvic volume increases
-veins are torn
-the normal tamponade is lost so bleeding gets worse.
Vertical shear pelvic fracture
-One half of the pelvis moves upward
-major ligament disruption
-major vessel injury risk
-very unstable
Lateral compression pelvic fracture
-pelvis is pushed inward from the side
-instead of opening the pelvis is squeezed
-this cans it’ll bleed but it does not increase pelvis volume like open blood fracture does
