The author's right to be identified as the author of this work has been asserted under the Copyright, Designs and Patents Act 1988. The text is interspersed with working clinical case studies that remind the reader of the everyday practical use of the content. This book provides the clinician with a systematic and comprehensive approach to the initial assessment and management of the trauma patient.
Although the determination of the MOI is an integral part of the initial patient assessment, it should never delay the primary survey and the detection of life-threatening injuries if the information is not available. The purpose of this chapter is to identify the common MOIs that cause traumatic injury and how knowledge of these can assist in the assessment and resuscitation of the trauma patient. Understand the importance of MOI in the assessment, management and ongoing evaluation of the trauma patient.
98% of trauma in the UK is blunt injury, and other mechanisms make up the rest. A summary of information that may be useful for assessing the patient can be found in Table 1.1.
Road Traffi c Accidents (RTAs)
The occupant can also follow a downward and underpass, sliding under the dashboard.1 This can lead to fractures and dislocations of the ankle, knee, femur and femoral head.1,3. Injuries refer to the side on which the force was applied, so a side impact on the driver's side could potentially result in injuries to the right side of the body, such as a liver laceration, while a crash on the left side could result in a passenger being injured. - a ruptured spleen. If the force is great enough, the occupant can be pushed from one side of the car.
The head can also be injured if the victim hits another passenger in the vehicle or hits the head against the window on the same side as the collision.3. An unrestrained passenger can impact any part of the vehicle's interior1 or can be ejected.4 Damage to the musculoskeletal system on any part of the body can occur with associated internal organ damage. Roof collapse can lead to significant head injuries4 and compression fractures of the spine are common.
Compression injuries occur when the anterior (front) part of the torso stops moving forward and the posterior (back) part of the torso and internal organs continue to move forward. This leads to compression of the organs of the posterior part of the internal chest and abdomen,1 but can also occur in the skull and cause brain damage.3.
Pedestrian impact
Different types of vehicles, such as lower-riding sports cars or taller four-wheel drive vehicles, will also change the point of impact. If a patient is hit by a bus or truck, he or she may be thrown onto the side of the vehicle or dragged underwater.2 This could result in a body part being run over or dragged under a vehicle. After hitting the bumper, the victim can then be thrown onto the hood and also crash into the windshield.1,4 Occasionally, patients can be thrown over the roof of the car, if the impact is great enough.2 Types of The injuries sustained during this phase depend on which part of the body the car hits and at what speed the incident occurred.
Eventually the victim will fall off the hood (or roof if the speed was high enough) and hit the ground. This will typically cause head and neck injuries when the victim falls to the ground. Road traffic injuries occur when the vehicle, or part of the vehicle, runs over the victim or perhaps even drags him along the road.
Serious injuries can occur on any part of the body3 and are often immediately life-threatening. Due to the lowest impact point, children may be at risk of being thrown sideways or under the car2, although they too can be forced onto the bonnet under the right circumstances.
Cycle and motorcycle accidents
However, most motorcyclist deaths are caused by head injuries.3 Tight leather pants, such as those worn by motorcyclists, can help reduce blood loss from lower extremity fractures.3. There are common MOIs for cyclists and motorcyclists that can predict injury patterns, although injuries may be more severe for motorcyclists due to the speeds involved.2. In a frontal collision, the front wheel of the bicycle/motorcycle collides with an object and stops.
However, the rider will continue to move forward until something stops this momentum, such as the ground or another stationary object.1 During this event, the head, chest or abdomen may collide with the handlebars resulting in blunt trauma to these areas, such as pelvic fractures and injuries to the organs contained therein. If the cyclist is thrown from the bike, femoral injuries can occur as a result of impact with the handlebars.1 The final impact, with the ground, can result in other injuries such as spinal fractures. If the cyclist is hit from the side, they can suffer open or closed fractures, or crush injuries, to the lower limbs1, as well as ejection and ground impacts as described above.
Ejection from the bicycle may also lead to the patient being involved in a further incident with another vehicle. This can lead to significant fractures and/or soft tissue injuries in the lower limbs.
Assaults
Falls
The Revised Trauma Score (RTS) is a scoring system based on the patient's physiological signs. If the mechanism of injury and the status of the patient suggest serious. Pia mater - the soft membrane that is attached to the outer surface of the brain.
Note if bleeding, report the amount to the clinician responsible for the patient's care. The underwater sealing system and bottle should always be kept below the patient's chest level. After that, the patient's chest should be fully exposed. allow systematic assessment of the breast.
Assessment of the patient's circulatory status is important because of the risk of hypovolemia and cardiac arrhythmias associated with thoracic injury. Careful observation of the patient's respiratory effort is necessary, and ventilatory support may be required. A urinary catheter should be inserted to monitor urine output and allow assessment of the patient's fluid balance.
The patient should be undressed and the patient should be carefully rolled up so that the back can be examined. Reimplantation of the amputated part may be possible depending on the severity of the damage to the part of the body and the status of the patient. This results in reduced blood flow to the tissues below the level of the injury.
This can also be done at a later stage in the patient's care if other injuries are a priority.
