Kinematics of Trauma Kimberly Ann Holmes Kenney RN, CNS-Rx, MS(N), MS CCRN, CEN, CFRN, NREMT-P

Kinematics of Trauma

Kinematics of Trauma

Kimberly Ann Holmes Kenney

RN, CNS-Rx, MS(N), MS

CCRN, CEN, CFRN, NREMT-P

ObjectivesObjectives

Discuss the laws of energy and motion.

Discuss trauma associated with blunt impact and penetrating injury.

Overview of the effects of energy distribution in MVCs.

Review the kinematics of blast and violent injuries.

Use kinematics to predict injury patterns.

Discuss the laws of energy and motion.

Discuss trauma associated with blunt impact and penetrating injury.

Overview of the effects of energy distribution in MVCs.

Review the kinematics of blast and violent injuries.

Use kinematics to predict injury patterns.

mv2

2

mass (weight) x velocity (speed)2

2

Kinetic EnergyKinetic Energy

oror

Kinetic energy is the energy of motion.

Kinetic energy is the energy of motion.

KE =

KE =

Example of Kinetic EnergyExample of Kinetic Energy

The The KEKE of a of a 150-lb.150-lb. person person

traveling at traveling at 30 mph30 mph would be: would be:

= 67,500 KE units150 x 30 x 30

2

150 lb. person traveling at 30 mph = 67,500 KE units

180 lb. person traveling at 30 mph = 81,000 KE units

150 lb. person traveling at 40 mph = 120,000 KE units

150 lb. person traveling at 30 mph = 67,500 KE units

180 lb. person traveling at 30 mph = 81,000 KE units

150 lb. person traveling at 40 mph = 120,000 KE units

Velocity vs. MassVelocity vs. Mass

What is more What is more important: important: velocityvelocity or or mass?mass?

VelocityVelocity

A body at rest will stay at rest.

A body in motion will remainin motion.

Unless what?

A body at rest will stay at rest.

A body in motion will remainin motion.

Unless what?

Newton’s First Law of MotionNewton’s First Law of Motion

Car strikes pole.

Driver continues moving forward.

Anterior surface of body strikes steering wheel.

Posterior body continues moving forward.

Organs compressed within body.

Car strikes pole.

Driver continues moving forward.

Anterior surface of body strikes steering wheel.

Posterior body continues moving forward.

Organs compressed within body.

Newton’s First Law and Blunt TraumaNewton’s First Law and Blunt Trauma

0But, energy can change forms and can be transferred.

Energy cannot be created.

Energy cannot be destroyed.

Energy cannot be created.

Energy cannot be destroyed.

Law of Conservation of EnergyLaw of Conservation of Energy

Can you give Can you give an example?an example?

How does the Law of Conservation of Energy pertain to trauma?

How does the Law of Conservation of Energy pertain to trauma?

Can you give some examples?Can you give some examples?

Compression InjuryCompression Injury

Deceleration and Acceleration

Shear InjuryShear Injury

Deceleration and Acceleration

Organ Injury

In a 50 mph MVC, what types injuries would occur if the patient were to strike the windshield?In a 50 mph MVC, what types injuries would occur if the patient were to strike the windshield?

Head InjuryHead Injury

Fractures.

Ligamentous injuries.

Soft tissue injury.

Brain injury.

Cord damage.

Fractures.

Ligamentous injuries.

Soft tissue injury.

Brain injury.

Cord damage.

Torso InjuryTorso Injury

Rib fractures.

Heart & lung damage.

Abdominal organ damage.

Major vessel damage.

Rib fractures.

Heart & lung damage.

Abdominal organ damage.

Major vessel damage.

Extremity InjuryExtremity Injury

Fractures.

Ligamentous injury.

Soft tissue injury.

Fractures.

Ligamentous injury.

Soft tissue injury.

Frontal impact.

Lateral impact.

Rotational impact.

Rear impact.

Rollover.

Frontal impact.

Lateral impact.

Rotational impact.

Rear impact.

Rollover.

Types of Motor Vehicle CollisionsTypes of Motor Vehicle Collisions

What type of injury patterns might you see in a frontal impact?What type of injury patterns might you see in a frontal impact?

Frontal Impact - Occupant PathwaysFrontal Impact - Occupant Pathways

What injuries would you expect with an up and over pathway?What injuries would you expect with an up and over pathway?

Injuries with Up & Over PathwayInjuries with Up & Over Pathway

Head injuries.

Spine injuries.

Chest injuries. Fractures. Pneumothorax. Hemothorax. Contusions. Great vessel injury.

Head injuries.

Spine injuries.

Chest injuries. Fractures. Pneumothorax. Hemothorax. Contusions. Great vessel injury.

continued...continued...

Abdominal injuries. Solid organs. Hollow organs. Diaphragm.

Fractured pelvis.

Abdominal injuries. Solid organs. Hollow organs. Diaphragm.

Fractured pelvis.

Injuries with Up & Over PathwayInjuries with Up & Over Pathwaycontinued...continued...

Frontal Impact - Occupant PathwaysFrontal Impact - Occupant Pathways

What injuries would you expect with a down and under pathway?What injuries would you expect with a down and under pathway?

Injuries with Down & Under PathwayInjuries with Down & Under Pathway

Posterior knee/hip dislocations.

Femur fractures.

Lower extremity fractures.

Pelvic/acetabular fractures.

Posterior knee/hip dislocations.

Femur fractures.

Lower extremity fractures.

Pelvic/acetabular fractures.

Rear ImpactRear Impact

What types of injuries would you expect?What types of injuries would you expect?

Lateral ImpactLateral Impact

What types of injuries would you expect?What types of injuries would you expect?

Body Motion during Lateral ImpactsBody Motion during Lateral Impacts

Neck

Chest

Pelvis

Neck

Chest

Pelvis

Rotational ImpactRotational Impact

What types of injuries would you expect?What types of injuries would you expect?

RolloverRollover

What injury patterns might you see following this collision?What injury patterns might you see following this collision?

Properly positioned lap restraint.

Improperly positioned lap restraint.

Properly positioned lap restraint.

Improperly positioned lap restraint.

Lap Restraint DeviceLap Restraint Device

What types of injuries should you anticipate?

Lap & Shoulder Restraint SystemLap & Shoulder Restraint System

What types of injuries should you anticipate?

Shoulder harness only; lap belt not used. (Victim moves down and under).

Lap restraint only; shoulder harness not used. (Victim moves up and over)

Shoulder harness only; lap belt not used. (Victim moves down and under).

Lap restraint only; shoulder harness not used. (Victim moves up and over)

What types of injuries would you expect to see?

What injuries would occur in a second collision?

What types of injuries would you expect to see?

What injuries would occur in a second collision?

Airbag DeploymentAirbag Deployment

What concerns would you have about a:

Small patient?

Child in a car seat?

What concerns would you have about a:

Small patient?

Child in a car seat?

Airbag DeploymentAirbag Deployment

Motorcycle CollisionsMotorcycle Collisions

Mandatory helmet laws

have been associated

with up to 300% fewer

head injuries and

deaths.

Mandatory helmet laws

have been associated

with up to 300% fewer

head injuries and

deaths.

Types of Impact: Frontal/EjectionTypes of Impact: Frontal/Ejection

How many impacts did this collision involve?

What types of injuries would you expect to see?

How many impacts did this collision involve?

What types of injuries would you expect to see?

Types of Impact: LateralTypes of Impact: Lateral

How many impacts did this collision involve?

What types of injuries would you expect to see?

How many impacts did this collision involve?

What types of injuries would you expect to see?

Pedestrian vs. Motor VehiclePedestrian vs. Motor Vehicle

How would the injury patterns differ between the adult and the child?How would the injury patterns differ between the adult and the child?

FallsFalls

Impact surface.(Harder surface = greater injury.)

Height.(Greater height = greater injury.)

Falls from a distance of more than three times the patient’s height produce critical injuries.

Impact surface.(Harder surface = greater injury.)

Height.(Greater height = greater injury.)

Falls from a distance of more than three times the patient’s height produce critical injuries.

FallsFalls

Deceleration injuries. Liver.

Aorta.

Spleen.

Kidney.

Deceleration injuries. Liver.

Aorta.

Spleen.

Kidney.

Landing Feet First(Don Juan Syndrome)

Landing Feet First(Don Juan Syndrome) Injuries seen in patients

landing feet first: Bilateral heel fractures. Ankle fractures. Distal tibia/fibula fractures. Knee dislocations. Femur fractures. Hip injuries. Spine compression fractures.

Injuries seen in patients landing feet first: Bilateral heel fractures. Ankle fractures. Distal tibia/fibula fractures. Knee dislocations. Femur fractures. Hip injuries. Spine compression fractures.

Landing Arms/Hands FirstLanding Arms/Hands First

Physical findings: Colles’ fractures of wrists.

Shoulder dislocations.

Fractures of the clavicles.

Physical findings: Colles’ fractures of wrists.

Shoulder dislocations.

Fractures of the clavicles.

Landing Head-FirstLanding Head-First

Physical findings: C-spine

injuries.

Facial injuries.

CNS damage.

Physical findings: C-spine

injuries.

Facial injuries.

CNS damage.

Acceleration Deceleration Hyperextension Hyperflexion Twisting Falling

Acceleration Deceleration Hyperextension Hyperflexion Twisting Falling

Sports & Recreational Activity Mechanisms

Sports & Recreational Activity Mechanisms

What types of sporting What types of sporting

or recreational injuries or recreational injuries

are common to your are common to your

area?area?

Kinematics & forces involved.

Equipment contributing to injury.

Involvement of protective equipment.

Nature of the sport.

Kinematics & forces involved.

Equipment contributing to injury.

Involvement of protective equipment.

Nature of the sport.

Predicting Sports-Related InjuriesPredicting Sports-Related Injuries

Blast InjuriesBlast Injuries

Warfare.

Civilian areas. Mines. Shipyards. Chemical plants. Tank trucks. Refineries. Fireworks firms. Silos. LP gas tanks.

Warfare.

Civilian areas. Mines. Shipyards. Chemical plants. Tank trucks. Refineries. Fireworks firms. Silos. LP gas tanks.

Do you have any of Do you have any of

these in your area?these in your area?

Blast-Related InjuriesBlast-Related Injuries

Three mechanisms of injury: Primary.

Secondary.

Tertiary.

Three mechanisms of injury: Primary.

Secondary.

Tertiary.

Primary Phase InjuriesPrimary Phase Injuries Cause: pressure wave from blast.

Affected area: gas-containing organs.

Injuries: Pulmonary bleeding. Pneumothorax. Air emboli. Perforation of the GI tract. Burns.

Death may occur in absence of outward signs.

Cause: pressure wave from blast.

Affected area: gas-containing organs.

Injuries: Pulmonary bleeding. Pneumothorax. Air emboli. Perforation of the GI tract. Burns.

Death may occur in absence of outward signs.

Secondary Phase InjuriesSecondary Phase Injuries

Cause: flying debris.

Affected area: Body surface. Skeletal system.

Injuries: Lacerations. Fractures. Burns.

Cause: flying debris.

Affected area: Body surface. Skeletal system.

Injuries: Lacerations. Fractures. Burns.

Cause: victim thrown against an object.

Affected area: area of impact or referred energy.

Injuries: similar to those sustained in a vehicle ejection.

Cause: victim thrown against an object.

Affected area: area of impact or referred energy.

Injuries: similar to those sustained in a vehicle ejection.

Tertiary Phase InjuriesTertiary Phase Injuries

Physics.

Weapon velocity.

Bullet design.

Physics.

Weapon velocity.

Bullet design.

Penetrating TraumaPenetrating Trauma

Penetrating TraumaPenetrating Trauma

Newton’s First Law and ballistics: Bullet in brass cartridge is at rest.

Bullet propelled by rapid combustion of powder.

Bullet leaves barrel of gun.

Bullet strikes a body.

Bullet transfers energy to victim.

Newton’s First Law and ballistics: Bullet in brass cartridge is at rest.

Bullet propelled by rapid combustion of powder.

Bullet leaves barrel of gun.

Bullet strikes a body.

Bullet transfers energy to victim.

Low-Energy InjuriesLow-Energy Injuries

Low velocity.

Usually hand-driven weapons.

Less secondary trauma.

Multiple wounds from a single weapon.

Low velocity.

Usually hand-driven weapons.

Less secondary trauma.

Multiple wounds from a single weapon.

Low-Energy Penetrating WoundsLow-Energy Penetrating WoundsHow does the length

of the weapon relate

to the cone of

damage?

How does the length

of the weapon relate

to the cone of

damage?

Type of weapon involved.

Path of weapon.

Depth of penetration.

Number of wounds.

Underlying anatomy.

Type of weapon involved.

Path of weapon.

Depth of penetration.

Number of wounds.

Underlying anatomy.

Assessment of Low-Energy InjuriesAssessment of Low-Energy Injuries

Medium-Energy Penetrating InjuriesMedium-Energy Penetrating Injuries

High-Energy Penetrating InjuriesHigh-Energy Penetrating InjuriesHow do these weapons differ How do these weapons differ from handguns and shotguns?from handguns and shotguns?

How do the wounds differ internally and externally?

How do the wounds differ internally and externally?

The larger the frontal area of the projectile, the greater the damage.

The larger the cavitation and the greater the damage, the greater the exit wound.

The larger the frontal area of the projectile, the greater the damage.

The larger the cavitation and the greater the damage, the greater the exit wound.

Projectile - Frontal AreaProjectile - Frontal Area

Gunshot Wounds - CavitationGunshot Wounds - CavitationReformation by

elastic tissueTemporarycavity

Compressionand crush

Permanentcavity

Direction of travel Bullet

Gunshot WoundsGunshot Wounds

Describe the difference between entrance and exit wounds.Describe the difference between entrance and exit wounds.

Tumbling ProjectilesTumbling Projectiles

Some projectiles are designed to tumble.

Tumbling creates greater tissue damage and more tissue destruction.

Some projectiles are designed to tumble.

Tumbling creates greater tissue damage and more tissue destruction.

FragmentationFragmentation

The shotgun round is the ultimate in fragmentation.The shotgun round is the ultimate in fragmentation.

Scene safety.

Patient care is the priority!

Weapon type.

Range at which weapon was fired.

Number of entrance and exit wounds.

Underlying anatomy and track.

Crime scene preservation.

Scene safety.

Patient care is the priority!

Weapon type.

Range at which weapon was fired.

Number of entrance and exit wounds.

Underlying anatomy and track.

Crime scene preservation.

Considerations for Penetrating TraumaConsiderations for Penetrating Trauma

Kinematics SummaryKinematics SummaryThe cornerstone of

assessment is early

consideration of

kinematics to predict

hidden injury.

The cornerstone of

assessment is early

consideration of

kinematics to predict

hidden injury.