Vehicle Collisions: Injuries and Impact

Collisions and Patient Impact in Vehicle Accidents

• The force of impact is directly related to the severity of patient injuries in a collision of a vehicle against another object.
• Common injuries from a passenger's collision with the interior of the car include lower extremity fractures, rib fractures, and head trauma.
• Coup-contrecoup brain injuries can occur when the heart and aorta experience sudden deceleration, leading to rupture and potential fatal bleeding.

Assessing Fatal Motor Vehicle Collisions

• When dealing with motor vehicle collisions where there are fatalities, assume that surviving patients experienced the same amount of force.
• Prioritize rapid transport for these patients to a trauma center.

Bullet Wounds

• Bullet wounds are hard to predict due to bullets ricocheting off hard objects like bones, altering their path.

Blast Injuries

• Primary blast injuries result in disruption of major blood vessels, ruptured eardrums, and damage to major organs, especially hollow organs.
• Secondary blast injuries are caused by flying debris, such as shrapnel, striking the body.
• Tertiary blast injuries occur when the patient is thrown against a secondary object by the force of the explosion.
• Quaternary blast injuries include burns, toxic gas inhalation, suffocation, poisoning, medical emergencies, crush injuries, contamination wounds, radiation injuries, and mental health injuries.

Pulmonary Blast Injuries

• Pulmonary blast injuries occur when there's a short-range exposure to the detonation of explosives.
• When an explosion happens in an open space, both lungs usually get injured.
• Signs and symptoms include chest tightness or pain, coughing up blood, tachypnea, and crackling under the skin of the chest.

Multisystem Trauma

• Patients who have a GCS score of 13 or less with a mechanism of injury attributed to trauma should be transported to the highest-level trauma center.

Factors for Determining Serious Injury

• Factors to consider are evidence of serious injury, need for ALS-level care and stabilization, traffic conditions or hospital availability making timely trauma center arrival unlikely, and a mass casualty incident with serious injuries.

Body's Response to Tissue Injury

• Platelets collect at the injury site, clump together, and are reinforced by protein and plasma converting to a mesh-like clot.

Blood Loss

• The body cannot tolerate an acute blood loss of more than 20% of the total blood volume or more than 2 pints, causing increased heart and respiratory rates, and decreased blood pressure.
• A one-year-old has a total blood volume of 27 oz.
• A small child will show significant signs and symptoms with a blood loss of 100-200 mL.

Hypovolemic Shock

• Hypovolemic shock occurs when low blood volume results in inadequate perfusion.

Internal Bleeding

• Dizziness, faintness, or weakness may be the first signs of nontraumatic internal bleeding in older patients, along with tenderness, guarding, rigidity, pain, and distension.

External Bleeding

• Life-threatening external bleeding should be addressed first by controlling it quickly, then assessing the XABCs.

Secondary Assessment

• During the secondary assessment, all areas of the body should be assessed for injuries or illnesses that might have been missed.

Controlling External Bleeding

• External bleeding can be controlled, in order, by:
  • Direct pressure
  • Pressure dressings and/or splints
  • Tourniquet
  • Junctional tourniquet
  • Hemostatic dressing
  • Wound packing
• Most cases of external bleeding can be controlled with direct pressure.
• Air splints are used for severe extremity injuries, such as fractures.
• Epistaxis is controlled by pinching the nostrils together, applying pressure with a gauze bandage between the upper lip and gum, and applying ice over the nose.
• The most effective way to control internal bleeding on an extremity is by applying a splint.

Skin Functions

• Skin protects against infections and pathogens, providing a waterproof barrier.

Closed Injuries

• Characteristics of closed injuries include a history of blunt trauma, pain at the site of injury, swelling beneath the skin, and discoloration.

Compartment Syndrome

• Compartment syndrome arises where the body makes its own tourniquet due to swelling, and commonly develops in the extremities with open or closed injuries, or under restrictive immobilized devices.

Dangers of Skin Breaks

• Breaks in the skin can lead to extensive bleeding, contamination, and infection with pathogens.

Contamination

• Contamination refers to the presence of infectious organisms, pathogens, or foreign bodies like dirt or metal in a wound.

Treatment of Avulsed Tissue

• Avulsed tissue should be replaced to its original position, if not contaminated, and wrapped in sterile gauze.

Open Neck Injury

• An open neck injury can lead to air being sucked into blood vessels, blocking blood flow to the lungs and causing cardiac arrest.
• Cover the wound with an occlusive dressing and apply manual pressure.

Bites

• Human bites pose the biggest threat for infection.

Airway Burns

• Signs of significant airway burn include singed nostril hair, hoarseness, and hypoxia.

Burns in Children

• Burns to children are more serious than burns to adults because children have more surface area relative to total body mass and do not tolerate burns as well as adults.

Rule of Palm

• The rule of palm says if a burn is too small to use the rule of nines, estimate using the patient's palm where a burn the size of the patient's palm is 1% of their body.

Head Injuries

• In unconscious patients, unequal pupil size may indicate acute brain damage.
• Injuries about the face and neck can often lead to major bleeding.
• Insertion of an NPA into a patient with facial or head trauma can result in the device going through the injury and potentially entering the brain.
• Reassess the ABCs frequently in a patient with facial or neck injuries.
• If a patient with spinal motion restriction applied has blood pooling in their mouth or starts to vomit, suction the airway and keep it patent using the jaw-thrust maneuver.
• When dealing with a penetrating object to the eye, place a dressing over the eye with a protective barrier and hold the impaled object in place, then secure with a rolled bandage.
• Both eyes should be bandaged when there is an injury to one eye because movement in one eye affects the other.
• If there is a laceration to the globe of the eye, do not apply pressure.
• Eye-related indications of possible head injury include unequal pupil size, eyes not moving together or pointing in different directions, failure of the eye to follow movement when instructed, bleeding under the white portion of the eye, and protrusion or bulging of one eye.
• To identify if blood drainage from the ears or nose contains cerebrospinal fluid (CSF), use the halo test; a yellow ring around the blood drop indicates CSF is present.
• CSF drainage from the ears or nose indicates a skull base fracture.
• To control bleeding from the nose, have the patient sit in a sitting position, leaning forward, and pinch their nostrils together for 10 to 15 minutes.
• An avulsed tooth should be placed in sterile water or milk.
• When controlling bleeding from a neck injury, apply direct pressure and a sterile occlusive dressing.

Brain Function

• The cerebrum is responsible for coordinating balance and body movements.
• The brain stem controls virtually all functions necessary for life, including cardiac and respiratory systems.

Spine Divisions

• The five divisions of the spine and their number of vertebrae:
  • Cervical (7)
  • Thoracic (12)
  • Lumbar (5)
  • Sacrum (5)
  • Coccyx (4)

Scalp Lacerations

• Scalp lacerations are serious because they have a rich blood supply and can lead to severe blood loss.
• Scalp lacerations can indicate direct blows to the head and may be indicators of more serious injuries.

Basilar Skull Fractures

• Signs of a basilar skull fracture include cerebrospinal fluid drainage from the nose and ears, raccoon eyes, and Battle's sign.
• It can take up to 24 hours for signs of a basilar skull fracture to develop.

Common Cause of Brain Injuries

• Motor vehicle crashes are the most common cause of brain injuries, often occurring when a passenger hits their head on the windshield or steering wheel.

Coup-Contrecoup Injury

• A coup-contrecoup injury is caused by the patient's head hitting something, such as a headrest or steering wheel, causing the brain to slam into the skull.

Cheyne-Stokes Respirations

• Cheyne-Stokes respirations are characterized by rapid breaths followed by apnea.

Central Neurogenic Hyperventilation

• Central neurogenic hyperventilation is characterized by deep, rapid breathing.

Mechanisms of Head and Spinal Injury

• MOIs that would lead you to suspect a possible head or spinal injury:
  • Motor vehicle crashes
  • Pedestrian-motor vehicle crashes
  • A fall from 20 ft or more from an adult
  • Falling 10 ft or more from a pediatric
  • Blunt trauma
  • Penetrating trauma to the head, neck, back, or torso
  • Rapid deceleration injuries
  • Hanging
  • Axial loading injuries
  • Diving accidents
• These cause head and spinal injuries.

Cervical Collars

• A cervical collar, once applied, should only be removed if it causes a problem with the patient's airway.
• The airway should be opened using the jaw-thrust maneuver in a patient with a suspected spine injury to avoid moving the head and causing more damage to the spine. The most reliable sign of a head injury is a decreased level of consciousness.

Skull Fractures and Padding

• If you suspect a skull fracture, do not apply direct pressure to the open wound.
• Small children may require additional padding to maintain the in-line neutral position of their head because they have bigger heads.