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Mechanism of Injury(MOI)
The factors and force that cause traumatic injury
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Kinetics of Trauma
The science of analyzing MOI
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Three Impacts
- Vehicle collision
- Body collision
- Organ collision
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High Index of Suspicion to the Followings
- Death of another occupant of the vehicle.
- An unresponsive patient with an AMS.
- Intrusion of greater than 12 inches for the occupant site or greater than 18 inches anywhere to the vehicle.
- Ejection from the motor vehicle.
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Frontal Impact
- Partial ejection
- Injuries to the abdomen, chest, face, head, and neck
- Dashboard
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Rear-end Impact
- Whiplash injury
- Improper positioned headrest
- Up-and-over or down-and-under injuries
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Lateral Impact
- T-bone
- Injuries to the head, neck, chest, abdomen, and the pelvis
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Rotational or Rollover
- Multiple injuries
- Vehicles with high center of gravity
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Vehicle-Pedestrian
- Adult-up and over, usually from the side of the vehicle
- Child-down and under, usually facing the vehicle
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Restraints
- Hidden injuries
- Belts, airbags
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Motorcycle Collisions
- Head-on Impact: the bike tips forwards
- Angular Impact: the rider strikes an object at an angle
- Ejection: after the collision, the rider is ejected
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Falls
Greater than 15 ft or 2 times the patient's height.
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Penetrating Injuries
- Low velocity
- Medium velocity
- High velocity
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Medium and High velocity Injuries
- Dissipation of Energy: How energy is transferred to the human body by the forces acting on it. It is affected by
- 1. Drag: The factors that slow a projectile
- 2. Profile: The size and shape of a bullet's point of impact
- 3. Cavitation: A cavity formed by a pressure wave resulting from the kinetic energy of a bullet travelling through body tissue; also called pathway expansion
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Blast Injuries
- Primary phase
- Secondary phase
- Tertiary phase
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Primary Phase Injuries
- Due to the pressure wave of the blast
- Primarily affects the gas containing organs
- Severe damage and death might occur without any external signs of injury
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Secondary Phase Injuries
- Due to flying debris propelled by the force of the blast, or blast wind.
- Lacerations, impaled objects, fractures, and burns
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Tertiary Phase Injuries
- Occur when the patient is thrown away from the source of the blast.
- Ejections
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The Golden Period
The hour from the onset of injury to the ER
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The Platinum 10 minutes
10 from arrival to transportation.
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Indication of On-scene time 0f 10min or Rapid Transport
- Airway occlusion
- Respiratory rate < 10 or > 29
- Inadequate tidal volume
- Hypoxia (SpO2<95%)
- Respiratory distress, failure, or arrest
- Suspected skull fracture
- Flail chest
- Suspected pneumothorax, hemothorax, or tension pneumothoroax
- Pelvic fracture
- Two or more proximal long bone fracture
- Crushed or mangled extremity
- Uncontrolled external hemorrhage
- Suspected internal hemorrhage
- Signs and symptoms of shock
- Significant external blood loss
- Glascow Coma Scale <15
- AMS
- Seizure activity
- Sensory or motor deficit
- Any penetrating trauma to head, neck, anterior or posterior chest or abdomen, and above elbow or knee
- Amputation of an extremity proximal to the finger
- Trauma in patient with significant medical history(cardiac condition, pregnancy)
- Multisystem trauma
- Open or depressed skull fracture
- Suspected brain injury
- Paralysis
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The Trauma System
- Level I-Regional Trauma Center: All trauma 24-7+ research
- Level II-Area Trauma Center: All trauma 24-7
- Level III-Community Trauma Center: stablizing patient for transport
- Level IV-Trauma Facility: stablizing
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