MECHANISMS OF INJURY Trauma- defined by the American Heritage Dictionary as a wound, especially one produced by sudden physical injury.

Injury- defined by the National Committee for Injury Prevention and Control as unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical or chemical energy or from the absence of such essentials as heat or oxygen. -occurs when force deforms tissues beyond their failure limits. Mechanism of Injury- refers to the way damage to skin, muscles, organs and bones happen

BLUNT INJURY -Also called Non-penetrating injury -includes MVCs, falls, assaults and contact sports -more life-threatening -extent is less obvious -diagnosis can be more difficult -caused by: Acceleration- increase in velocity or speed of a moving object Deceleration- decrease in the velocity of the moving object Shearing- occurs across a plane when structures slip relative to each other Crushing- occurs when continuous pressure is applied into the body Compressive Resistance- ability of an object or the structure to resist squeezing forces or inward pressure -direct impact that causes the greatest injury -force may be transmitted internally with dissipation of energy to the internal structures - wearing shoulder and lap restrains reduce the incidence and severity of injury PENETRATING INJURY - produced by foreign objects penetrating the tissue that breaks the skin integrity - damage depends on three factors: Density and compressibility of the tissue injured Missiles velocity Fragmentation of the primary missile STAB WOUNDS AND IMPALEMENTS -low-velocity injury -determinants are: Length Width Trajectory of the penetrating object Presence of vital organs in the area of the wound BLAST - caused by an explosive element, which may be intentional or accidental THERMAL -caused by extreme heat such as re, or extreme cold such as frostbite

INITIAL ASSESSMENT AND MANAGEMENT PREHOSPITAL MANAGEMENT -Definitive care should be initiated within one hour of injury Stay and Play Theory- time in the field can be well spent stabilizing the physiologic status -appropriate in rural areas Scoop and Run Theory- only life-threatening issues should be addressed in the field -may be appropriate in urban areas -Prioritize ABCs (airway, breathing and circulation) -Assess neurologic status (level of consciousness, pupil size and reaction) -Conduct secondary assessment to determine any other injury HOSPITAL MANAGEMENT -Entails rapid primary evaluation and resuscitation of vital functions, a more detailed secondary survey and initiation of definitive care -ABCDEs (airway, breathing, circulation, disability and exposure) -Primary Survey: Be certain that the assessment will not continue to the next phase until each preceding priority is effectively managed Assess for evidence of hypovolemia (pallor, poor skin turgor, diaphoresis, tachycardia and hypotension) stop the bleeding and replace lost intravascular fluid Perform ECG, pulse oximetry and end-tidal carbon dioxide monitoring Place Foley catheter and nasogastric or orogastric tube Conduct bloodwork analysis (evaluation of electrolytes, hemoglobin and hematocrit, blood type and crossmatch and arterial blood gas) Assess for hypothermia -Secondary Survey: Cephalocaudal Plan is developed and diagnostic procedures are held More detailed patient history and assessment from the client, field providers or relatives Continuous reassessment of the client -Fluid Resuscitation- maintain physiologic support of circulation and oxygen transport while avoiding physiological and hemostatic deficiencies -provides adequate intravascular volume and oxygen-carrying capacity to transport needed nutrients to the tissues Crystalloids- water and electrolytes (sodium, potassium and chloride) premixed into fluids -tonicity- based on the amount of sodium -rapid infusion of isotonic crystalloid as rapidly as possible may be an initial management for trauma patients Hypertonic Saline- more rapid restoration of cardiac function with smaller volume of fluid (3%, 7.5% or 23.4%NaCl solution); shifts water into plasma resulting to rapid increase in

blood volume, mean arterial pressure and cardiac output which further results to peripheral vasodialtion that allows increase in total splanchnic, renal, pulmonary and mesenteric blood flow Colloids- used to resuscitate trauma patients -albumin, dextran and hetastarch create oncotic pressure which encourages fluid retention and movement of fluid into the intravascular space -less volume of fluid is necessary -fluid is retained in the intravascular space longer -may cause anaphylaxis and coagulopathy Blood Products- excellent resuscitation fluid -Red Blood Cells increase oxygen-carrying capacity and allow for volume expansion -stays in he intravascular space for longer periods -should be transfused when patients are hemodynamically unstable or are showing signs of tissue hypoxia despite crystalloid infusion -crossmatched blood is preferred or O-negative blood for uncrossmatched blood - may increase risk for acute respiratory distress syndrome, disseminated intravascular coagulation and renal failure -Autotransfusion may also be done Blood Substitutes-do not require crossmatching and do not carry the risk of blood borne pathogen transmission -long shelf life and are not immunosupressive -lower viscosity which promotes flow and peripheral oxygen delivery -Definitive Care- choose non-operative management as much as possible -monitor development of risks and complications GENERAL INTERVENTIONS Ensure adequate airway with spinal immobilization Ventilate and initiate oxygen therapy at 6 to 10 L/min. Insert one or two peripheral intravenous lines (14 to 16- gauge catheter) Initiate cardiac monitoring; obtain a 12-lead ECG Insert nasogastric tube (18 French Salem Sump) Insert a urinary catheter, if no blood is present at the meatus Monitor urine output every 15 to 30 minutes Monitor vital signs continuously and document Provide psychosocial support

Reference: Critical Care Nursing : A Holistic Approach by Morton, Fontaine, Hudak and Gallo

Medical Surgical Nursing: A Psychophysiologic Approach by Black and Matassarin-Jacobs Advanced Practice in Critical Care by McGloin and McLeod www.wikiradiography.com/.../Fracture+Types+and+Mechanisms+of+Injur y