An accident or mishap is an unforeseen and unplanned event or circumstance, often with lack of intention or necessity.

It implies a generally negative outcome which may have been avoided or prevented had circumstances leading up to the accident been recognized, and acted upon, prior to its occurrence. Experts in the field of injury prevention avoid use of the term 'accident' to describe events that cause injury in an attempt to highlight the predictable and preventable nature of most injuries. Such incidents are viewed from the perspective of epidemiology predictable and preventable. Preferred words are more descriptive of the event itself, rather than of its unintended nature (e.g., collision, drowning, fall, etc.) Accidents of particularly common types (crashing of automobiles, events causing fire, etc.) are investigated to identify how to avoid them in the future. This is sometimes called root cause analysis, but does not generally apply to accidents that cannot be deterministically predicted. A root cause of an uncommon and purely random accident may never be identified, and thus future similar accidents remain "accidental. Types; Physical and non-physical Physical examples of accidents include unintended collisions or falls, being injured by touching something sharp, hot, or electrical, or ingesting poison. Non-physical examples are unintentionally revealing a secret or otherwise saying something incorrectly, forgetting an appointment, etc By activity Accidents during the execution of work or arising out of it are called work accidents. According to the International Labour Organization (ILO), more than 337 million accidents happen on the job each year, resulting, together with occupational diseases, in more than 2.3 million deaths annually.[1] In contrast, leisure-related accidents are mainly sports injuries. By vehicle Bike accident Tram accident Traffic collision Sailing ship accidents Most common cause; Incidence of accidents, sorted by activity (in Denmark in 2002). For physical traumas or injuries leading to hospital discharge, most common causes are traffic accidents and falls.

Injury is damage to a biological organism which can be classified on various bases. By cause [1] Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident Other injuries from external physical causes, such as radiation injury, burn injury or frostbite Injury from infection Injury from toxin or as adverse effect of a pharmaceutical drug Metabolic injury Complications of diabetes due to hyperglycemia Complications of lysosomal and glycogen storage diseases Injury due to autoimmunity Injury due to cancer Injury secondary to any other disease By location Wound, an injury in which skin is torn, cut or punctured (an open wound), or where blunt force trauma causes a contusion (a closed wound). In pathology, it specifically refers to a sharp injury which damages the dermis of the skin. Brain injury Spinal cord injury Nerve injury Soft tissue injury Cell damage, including direct DNA damage By activity Sports injury Occupational injury Trauma (from Greek , "wound" ) refers to "a body wound or shock produced by sudden physical injury, as from violence or [2] [3] accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma (defined by an Injury
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Severity Score of greater than 15) can result in secondary complications such as circulatory shock, respiratory failure and death. Resuscitation of a trauma patient often involves multiple management procedures. Trauma is the sixth leading cause of death worldwide, accounting for 10% of all mortality, and is a serious public health problem with significant social and economic costs [5] [6] Classification Trauma can be classified by the affected area of the body (percentages of total incidence ): Polytrauma (40%) Head injury (30%) Chest trauma (20%) Abdominal trauma (10%) Extremity trauma (2%) Facial trauma Spinal cord injury Genitourinary system trauma Pelvic trauma Soft tissue injury Trauma may also be classified by the affected demographic group (for example, trauma in the pregnant, pediatric, or geriatric patient).[5] They may also be classified by the type of force applied to the body, such as blunt trauma versus penetrating trauma Causes; Blunt trauma is the leading cause of traumatic death in the United States. Most cases of blunt trauma are caused by motor vehicle [7] [8] accidents. Falls, a subset of blunt trauma, are the second most common cause of traumatic death. In most cases a fall of greater [8] than three times the victim's height is defined as a severe fall. Penetrating trauma is caused when a foreign object such as a bullet or a knife enters a tissue of the body, creating an open wound. In the United States most deaths caused by penetrating trauma occur [9] in urban areas and 80% of these deaths are caused by firearms. Blast injury is a complex cause of polytrauma. It commonly includes both blunt and penetrating trauma and may also be accompanied by a burn injury. By identifying risk factors present within a community and creating solutions to decrease the incidence of injury, trauma referral [10] systems can help to enhance the overall health of its population. Ingestion of alcohol and illicit drugs are risk factors for trauma, [6] [6] particularly traffic collisions, violence and abuse. Long-acting benzodiazepines increase the risk of trauma in elderly people. Diagnosis Physical examination The purpose of the primary survey is to identify life-threatening problems. Upon completion of the primary survey, the secondary survey is begun. This may occur during transport or upon arrival at the hospital. The secondary survey consists of a systematic assessment of the abdominal, pelvic and thoracic area, complete inspection of the body surface to find all injuries, and a neurological examination. The purpose of the secondary survey is to identify all injuries so that they may be treated. A missed injury is one which is not found during the initial assessment (for example, as a patient is brought into a hospital's emergency department), [11] but rather manifests itself at a later point in time. Imaging [6] X-rays of the chest and pelvis are commonly performed in major trauma. Focused assessment with sonography for trauma (FAST), [12] can also be used. Computed tomography (CT) scans are the gold standard in imaging in major trauma. They however may only be [6] performed in people with a relatively stable blood pressure, heart rate, and sufficient oxygenation. Full-body CT scans known as [13] pan-scans improve survival in those who have suffered major trauma. The scans are done using intravenous radiocontrast but not [14] oral contrast. There are concerns of radiation exposure and concerns regarding negative effects of contrast on the kidneys. However some centers routinely do CTs with contrast before verifying renal function even in the elderly and have not found [12] negative side effects with respect to the kidneys. With modern imaging technology a complete scan can be performed in less than [6] 10 minutes. In the emergency department in the United States CT or MRI imaging is done in 15% of people who present with [15] injuries as of 2007 (up from 6% in 1998). In those with poor blood pressure or a fast heart rate from a presumed abdominal [16] bleeding delaying surgery for abdominal CT imaging may worsen outcomes. Surgical techniques Surgical techniques, such as diagnostic peritoneal lavage, placement of a thoracostomy tube, or pericardiocentesis are often used in cases of severe blunt trauma to the chest or abdomen, especially in the setting of deteriorating hemodynamic stability. In those who are hypotensive due to presumed internal abdominal bleeding transfer to the operating room for a laporotomy is the preferred [6] method of determining a definitive diagnosis. Management A Navy corpsmen listens for the correct tube placement on an intubated trauma victim during a search and rescue (SAR) exercise People who have severe trauma frequently require specialized physicians and equipment. Designated trauma centers have [6] improved outcomes compared to non designated centers. The transfer directly to a trauma center is associated with improved [17] outcomes compared to transfer to a non trauma center. Stabilization and transportation Typical trauma room
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In the prehospital setting the use of stabilization techniques improve the chances of a person surviving the transport to the nearest trauma-equipped hospital. After ensuring their own safety and taking isolation precautions, a primary survey is performed, consisting of checking and treating airway, breathing, and circulation (called the ABC's) then an assessment of the level of [11] consciousness. To prevent further injury, unnecessary movement of the spine is minimized by securing the neck with a cervical collar, and the back with a long spine board with head supports, or other medical transport device such as a Kendrick extrication [18] device, before moving the person. [6] Rapid transportation of those who are severely injured is associated with improved outcomes. Unless the person is in imminent [11] danger of death, first responders will typically "load and go," transporting to the nearest appropriate facility. Helicopter EMS [19] transport reduces mortality compared to ground based transport in adult trauma patients. In the prehospital environment, the [20][21] availability of advanced life support does not improve outcomes for major trauma, when compared with basic life support. The evidence is also inconclusive with respect to support for prehospital intravenous fluid resuscitation and some evidence has found it [22] may be harmful. People who have suffered trauma may require specialized care, including surgery and blood transfusion. Outcomes are better if this occurs as quickly as possible thus the so called golden hour of trauma. This is not a strict deadline, but recognizes that many deaths [23] which can be prevented by appropriate care occurring in a relatively short time after injury. Community-based trauma referral systems seek to decrease overall injury-related morbidity and mortality and years of life lost [10] within a population by ensuring the provision of optimal care during both the acute and late phases of injury. The care of acutely injured people is a public health issue that involves bystanders and community members, health care professionals, and health care systems. It encompasses prehospital assessment and care by emergency medical services personnel, emergency department [24] assessment, treatment, and stabilization, and in-hospital care among all age groups. An established trauma system network is also an important component of community disaster preparedness, facilitating the care of victims of natural disasters or terrorist [10] attacks. In those with cardiac arrest due to trauma cardiopulmonary resuscitation (CPR) is considered futile but still [25] recommended. [edit] Intravenous fluids [26] Traditionally, high volume intravenous fluids were given in people with hemodynamic instability due to trauma. This is still [27] appropriate for those with isolated extremity, thermal or head injuries. The current evidence however supports limiting the use of [5][27] fluids for penetrating thorax and abdominal injuries allowing mild hypotension to persist (known as permissive hypotension). [28][26] Targets include a mean arterial pressure of 60 mmHg, a systolic blood pressure of 70-90 mmHg, or until their adequate [26] mentation and peripheral pulses. As no intravenous fluids used for initial resuscitation has been shown to be superior to warmed Lactated Ringer's solution it [26] continues to be the solution of choice. If blood products are needed a greater relative use of fresh frozen plasma and platelets to [29] packed red blood cells has been found to result in improved survival and less overall blood product usage. A ratio of one:one:one [28] [26] is recommended. Cell salvage and autotransfusion may also be of use. Blood substitutes such as hemoglobin-based oxygen carriers and perfluorocarbon emulsions are in development. As of 2011 [30][31][26] however there are none available for commercial use in North America or Europe. The only countries where these products [30] are available for general use is South Africa and Russia. Medications [32][33] In people who are bleeding due to trauma tranexamic acid decreases mortality. Factor VII may also be appropriate in certain [27] [6] cases associated with severe bleeding such as those who have bleeding disorders. While it decreases blood use it does not [34] appear to decrease mortality. Surgery [6] Damage control surgery is employed in the management of trauma. This involves performing the least number of procedures to [6] [6] save life and limb. Less critical procedures are left until the person is more stable. Prognosis Death from trauma have been classically described as occurring during three peaks: immediately, early, and late. The immediate deaths are usually due to apnea, severe brain or high spinal cord injury, and rupture of the heart or large blood vessels. The early deaths occur within minutes to hours and are often due to a subdural hematoma, epidural hematoma, hemothorax, pneumothorax, ruptured spleen, liver laceration, or pelvic fractures. This is known as the golden hour. The late deaths occur days or weeks after the [11] [6] injury. This classical distribution however may no longer be occurring in the United States due to improvements in care. [35] Long term prognosis is also frequently complicated by pain with over half of people having moderately severe pain one year later. [36] Many also experience a reduced quality of life years later. 20% of people who sustain a traumatic injury will sustain some form of [37] [38] disability. Physical trauma can lead to development of post-traumatic stress disorder (PTSD). However, one study found no [39] correlation between the severity of trauma and the development of PTSD. Epidemiology Incidence of accidents by activity Trauma is the sixth leading cause of death (accounting for 10% of all mortality) worldwide, and the fifth leading cause of significant [4] [4][5][23][37][41] disability. In people between the ages of 145 years, trauma is the leading cause of death. The primary causes of death are central nervous system injury, followed by exsanguination.