Mechanisms of Injury and Initial Trauma Assessment

Classification of Traumatic Injuries

Common Injury Types and Causes

• Contusion: Falls, sports injuries, car accidents, strokes.
• Tears and Strains: Inadequate warm-up, muscular effort, imbalance between muscles.
• Dislocation: Precarious containment between articular surfaces, ligamentous laxity, degree of muscle force exerted on a joint.
• Distension (Strain): Lack of exercise, abrupt movements, workouts without preparation, poor flexibility.
• Fractures: Falls from heights, motor vehicle accidents, direct blows, repetitive forces.

Physiological Factors

Factors Affecting Respiration

• Exercise
• Hemoglobin function
• Medications
• Pain
• Smoking/Tobacco use
• Neurological damage
• Anxiety
• Body posture

Lung Capacity

Varies according to gender, age, height, physical development, and body position.

Trauma Mechanisms in Vehicle Accidents

Impact Types and Associated Injuries

• Collision (General): Cranial trauma, multiple fractures of the thorax, pelvis, and spine with thoracoabdominal vascular visceral tears.
• Rear Impact: Cervical whiplash, cervical spine fracture.
• Side Impact: Cervical muscle strain, vertebral fracture, clavicle fracture, thoracic contusion with pleuropulmonary injury, fractured humerus, fractured pelvis, tibia, fibula, torn spleen, liver, and intestines.

Pedestrian Accidents

Two main types based on victim age and impact dynamics:

Adult Pedestrian Impacts

1. 1st Impact (Bumper): Hit by the bumper in the leg (tibia and fibula fracture).
2. 2nd Impact (Hood/Windshield): Abdomen and thorax (fracture of superior femur, pelvis, ribs, and spine).
3. 3rd Impact (Ground): When the victim falls onto the pavement.

Child Pedestrian Impacts

Children are often hit while facing the vehicle due to their height.

1. 1st Impact (Bumper): Bumper hits the muscles and pelvis.
2. 2nd Impact (Hood/Vehicle): The chest strikes the vehicle.
3. 3rd Impact (Ground): Complex and unclear.

Motorcycle Accident Mechanisms

• Front Impact: Head injuries, chest, abdomen, bilateral femur fracture on impact with the handlebars.
• Angle Impact: Crushing of the leg, fractured tibia, fibula, dislocated ankle.
• Ejection: Driver thrown as a projectile.
• Dragging (Skidding): Skin abrasions and minor injuries.

Other Mechanisms of Trauma

• Crushing or Compression: Body compressed between two blunt surfaces.

  Note: Weight has greater influence than the speed of the vehicle.

  Results in hematomas, deep lesions consisting of multiple fractures, internal bleeding, and important lacerations on viscera and vessels.

• Winding: Surrounding action or body rotating about its longitudinal axis determined by the action of the wheels and axles of the vehicle in motion.
• Drag (Hooking): Occurs over a long distance because the victim's clothing is hooked onto projecting parts of the vehicle.

Trauma Assessment and Consciousness

Falls from Height

20% of falls greater than 5 meters are associated with lumbar spine fracture.

Baseline and Secondary Assessment

General impression of the person's level of consciousness, airway, breathing, and circulation.

Estimation of the Level of Consciousness (AVPU Scale)

A

Alert

V

Responds to Verbal stimuli

P

Responds to Pain

U

Unresponsive (No Answer)