Traumatic injury remains a leading cause of death and disability around the world

Mechanism of Injury:

A history of the injury or examination of the injury-producing mechanism is very helpful in identifying specific types of injury.

Injury types can be classified according to the direction and amount of energy force

Blunt Trauma:

The severity of injury varies according to the amount of energy transferred to the human body.

The automobile accounts for a major part of severe blunt trauma. Also, falls, motorcycle and bicycle trauma can give rise to blunt trauma.

The direction of impact determines the pattern of injuries.

Body cavity injuries are produced by compression and deceleration.

So, with this information, the physician can judge what part of the body absorbed the greatest transfer of energy, and what injury patterns are likely in the affected cavities:-

A frontal impact should alert the examining physician to the potential for cervical spine injuries, central flail chest, myocardial contusion, pneumothorax, ruptured spleen or liver or fracture-dislocation of the hip.

A side impact may cause contra-lateral neck sprain or cervical fracture, lateral flail chest, pneumothorax, acceleration injury to the aorta, fracture spleen or liver (side of impact), and fractured pelvis or acetabulum.

Rear-impact collisions can result in neck injuries, and there is usually a frontal-impact as well because the occupant is projected into the steering wheel.

Ejection from a vehicle can result in multiple injuries, depending on which part of he body impacted first.

Penetrating trauma:

Two factors determine the type of the injury

The region of the body sustaining the injury determines the potential for specific organ injury

The transfer of injury determines the injury itself

For penetrating injuries, the speed of the missile is the most important in determining energy.

Immediately life-threatening chest injuries:

Airway obstruction

Tension pneumothorax

Open pneumothorax

Massive hemothorax

Flail chest

Cardiac tamponade

Potentially life-threatening injuries:

Pulmonary contusion

Myocardial contusion

Aortic disruption

Traumatic diaphragmatic hernia

Tracheobroncheal disruption

Esophageal disruption

Other chest injuries:

Subcutaneous emphysema

Simple pneumothorax

Hemothorax

Rib fractures

Abdominal Trauma:

High Index of Suspicion: peritoneal cavity..

Any patient sustaining significant deceleration injury or penetrating trauma is

assumed to have an abdominal visceral injury.

Blunt versus Penetrating:

Blunt: liver, spleen, or / and kidneys

Penetrating: liver, small bowel, colon, and / or stomach

Regions of the Abdomen:

Three anatomic compartments:

Peritoneal: also divided into: intrathoracic and abdominal segments

Pelvis: rectum, bladder, iliac vessels, and in women , the internal genetalia

Complications of severe injury:

Hemorrhage and Shock: pelvic fracture, spleen, liver kidneys, long bones,

muscles

Metabolic changes: glucose intolerance, high blood sugar, acidosis, disturbed

nitrogen balance

Abnormal coagulation profile, DIC

Infections: the second lading cause of death in trauma, e.g.; traumatic wounds,

Line-related infections, pneumonia, abdominal infections

Renal complications: traumatic rhabdomylosis (direct muscle injury and

ischemic muscle injury), and acute renal failure

Multiple Organ Failure (MOF): cerebral dysfunction, pulmonary insufficiency,

cardiac, renal and / or hepatic insufficiency

Stress gasrto-intestinal ulceration

Deep venous thrombosis (DVT): stasis, hypercoagulability, vessel wall damage

Pulmonary Embolism

Sepsis Syndrome

Disability

Brain Insult

Psychiatric Complications