Blunt trauma
Blunt trauma | |
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Other names | Blunt injury, non-penetrating trauma, trauma |
ventilation-perfusion mismatch, hypovolemia, reduced cardiac output |
Blunt trauma, also known as blunt force trauma or non-penetrating trauma, describes a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with
Blunt trauma can lead to a wide range of injuries including
Classification
Blunt abdominal trauma
Blunt abdominal trauma (BAT) represents 75% of all blunt trauma and is the most common example of this injury.
There are two basic physical mechanisms at play with the potential of injury to intra-abdominal organs: compression and deceleration.[7] The former occurs from a direct blow, such as a punch, or compression against a non-yielding object such as a seat belt or steering column. This force may deform a hollow organ, increasing its intraluminal or internal pressure and possibly lead to rupture.[citation needed]
Deceleration, on the other hand, causes stretching and
]When blunt abdominal trauma is complicated by 'internal injury,' the
In rare cases, this injury has been attributed to medical techniques such as the
Blunt abdominal trauma in sports
The supervised environment in which most sports injuries occur allows for mild deviations from the traditional trauma treatment algorithms, such as ATLS, due to the greater precision in identifying the mechanism of injury. The priority in assessing blunt trauma in sports injuries is separating contusions and musculo-tendinous injuries from injuries to solid organs and the gut and recognizing potential for developing blood loss, and reacting accordingly. Blunt injuries to the kidney from helmets, shoulder pads, and knees are described in American football,[11] association football, martial arts, and all-terrain vehicle crashes.
Blunt thoracic trauma
The term blunt thoracic trauma, or, more informally, blunt chest injury, encompasses a variety of injuries to the
The most immediate life-threatening injuries that may occur include tension pneumothorax, open pneumothorax, hemothorax, flail chest, cardiac tamponade, and airway obstruction/rupture.[12]
The injuries may necessitate a procedure, most commonly the insertion of an intercostal drain, or chest tube. This tube is typically installed because it helps restore a certain balance in pressures (usually due to misplaced air or surrounding blood) that are impeding the lungs' ability to inflate and thus exchange vital gases that allow the body to function.[13] A less common procedure that may be employed is a pericardiocentesis which by removing blood surrounding the heart, permits the heart to regain some ability to appropriately pump blood.[14][15] In certain dire circumstances an emergent thoracotomy may be employed.[16]
Blunt cranial trauma
The primary clinical concern with blunt trauma to the head is damage to the brain, although other structures, including the skull, face,
Traumatic brain injury (TBI)
Traumatic brain injury (TBI) is a significant cause of morbidity and mortality and is most commonly caused by falls, motor vehicle crashes, sports- and work-related injuries, and assaults. It is the most common cause of death in patients under the age of 25. TBI is graded from mild to severe, with greater severity correlating with increased morbidity and mortality.[17][18]
Most patients with more severe traumatic brain injury have of a combination of intracranial injuries, which can include
Blunt trauma to extremities
Injury to
Blunt pelvic trauma
The most common causes of blunt pelvic trauma are
One of the primary concerns is the risk of
A life-threatening concern is
Blunt cardiac trauma
Blunt cardiac trauma, also known as Blunt Cardiac Injury (BCI), encompasses a spectrum of cardiac injuries resulting from blunt force trauma to the chest. While BCIs necessitate a substantial amount of force to occur because the
Evaluation and diagnosis
In most settings, the initial evaluation and stabilization of traumatic injury follows the same general principles of identifying and treating immediately life-threatening injuries. In the US, the American College of Surgeons publishes the Advanced Trauma Life Support guidelines, which provide a step-by-step approach to the initial assessment, stabilization, diagnostic reasoning, and treatment of traumatic injuries that codifies this general principle.[8] The assessment typically begins by ensuring that the subject's airway is open and competent, that breathing is unlabored, and that circulation—i.e. pulses that can be felt—is present. This is sometimes described as the "A, B, C's"—Airway, Breathing, and Circulation—and is the first step in any resuscitation or triage. Then, the history of the accident or injury is amplified with any medical, dietary (timing of last oral intake) and history, from whatever sources such as family, friends, previous treating physicians that might be available. This method is sometimes given the mnemonic "SAMPLE". The amount of time spent on diagnosis should be minimized and expedited by a combination of clinical assessment and appropriate use of technology,[33] such as diagnostic peritoneal lavage (DPL), or bedside ultrasound examination (FAST)[34] before proceeding to laparotomy if required. If time and the patient's stability permits, CT examination may be carried out if available.[35] Its advantages include superior definition of the injury, leading to grading of the injury and sometimes the confidence to avoid or postpone surgery. Its disadvantages include the time taken to acquire images, although this gets shorter with each generation of scanners, and the removal of the patient from the immediate view of the emergency or surgical staff. Many providers use the aid of an algorithm such as the ATLS guidelines to determine which images to obtain following the initial assessment. These algorithms take into account the mechanism of injury, physical examination, and patient's vital signs to determine whether patients should have imaging or proceed directly to surgery.[8]
In 2011, criteria were defined that might allow patients with blunt abdominal trauma to be discharged safely without further evaluation. The characteristics of such patients include:
- absence of intoxication
- no evidence of lowered blood pressure or raised pulse rate
- no abdominal pain or tenderness
- no blood in the urine.
To be considered low risk, patients would need to meet all low-risk criteria.[36]
Treatment
When blunt trauma is significant enough to require evaluation by a healthcare provider, treatment is typically aimed at treating life-threatening injuries, such as maintaining the patient's airway and preventing ongoing blood loss. Patients who have suffered blunt trauma and meet specific triage criteria have shown improved outcomes when they are cared for in a trauma center.[1] The management of patients with blunt force trauma necessitates the collaboration of an interpersonal healthcare team, which may include but is not limited to; a trauma surgeon, emergency department physician, anesthesiologist, and emergency and trauma nursing staff.[1]
Treatment of abdominal trauma
In cases of blunt abdominal injury, the most frequent damage occurs in the
Treatment of blunt cranial trauma
The treatment of blunt cranial trauma is dependent on the extent of the injury. A discussion between the patient and healthcare professions will take place in order to carefully assess the patient's condition and determine the best approach for treatment. When considering the management of cranial trauma, it is crucial to ensure that the patient can breathe effectively.
Treatment of blunt thoracic trauma
Nine out of ten patients with thoracic trauma can be treated effectively without a
Epidemiology
Worldwide, a significant cause of disability and death in people under the age of 35 is trauma, of which most are due to blunt trauma.[1]
References
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- ^ Cimino-Fiallos, Nicole (28 May 2020). "Hard Hits: Blunt Force Trauma". login.medscape.com. Medscape. Archived from the original on 2017-09-24. Retrieved 1 January 2021.
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- ^ "Assessment of abdominal trauma – Differential diagnosis of symptoms | BMJ Best Practice". bestpractice.bmj.com. 14 August 2018. Retrieved 1 January 2021.
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- ^ a b Nickson, Chris. "Pelvic Trauma". Life in the Fast Lane. Retrieved 20 December 2018.
- ^ Croce, Martin. "Initial Management of Pelvic Fractures". FACS. American College of Surgeons. Archived from the original on 2015-04-21. Retrieved 2018-12-20.
- ^ a b c d e f "Blunt Cardiac Injury". The American Association for the Surgery of Trauma. 2013-01-14. Retrieved 2023-09-22.
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