Paramedic Care Principles Practice, V4, 5e Bledsoe SM Completed with Answers

Paramedic Care Principles Practice, V4, 5e Bledsoe SM Completed with Answers Paramedic CarePrinciples _ Practice, V4, 5e Bledsoe SM©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Detailed Lesson Plan Chapter 1 Trauma and Trauma Systems 135–155 Minutes Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture. 5 II. Introduction to Trauma and Trauma Care A. Trauma: physical injury or wound caused by external force or forces B. Third leading cause of death in United States; leading killer of persons < age 44 C. Steals greatest number of productive years from victims, and may be most expensive medical problem due to lost productivity and high cost of care D. More than 170,000 deaths per year; 34,500 due to automobile crashes, 31,500 due to gunshot wounds; other causes include falls, blasts, burns, stabbing, crush injuries, drowning, sports injuries E. Overall trauma and injury mortality rates have been increasing over the past decade F. Of EMS response, 30% is for trauma G. Role of EMS is to understand design and purpose of trauma care system, promote injury prevention, and provide care to trauma patients Critical Thinking Questions Why do you think that trauma injuries are increasing, even though prevention programs and engineering have attempted to reduce trauma incidence? Knowledge Application For an assignment, have students define each key term. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Critical Thinking Questions  Class Activities  Points to Emphasize  Knowledge Application©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 10 III. Trauma A. Severity ranges from slight abrasions to multiple-system trauma B. Broken down into blunt and penetrating trauma C. Penetrating trauma: occurs when arrow, bullet, knife, or other object enters the body and exchanges energy directly with the human tissue, thereby causing injury D. Blunt trauma: occurs as energy and collision forces associated with an object—not the object itself—enter the body and damage tissue E. Presentation can often mask patient’s true condition— assessment must be aggressive and look past distracting injuries F. Of trauma injury, less than 10% is life-threatening; lifethreatening injuries are mostly internal with hemorrhage into head or body cavity G. Prehospital care does not offer definitive stabilization of these injuries; definitive care is only available at a specialized treatment center (trauma center) H. Determining the difference between life-threatening trauma and those less injured is essential in the prehospital setting—guideline of trauma triage will aid determination, ensuring proper transport to correct facility Teaching Tips Using pictures, go over blunt versus penetrating injuries, and their presentations. Class Activities With the class, create a call on the board, with initial time, time dispatched, time en route, time on scene, and so on, until the squad reaches hospital. Go over how much time is actually left in the Golden Period, and how making a transport error can cost a patient possible loss of life and/or limb. 40 IV. Trauma as a Disease A. Only since the publication of ―Accidental Death and Disability‖ has trauma been viewed and managed as a disease B. Major factor of medicine is prevention: five factors to prevent or reduce trauma C. Surveillance 1. Collection of data to identify the existence, significance, and characteristics of disease 2. Trauma is number one cause of mortality from 1–44 years of age 3. Study of disease based on surveillance is epidemiology Discussion Topics Discuss with students the various trauma injury prevention programs in your area. Critical Thinking Questions What do you think is a leading trauma risk today? Has this changed over the past 10, 20, 30, or 40 years? Why? What sort of behaviors do you believe make people at risk for trauma?©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes D. Risk Analysis 1. Looks at disease and determines various factors that impact its development, course, and consequences 2. Due to risk analysis, we know that behavior plays an important role in trauma 3. The Haddon Matrix is a helpful tool in identifying risk elements a. Three-by-three matrix b. Incident (pre-event), during the incident (event), after the incident (post-event) c. Victim (host), causative factors (agent), factors surrounding incident (environment) d. Pre-event factors: things that happen well before collision and cause, influence, or prevent the outcome (injury)—include defensive driver training, traffic law compliance, use of safety equipment, behavior, general health, physical and medical conditioning, alertness, distractions e. Agent: kinetic energy exchange, reduced by auto designs, use of safety equipment f. Environment: improved traffic patterns, visibility, speeds, traffic law enforcement g. Event factors: exist during the crash; include health of occupant, alertness, influences in behaviors, use of safety equipment h. Agent: impact; lower vehicle speeds, braking, crumple zones, safety equipment i. Environment: crash barriers, weather visibility, vehicle control, stopping distance j. Post-event factors: those that worsen or improve victim’s outcome after energy exchange k. Host: knowledge of first aid, accessing EMS, victim ability to deal with blood loss and shock, general health, medication effects l. Agent: fire-resistant fuel systems, OnStar Class Activities As a group, identify a possible risk of trauma, and apply the five factors of prevention/reduction. Using the Haddon Matrix, have students change events and other details for different patient outcomes (e.g., use of safety equipment, texting, prevention programs, etc.) Host Agent Environment Pre-event Event Post-event *This works really well, especially if you print off an 8 × 11 copy and laminate. You will be able to use markers to continuously change the outcomes of the trauma. Make sure that students also include EMS response in the postevent (BLS versus ALS, transport time, etc.) Create scenarios in which students have an opportunity to use a teachable moment. Have them explain the behaviors that caused the risk, and what steps the patient can take to prevent future risk.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes m. Environment: video surveillance, priority dispatch, EMS response, teachable moments, adverse weather conditions E. Intervention Development 1. Creates or modifies programs to reduce both the incidence and the seriousness of trauma 2. Technology allows information to be tracked during a motor vehicle collision (MVC) that will allow for accurate auto crash dynamics (OnStar, SYNC, Assist) 3. EMS is a post-event intervention 4. Includes safer automobile designs, use of safety equipment, prevention programs F. Implementation 1. Putting an intervention into practice 2. It includes enforcing laws, reducing speed limits, safer automobiles, gun safety programs, safety education, continually improving EMS systems, and so on 3. As health care providers, we must promote, teach, and teach by example 4. Use of teachable moment—patient comes near harm due to carelessness or disregard for safety; in a nonjudgmental manner, we can suggest that a positive behavior change can prevent event from occurring again G. Evaluation 1. Repeating the surveillance that took place before an intervention to identify benefits of the intervention 2. Continued searching of risk factors, development and implementation of interventions, and evaluation of performance must always be performed 10 V. The Trauma Care System A. Development of today’s trauma care system came from investigation of death toll on U.S. highways B. Studies in the 1960s revealed that victims suffered from crash-related injuries and lack of organized approach to Critical Thinking Questions Discuss the advantages and disadvantages of a staged response of EMS providers (i.e., EMR initial, EMT-B second, ALS as needed third).©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes providing definitive care C. Trauma Care Systems Planning and Development Act of 1990 helped established guidelines, funding, and state-level leadership support for trauma systems D. Proper hospital care for serious trauma includes immediate availability of skilled surgical intervention E. Well-designed EMS systems utilize hospitals with special resources and commitments to trauma patient care— hospitals designated as trauma centers Discussion Topics Go through a trauma call with students. Start with first responders, and end with rehabilitation. Estimate costs for each level of care. 15 VI. Trauma Center Designation A. The current model for a trauma system includes four trauma center levels: 1. Level I: regional trauma center, usually a teaching hospital, prepared to handle all types of specialty trauma on a 24 hour a day basis a. Neurosurgery, microsurgery, care for multisystem trauma b. Provides leadership to other trauma center levels, data collection, research, continuing medical and public education 2. Level II: area trauma center has high commitment to trauma care, but not as great as Level I; surgical care capabilities at all times, can handle all but most seriously injured; staff can stabilize patients for transport to Level I 3. Level III: community trauma center; general hospital with commitment to special staff training and resource allocation for trauma patients; located in smaller communities and well prepared to care for most trauma patients and to stabilize and triage the more seriously injured for transport to high-level care 4. Level IV: patients taken for stabilization and care before transport; in these areas, trauma incident rate does not support resource allocation to meet requirement for Critical Thinking Questions Discuss the initial purpose of the ―Golden Hour‖ with students. Discuss if this is a reasonable expectation within their EMS system. Discussion Topics Discuss with students the different trauma level hospitals available in your area. Touch on patient flow between centers and critical care transfer of patients.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes trauma center B. Trauma system designs must be flexible enough to meet regional needs C. Specialty Centers 1. Certain medical facilities may be designed as specialty centers a. Neurocenters, burn centers, pediatric trauma centers, hand and limb replantation, hyperbaric oxygenation b. Specialty centers have a commitment of trained personnel, equipment, and other resources, along with specialized intensive care and state-of-the-art injury management 60 VII. Your Role as a Paramedic A. Role likely to begin with an appropriate patient assessment and triage; expeditious patient care and appropriate transport B. Trauma Assessment 1. Follows general patient assessment, but differs from medical with increased scene hazards, analyzing mechanism of injury and impact of environment, scene oversight, trauma triage guidelines, appropriate transport decision 2. Rapid trauma assessment versus focused assessment C. Scene Survey 1. Attention on scene safety and scene evaluation, mechanism of injury, environment, scene oversight D. Scene Safety 1. Associated hazards can include traffic, electrocution, jagged metal, glass, toxic substances, confined space, rough terrain, slippery spills, violence 2. Scene safety is the utmost importance for you, your crew, patient, and bystanders 3. Must look for scene hazards and rule them out Teaching Tips Review with students the trauma triage criteria. Review velocity in regard to trauma, along with mass. Review the Glasgow Coma Scale score with students. Review with students your local air medical service protocols. Discussion Topics Discuss with students different hazards that can present on trauma calls, and the appropriate resources to be notified. Discuss with students mechanism of injury, and the different injuries that can present based on various trauma. Discuss with students the use of the CUPS when deciding to transport. Critical Thinking Questions©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 4. Do not enter scene unless it is safe; always request assistance to make scene safe if necessary E. Mechanism of Injury Analysis 1. Mentally re-creating incident from evidence available at the scene 2. Attempt to identify strength of forces involved, direction, and areas of patient’s body injured 3. Automobile collisions require you to look at energy exchange between auto, patient, auto interior, and body organs; inspect collision and damage to auto 4. Index of suspicion: mental summation of anticipated injuries based on event analysis 5. Kinetic energy, velocity, body area have to be taken into account; strength and nature of impact can allow anticipation of injuries 6. Mechanism of injury (MOI) is an indirect indicator of energy transmission; signs of physical injury must be assessed 7. Signs and symptoms, vital signs, Glasgow Coma Scale (GCS), and level of consciousness (LOC) assessed in addition to MOI 8. Physical signs include: signs/symptoms of shock, head injury, LOC, GCS, vital signs; constant reassessment in necessary F. Environmental Impact Consideration 1. Adverse weather can impact assessment and patient care 2. Use available resources to protect patient from weather conditions G. Scene Oversight 1. Scene organization is critical to scene safety 2. Establish oversight and report any findings; relinquish when appropriate resources arrive H. Primary Assessment 1. Patient impression; rule out spinal precautions; secure How could an incomplete run report affect the trauma registry information? Class Activities Have students use different safety equipment and simulate injuries; you can use bicycle helmets, motorcycle helmets, seat belts, and so on. Show the proper use, and then have students identify what injuries can present when the equipment is used incorrectly. Create a trauma scenario and include different weather conditions. Have students discuss what actions they can take to protect their patients from the different weather elements. Create a trauma scenario, have students perform an assessment, and document the care. As a group, go over the call in a QI fashion, focusing on the injury and potential ways to prevent the injury in the future. Using hard boiled eggs, throw them at a wall or at the ground using different forces and speeds. This allows students to visualize the damage that occurs when speed is increased (this makes a mess, so make sure you use tarps, or do it outside where the mess can be hosed down). Knowledge Application For homework, have students research various trauma prevention programs that are offered in your area. Points to Emphasize Remind students that speed increases the level of injuries sustained.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes airway, breathing, circulation (discuss ABC vs CAB); identify priority patient for care and transport 2. Determine orientation, responsiveness, chief complaint, and anxiety level, which will form your general impression 3. Spinal precautions cannot be excluded if your patient is a poor or reliable reporter (decreased LOC, significant distracting injury, elderly or very young) 4. Patients who cannot make it out of primary assessment are critical patients (C) 5. Patients with limited injuries and stable ABCs are stable (S) 6. Patients in between are either unstable (U) or potentially unstable (P) 7. CUPS categorization of patient severity I. Secondary Assessment 1. Stable patients receive a focused trauma assessment, which is a detailed assessment focusing on suspected injury or chief complaint 2. Vital signs, LOC, GCS will be reassessed continuously 3. Unstable or potentially unstable patients will receive a rapid trauma assessment, including LOC, vital signs (VS), and GCS J. Reassessment 1. Reassessment includes any primary and secondary assessment elements that revealed signs or symptoms and a set of vital signs. 2. Repeat every 5 minutes for unstable patient and every 15 minutes for stable patients K. The Golden Period 1. Goal for incident-to-surgery time is 1 hour 2. Important for EMS to minimize scene and transport time 3. Golden Period used to be called the Golden Hour 4. Some time-consuming factors are out of EMS control (extrication for instance) Trauma patients may initially present with stabile vital signs, so reassessment is imperative when treating your patient.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5. Primary and secondary stabilization, packaging, and initiation of transport should be kept under 10 minutes 6. Prolonged ground transport may indicate air medical service 7. Measure air service request against patient condition, transport times, weather conditions L. Decision to Transport 1. Trauma triage criteria: GCS, vital signs (physical findings), anatomy of injury, mechanism of injury, age are all elements of trauma care and transport decision tree 2. MOI is first element of patient assessment, as it will provide preliminary information to determine patient priority (CUPS) 3. One of most difficult decisions made is when to transport 4. Patients who display key clinical and anatomical findings, particular MOI need to be transported immediately 5. IVs, intubation, other time-consuming procedures should be done en route 6. When using the trauma triage criteria, err on side of caution if suspicious about your patient 7. Trauma triage protocols are sensitive for injury and can lead to ―over-triage‖ M. Injury Prevention 1. Prevention is the best, most cost-effective way to reduce trauma 2. EMS has responsibility to support prevention programs, participate in and promote development 3. Technical (engineering) developments play major roles in reducing injury and death N. Data and the Trauma Registry 1. Surveillance is the only way to recognize trauma care practices and procedures that benefit the patient©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 2. Trauma registry: uniform and standard set of data collected by regional trauma centers that is analyzed to describe types of patients and injuries responded to, how well system is performing, and identifying factors that may lessen or increase survival 3. Patient prehospital care reports need to be completed accurately and completely to describe assessment findings, patient care, reassessment, and times associated with calls 4. Consider taking part and supporting prehospital research projects O. Quality Improvement (QI) 1. Examines system performance with aim of providing better patient care 2. Looks at selected care indicators to determine if designated system care standards are being met 3. Studies trauma triage criteria application, field skill performance, time spent in response, assessment, care, transport, and documentation 4. If criteria not met, suggested steps include continuing education programs, EMS equipment modifications, protocol revision 5. True QI does not identify fault with individual providers 5 VIII. Summary A. Trauma remains one of society’s greatest tragedies B. Accounts for frequent death and disability C. A well-implemented trauma system offers ways to lessen the incidence and impact D. System consists of trauma centers, prevention programs, trauma triage protocols E. EMS must evaluate mental status, physical signs of injury, vital signs, mechanism of injury, trauma criteria©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 1 objectives can be found on text p. 1. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 IX. Case Study Class Activities Discuss the case with students now that they are familiar with the chapter. 5 X. You Make the Call Class Activities Read and discuss the call and questions as a group. 5 XI. Review Questions Class Activities Pass out review questions before the lesson starts. Have students answer them. Then go over the questions again after the lecture, to assess their understanding of the information.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Detailed Lesson Plan Chapter 2 Mechanism of Injury 290–330 Minutes Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5 I. Case Study Teaching Tips Have a student read the scenario. Tell students the case will be reviewed after the lecture. 5 II. Introduction to Mechanism of Injury A. Mechanism of injury is the manner by which the injury occurred B. Trauma is typically classified as either blunt or penetrating C. Patients commonly have some component of both injury types 20 III. Kinematics of Trauma A. Kinetics: a branch of physics dealing with objects in motion and energy exchanges that occur as these objects collide 1. Measurement of how much energy an object in motion has; significant energy applied to human anatomy results in trauma B. Kinematics: studies the motion of a body or a system of bodies without consideration given to mass or force C. Inertia: Newton’s first law; a body in motion will remain in motion unless acted upon by an outside force—a body at rest will remain at rest unless acted upon by an outside force D. Energy Conservation: Energy can neither be created or destroyed; it can only be changed from one form to another E. Force: Newton’s second law; force strength is related to an object’s weight (mass) and the rate of its change in velocity: Force = [mass (weight) × acceleration (or deceleration)] / 2 F. Kinetic Energy: energy of an object in motion – object’s mass and velocity: Kinetic Energy = [mass (weight) × velocity squared] / 2; as speed increases, so does kinetic injury Knowledge Application For an assignment, have students define each key term. MASTER TEACHING NOTES  Teaching Tips  Discussion Topics  Critical Thinking Questions  Class Activities  Points to Emphasize  Knowledge Application©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 15 IV. Kinetics of Impact A. Can provide insight into the events that produce injury (the mechanism of injury) B. The manner in which energy exchange damages human tissue is known as biomechanics of trauma C. Index of suspicion: anticipation of the nature and severity of likely injuries Teaching Tips Using small toy cars, begin the explanation of the laws of motion. Discussion Topics Discuss the engineering advances that change the outcomes of blunt trauma (e.g., seat belts, air bags, etc.) Class Activities Have students practice the formulas of kinetic energy, changing acceleration and deceleration speeds; once this is done, have them begin to discuss the possible injuries that may be sustained in highversus low-velocity situations. 30 V. Biomechanics of Trauma A. Biomechanics of trauma is an investigation of the injury process 1. Examines kinetic energy forces as they progress from body’s external surface to internal organs 2. Bound by laws of inertia, force, and energy conservation 3. Divided into blunt and penetrating trauma 4. Penetrating—object physically enters body and directly or indirectly injures tissue 5. Blunt trauma—kinetic energy forces; object does not enter body and damage tissue 6. As kinetic energy and rate of velocity change, blunt impact causes injury (may be that person in motion contacts stationary object or stationary person is struck by something in motion) 7. Blunt trauma involves continuous series of collisions—compressing, stretching, shearing forces a. Compression injury—blunt trauma abruptly halts a portion of the body while inertia causes remaining anatomy to continue its motion b. Stretch—protein fibers that hold tissues together are pulled and Teaching Tips Using balloons filled with water, show students the attachment point versus the weight of organ. Use a cantaloupe to illustrate the laws of kinetic energy by dropping it on the ground to observe the damage. You can do this from various heights. This makes a mess, so do it in an area that can be cleaned easily. Discussion Topics Discuss the most common organs that shear or tear from their point of attachment. If possible, obtain a steering wheel from the local auto junk lot. Have students attempt to©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes injured or torn; occurs as one part of body is pulled away from another c. Shear—occurs along edges of impacting force or at organ attachments; attaching ligaments resist motion and tears B. The laws of physics play a significant role in the pathophysiology of both blunt and penetrating injuries. 1. Solid organs are at greater risk of injury following blunt trauma than hollow organs C. Assessment of the mechanism of injury can provide important information regarding the likelihood of patient injuries 1. The Centers for Disease Control and Prevention has identified several mechanisms of injury as good predictors of the need for trauma center care bend it, then reiterate the amount of energy that is required to bend the steering wheel. Critical Thinking Questions Why would identifying the index of suspicion provide better patient care? 85 VI. Blunt Trauma A. Blunt trauma most can result from motor vehicle collisions involving automobiles, motorcycles, bicycles, pedestrians, or off-road vehicles. It can also result from falls, explosions, crush injuries, and sports injuries. B. Looking at the different blunt trauma types allows for understanding of MOI and effects on human body (indexes of suspicion) C. Vehicular Collisions 1. Large portion of paramedic responses 2. Rapid assessment and appropriate care must be performed 3. Recognition of types of vehicular impacts, possible mechanisms of injury, and index of suspicion allows for excellent patient care in a situation of time constriction D. Events of Impact 1. Vehicle collision—begins when vehicle strikes object a. Vehicle kinetic energy causes damage as it converts to mechanical/heat energy and vehicle stops b. Forces developed depend on initial velocity and stopping distance (rate of deceleration) c. Degree of auto deformity is indicator of strength and direction of forces experienced 2. Body collision—occurs when occupant strikes vehicle interior a. Unrestrained occupant remains at or close to initial speed Knowledge Application For an assignment, have students define each key term. Class Activities Have students review the coup contracoup injuries commonly seen in deceleration/acceleration collisions and identify signs and symptoms. As a demonstration, drop a cantaloupe to determine the damage. Place a bicycle helmet on another cantaloupe and then drop it. You should be able to observe that without safety equipment, more damage occurs. Teaching Tips Using several pictures of skeletons, mark the likely fractures students will see with the different types of falls, and the pathway the energy takes.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes b. Kinetic energy is transformed into initial tissue deformity c. Restraints decrease occupant’s rate of deceleration, impact force strength, and seriousness of expected injuries 3. Organ collision—tissues behind contacting surface of occupant’s body collide, one into another, as body comes to a halt a. Causes compression, stretching, shearing as tissues and organs violently press into each other b. Organs may twist or tear at point of attachment or at blood vessel 4. Secondary collision—occurs when occupant is impacted by objects traveling within the auto a. Always consider possibility of secondary collisions 5. Additional impacts—occurs when vehicle receives a second impact a. Vehicle hit by another vehicle, deflected b. May induce additional injuries or increase seriousness of present injuries 6. Restraints a. Seat belts, air bags, child safety seats b. Have a profound effect on injuries; significantly reduce collisionrelated deaths c. Consider the use of restraints when assessing the scene d. Paramedic should always use restraints when driving ambulance 7. Seat Belts a. Prevents wearer’s continuous and independent movement during a vehicle collision b. Allows occupant to slow with auto, reducing deceleration rate and lessening likelihood of serious injury (including ejection) c. Shoulder and lap belts must be worn properly to be effective, and they must be worn together; improper use may cause injury Does not protect against intrusion; rapid deceleration may cause injury even with lap and shoulder belt 8. Supplemental Restraint Systems (SRSs) a. Air bags b. Effective for frontal collisions c. Explosive inflation upon auto impact, providing a cushion to absorb energy Use pictures of various motor vehicle collisions and go over the expected injuries with each impact. Using pictures, show students expected injuries when lap and shoulder belts are worn incorrectly. Obtain crash test dummy safety videos to watch. Discussion Topics Discuss how people who fall < 15 feet tend to land in the position in which they originally fell, whereas people who fall > 15 feet are generally able to turn themselves to land on their feet. Discuss the likelihood of head and spine trauma in motorcycle riders, even with helmets worn. Discuss different distractions that can occur that may cause motor vehicle collisions, and ways that they could be prevented. Discuss the dangers of ATVs, due to young riders and lack of experience. Discuss the expected injuries when dealing with a jet ski. Discuss the expected ―crumple zones‖ of an automobile, and how these zones are©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes d. Ignition depends on detectors that sense very strong frontal deceleration e. Ignition is instantaneous; reduces vehicular trauma and death f. Positioned in steering wheel, with SRS insignia, dash for passengers, sides of car, and so on g. May induce injury to hands, face, arms due to rapid inflation; residue from SRS may cause irritation of eyes h. Children and infants at risk for serious injury; children under the age of 12 should ride in the back seat i. Paramedic should always check under the airbag to determine if any structural damage has occurred j. Fire, rescue, and extrication personnel should be trained in SRS deactivation and should deactivate any undeployed devices at the crash scene. 9. Child Safety Seats a. Anatomy of child makes vehicle collision protection difficult b. Infants and very small children (up to two years of age) should be placed in rear seating area, facing backward, and latched firmly c. Infants and small children should be placed in appropriate child safety seats d. Children held on an adult’s lap are not protected during a collision; child becomes an unrestrained moving object 10. Head Rests a. Designed to prevent unopposed rearward motion of head during rear-end collision b. If there is no headrest, or headrest is pushed down, head will fling back in relation to torso c. Properly aligned head rest will cause the head to move with the rest of the body, preventing violent backward rotation and extension; this reduces injury to spinal column, neck ligaments, and neck muscles d. Check head rest whenever evaluating a rear-end collision 11. Passenger Compartment Intrusion a. Occurs when collision forces push through the vehicle’s structure and deforms occupant compartment created to absorb the energy and will appear as destruction to the automobile. Discuss the risks of intoxicated driving. Class Activities Using toy cars (plastic, can usually be purchased at garage sales, thrift stores, etc.), create an impact—you will need several cars. Have students discuss the injuries, then add SRS and seat belts to identify what injuries might be prevented (you can even add dolls—Barbie dolls work well—to shade in expected injuries). Points to Emphasize Any intrusion into occupant compartment suggests stronger forces and failure of crumple zones, allowing for greater injury. The more rapid the deceleration (shorter stopping distance), the greater the force and resulting injury for any trauma.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes b. Suggests increased kinetic forces and likelihood of injuries c. Lateral impact intrusion is frequent, due to associated crumple zone limitations, and associated with high occupant mortality rate E. Types of Impacts 1. Frontal impact—most common type of impact; four pathways of patient travel a. Restrained pathway: use of lap and shoulder belts retrains movement and allows deceleration with vehicle, limiting interior impact and energy b. Up-and-over pathway: unrestrained occupant tenses legs, preparing for collision; upper body pivots forward and upward; femurs, abdominal cavity, and lower chest impinged with steering wheel; head propelled toward windshield, resulting in compression on cervical spine (axial loading); large number of deaths attributed to up-and-over pathway c. Up-and-over pathway injuries: bilateral femur fractures, holloworgan rupture, liver laceration, diaphragmatic rupture, thoracic injuries, soft-tissue injuries, skull or facial fractures, internal head injuries, vertebral fractures d. Down-and-under pathway: unrestrained occupant slides downward, with knees contacting firewall; upper body rotates, crashing against wheel or dash e. Down-and-under pathway injuries: knee, femur, and hip dislocations or fractures; flail chest; cardiac injury; aortic tears; tracheal and vascular injuries; ―paper bag‖ syndrome (occupant takes deep breath as impact is imminent, impact with steering wheel causes lungs to rupture); pneumothorax; pulmonary contusions f. Ejection: up-and-over pathway may lead to ejection; two impacts occur, contact with interior of vehicle and impact with outside environment (ground, tree, etc.), most commonly associated with frontal impacts g. Vehicle design has created the ―crumple zone‖ with realization that frontal impacts more common—this allows front of vehicle to absorb impact energy, resulting in structural damage to vehicle and©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes reduced force to occupants h. Air bags and seat belts also aid in reducing injuries 2. Lateral impact—occupants present in different position to collision forces, and limited amount of space available to absorb energy a. Greater likelihood of vehicle intrusion into occupant space, resulting in injuries b. Index of suspicion is higher in lateral impact due to kinetic forces c. Lateral injuries: clavicle, humerus, pelvis, and femur fractures on impact side; lateral rib fractures; cervical spine injury; lateral compressions may cause diaphragmatic rupture, pulmonary contusions, splenic injury (driver), liver injury (passenger), aortic injury, aortic tearing d. Unrestrained passengers may become objects that can strike other passengers 3. Oblique impact—struck at angle; four subcategories include left front, right front, side, or rear a. Index of suspicion blends lateral, front-end, and rear-end injuries b. If impact not directed at vehicle’s center of mass, impact will induce rotation, which will accelerate or decelerate from auto’s center, allowing deflection rather than abrupt stopping (rotation more common with oblique impact) c. Oblique impact injuries: any injuries can occur, although may be less serious than vehicle damage suggests 4. Rear-end impact—collision force pushes auto forward a. Seat propels occupant forward, neck extends and neck muscles and ligaments stretch while head rotates backward b. Once acceleration stops, head snaps forward and neck flexes c. Rear-end impact injuries: rapid hyperextension and hyperflexion can result in severe connective tissue and cervical vertebra injuries; other injuries may be present, but rear-end impacts tend to result in limited injuries 5. Rollover—normally caused by change in elevation and/or affecting a vehicle with high center of gravity a. As vehicle rolls, impacts ground at various points, while occupant impacts with each vehicle impact©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes b. Rollover injuries: ejection; head, limb, or torso trapped between vehicle and ground c. Mortality increases significantly when ejection is associated with a vehicle collision d. Seat belts are very effective in reducing ejection and injury during a rollover 6. Vehicle Collision Analysis a. Collisions often produce hazards to occupants, bystanders, and care providers b. Hazards include: hot engine, exhaust and transmission parts, hot fluids (radiator coolant, oil), battery acid, transmission and steering fluids, jagged metal edges, broken glass, slippery surfaces from gasoline or oil, along with fire danger, traffic moving near crash, downed electrical lines, and terrain of scene. Hybrid vehicles pose two additional hazards: First, high-voltage electrical propulsion system components, although well protected, can cause electrocution. Second, the electrical propulsion system in a hybrid vehicle can engage even when the engine does not seem to be running and cause unexpected movement of the vehicle; this danger can be eliminated by removing the ignition key or moving a proximity-ignition fob more than 16 feet from the steering column. c. Rule out all scene dangers before entering d. Collision evaluation includes: direction of impact, amount of vehicle damage, recognition of crumple zones, size of vehicles, deceleration or acceleration forces, striking objects e. Interior vehicle collision evaluation includes: vehicle intrusion into occupant compartment, spider-webbed windshield; deformed steering wheel; dented dash; deformities of gas, brake, or clutch pedals; deployed air bag; firewall or dashboard in occupant compartment; parts of vehicle may be imbedded in occupant, complicating extrication; assess use of restraints and headrest position 7. Impairment a. Consider possibility of alcohol or drug intoxication b. Assessment must be more diligent for use with suspected©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes intoxication, due to reduced reaction time, alertness, and masking of signs and symptoms of injury—patient may be anesthetized from trauma pain c. Look at all evidence surrounding collision for signs of driver trying to stop or avoid collision, possibility of distraction or medical condition causes 8. Vehicular Mortality a. Certain areas of anatomy prone to life-threatening injury b. Blunt trauma to head and body cavity accounts for 85% of vehicular mortality c. Assessment is focused on ABCs, rapid assessment of head, neck, thorax, abdomen, pelvis 9. Collision Evaluation a. Questions for collision evaluation include: how did objects collide; what direction and speed; similar sized or grossly different; secondary collisions present; anything contribute to collision; alcohol involved; any skid marks present? b. Questions for interior collision evaluation include: windshield damage, steering wheel deformed, dash dented, passenger compartment intrusion, seat belts worn, air bags deployed, head rest up? c. Answers to these questions will allow you to develop indices of suspicion F. Motorcycle collisions—lack the protection of vehicle structure; rider tends to absorb much of crash energy; injuries can be severe; high incidence of head injury 1. Frontal—bike front dips downward, propelling rider upward and forward; handlebars catch rider’s lower abdomen or pelvis, causing abdominal or pelvic injuries; rider may travel at higher speed, with handlebars trapping femurs, resulting in bilateral fractures and ejection 2. Angular—bike strikes object at oblique angle, with lower extremity trapped between object and bike, crushing foot, ankle, knee, and femurs; open wounds often result 3. Sliding—occurs when experienced rider faces imminent collision and ―lays the bike down‖; slides bike sideways into object, so bike hits object©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes first, absorbing most of energy; this reduces chances of ejection; increase in lacerations, abrasions, minor fractures 4. Ejection—common and usually results in serious injury; can occur with initial bike/object collision, rider/object collision, rider/ground impact 5. Likely ejection injuries include skull fractures, head injury, spinal fractures, paralysis, internal thoracic or abdominal injuries, extremity fractures 6. Protective equipment such as helmets, leather clothing, and boots help to reduce certain injuries G. Pedestrian collisions—often severely injured due to vehicle’s mass and speed and pedestrian’s lack of protection 1. Adult pedestrians: tend to turn away from oncoming vehicle, resulting in impact to lower leg, lateral upper body movement into hood, then possible ground impact 2. Adult pedestrian injuries include: lower leg, knee, and femur injuries; lateral chest and upper extremity fractures; head, neck, and shoulder trauma; injuries from secondary collision with ground 3. Pediatric pedestrians: tend to turn toward oncoming vehicle, resulting in impact to femur and pelvis, thrown into front of vehicle, then run over or pushed to side by vehicle; may be thrown onto hood 4. Pediatric pedestrian injuries include: femur fractures, thoracic and cardiac injuries, head and neck injuries 5. Look at the scene to determine speed at impact, distance pedestrian thrown H. Off-road collisions—increased incidence of related trauma, injuries similar to auto collision, but with no benefit of structural protection and restraint system 1. Response can be delayed due to difficulty in reaching and retrieving victims 2. Snowmobiles, watercrafts, and all-terrain vehicles (ATVs) are most often involved 3. Snowmobiles: collisions can be very violent due to speed and limited crumple zones; collisions usually result in ejection, crush injuries from rollover, and striking obstructions in snow 4. Snowmobile injuries include: severe head and neck injuries, neck lacerations, decapitation (running into unseen wire fence), cold©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes exposure, and hypothermia 5. Watercrafts: commonly result from impact with other boats, obstructions in water; not designed to absorb energy 6. Watercraft injuries include: head, neck, and spinal injuries; drowning; and hypothermia in colder water 7. ATV center of gravity high, contributing to rollover 8. ATV injuries include: head, neck, and spine injuries; upper and lower extremity fractures I. Falls 1. Most common form of blunt trauma, very infrequently result in lifethreatening injury 2. Very young and very old are most at risk 3. Falls are a release of stored gravitational energy 4. As height of fall increases, so do velocity and kinetic energy at impact 5. Stopping distance may be more important than fall height 6. Newton’s second law in falls: the more rapid the deceleration (the shorter the stopping distance), the greater the force and resulting injury 7. Landing surface also affects injury 8. Feet-first landing: energy transmitted up skeletal structure to calcaneus, tibia, femur, pelvis and lumbar spine; lumbar spine prone to compression injury 9. Fall forward after initial impact may result in wrist, shoulder, clavicle fractures 10. Fall backward after initial impact may result in pelvic, thoracic, and head injuries 11. Axial loading can result in crushed vertebra, as a result of shallow dives 12. Outstretched-arm falls result in hand, wrist, elbow, arm, and shoulder injuries 13. Greater than three times a person’s height constitutes a severe fall, and internal organs may be compressed, displaced, or twisted; exsanguination may occur if heart is torn away from aortic attachments 14. Evaluation of a fall includes: fall height, anatomical point of landing, force of impact, impact surface, transmission of energy along skeleton 15. Falls are common in elderly, due to decreased coordination, decreased eyesight, and weakened muscles and bones, with injuries sustained Teaching Topics Using pictures, describe the different categories of an explosion.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes from less energy J. Blast Injuries 1. Explosions can be caused by dust, fumes, explosive compounds—may be intentional or unintentional 2. Explosion a. Occurs when agent or environment combusts b. Fuel and oxidizing agent combine, chemical bonds broken and reestablished, releasing energy in form of rapidly moving molecules, known as heat c. Heat creates great pressure between exploding agent and surrounding air d. MOIs created include pressure wave, blast wind, projectiles, displacement of person, heat 3. Pressure Wave a. Superheating of surrounding air from combustible agent b. Compressed air pushes air further out from ignition point, creating a pressure wave c. This is a narrow compression wave that that moves rapidly outward (overpressure) d. Pressure of exploding cloud is extremely lethal and area can be extensive (confined space, underwater) e. Injuries include: body’s air-filled spaces subject to rapid and severe compression and decompression-—ear drum, middle ear, sinuses, bowel, lungs f. The greater the surface of the victim presented to the blast wave, the greater the impact and damage 4. Blast Wind a. Follows the pressure wave and travels just behind b. Outward movement of heated and expanding combustion gases from explosion epicenter c. Less strength but greater duration than pressure wave 5. Projectiles a. Container fragments become high-speed projectiles b. Ordnance: military explosion casing c. Flechette; arrow-shaped missiles Discussion Topics Discuss with students how they would proceed if the explosion was the result of a terrorist attack. Discuss the explosions that have occurred in your local area. Focus on incident command, treatment, and transport. Class Activities Have students list the injuries they expect to find in each blast-type injury and the care they would provide. Points to Emphasize Only personnel trained in confined-space rescue should enter this scene.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes d. Some explosions may contain nails, screws, ball bearings, other material that enhances range and potential for injury e. ―Dirty bomb‖ is a conventional explosive that distributes radioactive material f. If victim close to blast, debris may be forceful enough to tear off limbs or cause serious open wounds, impalement of bomb elements 6. Personnel Displacement a. Overpressure wave and blast wind may be strong enough to physically propel victim away from blast’s epicenter b. Victim becomes a projectile, then impacts the ground or other objects 7. Confined-Space Explosions and Structural Collapses a. Pressure wave maintains energy longer b. Danger of structural collapse, blast overpressure, and deadly overpressure c. Most lethal blasts are those that cause structural collapse, with confined-space blasts second d. Structural collapse causes severe crush injuries, makes victims difficult to find and difficult to extricate e. Hazards to rescuers increased by secondary collapse, fire, electrocution, and secondary explosions 8. Burns a. Flash burns may occur to those close to detonation, or as blast ignites combustible material (clothing, debris, etc.) b. Some devices designed to induce damage through combustion (Napalm) c. Some material spontaneously combusts when exposed to air (phosphorus) 9. Blast Injury Types a. Primary—caused by heat of explosion and overpressure wave; pressure injuries usually most serious and life threatening; generally damage air-filled body spaces b. Secondary—trauma caused by projectiles; may be as serious or more severe than primary blast injuries; generally multiple©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes penetrations, impalement, bleeding c. Tertiary—results from personnel displacement and structural collapse; crush injuries; soft tissue, skeletal system, nervous system, vascular tissue damage d. Quarternary—any other injuries caused by the explosion mechanism including crush injuries, burns, asphyxia, toxic exposures, and exacerbations of preexisting or chronic illnesses. 10. Blast Injury Assessment a. Attempt to determine if result of terrorist attack (due to suspicion of other exploding devices) b. Assess scene; request trained assistance; look for gas leaks, electrical wiring, debris, structural collapse c. Attempt to determine blast epicenter by noticing greater damage and injury d. Victims close to epicenter sustain extreme injury e. ABCs, and normal assessment priorities normally will be the role of a paramedic f. Most common life-threatening trauma is lung injury; anticipate with any patient involved; evaluate breathing, breath sounds, oxygen saturation (note: suspect lung injury in anyone with hearing loss or epistaxis) 11. Blast Injury Care a. Lungs i. Pulmonary blast trauma most frequent life-threatening pressure injury ii. Pressure wave rapidly and forcefully compresses, distorts, and then decompresses chest cavity, air passages, and alveoli iii. Extreme pressure damages/ruptures thin alveoli, resulting in inflammation, fluid accumulation, hemorrhage, air entry into bloodstream iv. Signs and symptoms include: pulmonary edema, difficulty breathing, hemoptysis, frothy sputum, reduced level of consciousness (LOC), history of detonation exposure v. Treatment includes: use extreme caution if using bag-valve©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes mask (BVM) with these patients, as positive pressure ventilation may cause small air bubbles to be pushed into vascular system and create emboli; if using BVM, only use enough pressure to create moderate chest rise and fall and adequate respiratory volume, along with high-concentration oxygen (O2) as supplied with reservoir b. Abdomen i. May damage air-filled bowel, resulting in hemorrhage and possible wall rupture and release of bowel contents into abdominal cavity (peritonitis) ii. Be alert to signs of developing shock; provide rapid transport and fluid resuscitation c. Ears i. Suffer greatly from blast wave forces ii. Eustachian tube cannot equalize pressure changes, causing stretching/rupture to tympanic membrane, and resulting in hearing loss iii. Treatment includes: support to victim and ensure that ear canal remains uncontaminated d. Penetrating Wounds i. Care is same as with any penetrating wound; remove any contaminated material if possible, cover with sterile dressing, stabilize any impaled objects e. Burns i. ABCs, stop burning process K. Sports Injuries 1. Most commonly produced by extreme exertion, fatigue, direct trauma forces 2. Secondary to acceleration, deceleration, compression, rotation, hyperextension, hyperflexion 3. Results in soft tissue damage, connective tissue injury to tendons and ligaments, skeletal trauma, and internal damage to hollow or solid organs 4. If debilitating injury occurs, transport for evaluation must occur before athlete can further participate in sport Discussion Topics Discuss steps that can be taken to prevent sports injuries. Discuss the pathophysiology of crush injuries and compartment syndrome, as well as the causes and treatments. Critical Thinking Questions What sports equipment can cause injuries? Class Activities Have students review the concussion checklist.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5. Some contact sports can create severe head impacts; any period of unconsciousness, neurological deficit, lowered orientation requires physician evaluation 6. Protective equipment reduces chance for significant injury, but can be a contributing factor 7. Removal of helmet is indicated if airway cannot be controlled and helmet is hindering care; otherwise, immobilize with helmet on L. Crush Injuries 1. Common type of trauma that can result from structural collapse, limb caught in machinery, and other mechanisms 2. Great force to soft tissue and bones, compressing surfaces and causing severe tissue disruption and hemorrhage 3. If crushing pressure remains in place for extended period, blood flow disrupted, anaerobic metabolism begins, and tissue death follows; if blood flow returned to limb, toxins carried back to central circulation, causing cardiac arrhythmias or damage to kidneys; may also cause severe hemorrhage once limb is released 4. Treatment may include: sodium bicarbonate, other medications to combat acidosis, limit damage, and preserve kidney function M. Compartment Syndrome 1. Blunt trauma associated with crush injuries 2. Swelling to a large muscle mass may be faster than fascial (connective) tissue can accommodate 3. Pressure increases and blood flow is reduced; after 3 to 4 hours, muscle stiffens and becomes painful 4. It is unlikely that compartment syndrome will be recognized in the field. 5. Frequent cause of post-blunt trauma disability; patient will complain of muscle pain long after injury is healed Points to Emphasize When responding to a sports emergency, look at the sports equipment used. If there is damage to the equipment, greater force is implied. 15 VII. Penetrating Trauma A. Perforating trauma, a form of penetrating trauma, occurs when an object enters and exits the body B. Overview and Incidence 1. The most common causes of penetrating trauma in the United States are gunshots and stabbings. 2. Penetrating trauma can also occur with motor vehicle collisions, falls, Knowledge Application For an assignment, have students define each key term.©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes industrial injuries, and similar events. 3. Three levels of penetrating trauma—low, medium, high a. Low velocity: bladed and pointed objects such as knives, swords, ice picks, arrows, ski poles, wire, nails, reinforcing rods; injuries usually limited to tissue actually contacted by object b. Medium velocity: handgun bullets; injuries usually more severe due to extensive injury pathways c. High-velocity: rifle bullets; injuries usually more severe due to extensive injury pathways 30 VIII. Kinetics of Penetrating Trauma A. When projectile hits a target, exchanges kinetic energy (energy of motion) with object struck B. Formula: Kinetic Energy = [mass (weight) × velocity (speed)2] / 2 C. The greater the mass or speed of an object, the greater the kinetic energy D. Mass to energy is direct, whereas velocity to energy is squared E. As speed increases, so does kinetic energy F. Mass and velocity relationship explains why different weights of bullets traveling at different velocities can cause different degrees of damage G. Medium velocity: handguns, shotguns, low-powered rifles (.22) H. High velocity: hunting and assault rifles I. Law of conservation of energy explains why projectile’s kinetic energy is transformed into damage as it slows—kinetic energy lost by bullet as it passes through tissue is transferred into tissue displacement, and converted to tissue damage J. Deceleration rate—force formula: Force = mass × acceleration (deceleration) K. The more quickly an object slows, the more rapidly it gives up kinetic energy L. Ballistics: study of projectiles in motion and their effects on objects they impact M. Trajectory, Drag, and Cavitation 1. Trajectory: curved path that a bullet follows after it is fired; pulled down by gravity; the faster the bullet and the farther it travels, the less gravity is able to change path—trajectory is straighter; close range = flat trajectory; longer distance = more trajectory curve Teaching Tips Review the Patho Pearls feature in the main text that discusses the bullet’s travel. This is very good information for students to understand the injuries caused by bullets. Use pictures to show the different velocities of penetrating trauma, and the damage that can occur with each. Draw the pressure wave, cavity, and anatomy affected for GSWs. Discussion Topics Discuss the different factors that can increase or decrease a bullet’s energy exchange rate. Critical Thinking Questions Are the military and police departments allowed to use bullets that defragment? Is this ethical? Why is a secondary impact dangerous to©2017 Pearson Education, Inc. Paramedic Care: Principles & Practice, Volume 4, 5th Ed. Chapter 2 objectives can be found in on text pp. 17-18. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 2. Drag: wind resistance bullet experiences in traveling through air; the faster the travel, the greater the drag and the greater the slowing effect; close range = greater damage due to minimal to no drag; longer distance = slowed by drag 3. Cavitation: semifluid body tissue set in motion, creating a shock wave and a temporary cavity; extent is determined by bullet’s velocity and rate of energy exchange related to size of projectile’s contracting surface, which is determine