Description

Blunt Abdominal Trauma (BAT) represents 75% of all blunt traumas and is the most common example of this injury. 75% of BAT occurs in motor vehicle crashes, in which rapid deceleration may propel the driver into the steering wheel, dashboard, or seatbelt, causing contusions in less severe cases or rupture of internal organs from briefly increased intraluminal pressure in the more severe cases, depending on the force applied. Assessment is more difficult and necessitates a high level of clinical suspicion because there may initially be few clues that a serious internal abdominal injury has occurred. There are two fundamental physical mechanisms at work with the possibility of injury to intra-abdominal organs: Compression and deceleration: The first is caused by a direct blow like a punch or by being compressed against something that won't give way, like a seat belt or steering column. A hollow organ may be deformed by this force, leading to an increase in intraluminal or internal pressure and possibly rupture.

Blunt Thoracic Trauma or Blunt Chest Injury

On the other hand, deceleration causes stretching and shearing at the anchor points for mobile abdominal contents like the bowel. The mesentery of the bowel may tear as a result, and the blood vessels that travel within the mesentery may be damaged. Exemplary instances of these components are a hepatic tear along the ligamentum teres and wounds to the renal supply routes. The liver and spleen (see blunt splenic trauma) are typically involved in cases of internal injury, followed by the small intestine. In rare instances, this injury has been attributed to medical procedures such as the Heimlich maneuver, manual thrusts to clear an airway and attempts at CPR. Although these are uncommon instances, it has been hypothesized that performing these life-saving techniques with excessive pressure results in them. Finally, it has been reported that individuals recovering from infectious mononucleosis, or mono experience splenic rupture as a result of mild blunt abdominal trauma. Blunt abdominal trauma in sports the supervised environment in which the majority of sports injuries occur permits minor deviations from traditional trauma treatment algorithms like ATLS due to the greater precision in identifying the mechanism of injury. When evaluating sports injuries caused by blunt trauma, it is most important to distinguish between contusions and musculo-tendinous injuries and injuries to solid organs and the gut. Additionally, it is important to recognize the potential for blood loss and respond accordingly. American football, association football, martial arts, and all-terrain vehicle crashes have all been associated with blunt kidney injuries. Blunt thoracic trauma, or blunt chest injury, as it is more commonly known, refers to a wide range of chest injuries. In general, this also includes damage from direct blunt force (like a fist or a bat in an assault) acceleration or deceleration (like in a rear-end car crash), shear force (a combination of acceleration and deceleration), compression (like a heavy object falling on a person) and blasts. Simple signs and symptoms like bruising are common, but more complex ones like hypoxia, a mismatch between ventilation and perfusion, hypovolemia and reduced cardiac output may also occur depending on how the thoracic organs were affected.

Significant Cause of Morbidity and Mortality

Blunt thoracic trauma isn't always obvious from the outside and such internal injuries may not show signs or symptoms right away or even for hours after the trauma. A CT scan may be helpful in situations where a high level of clinical suspicion is required to identify such injuries. A Focused Assessment with Sonography for Trauma (FAST), which can reliably detect a significant amount of blood around the heart or in the lung by using a special machine that visualizes sound waves sent through the body, will likely be performed on those who experience more obvious complications from a blunt chest injury. Tension pneumothorax, open pneumothorax, hemothorax, flail chest, cardiac tamponade and airway obstruction/rupture are the most immediate life-threatening injuries that may occur. The injuries may necessitate a procedure, most commonly the insertion of an intercostal drain or chest tube. Although only 10%-15% of thoracic traumas require surgery, they can have serious effects on the heart, lungs, and great vessels. Blunt cranial trauma the primary clinical concern with blunt trauma to the head is damage to the brain, although other structures such as the skull, face, orbits and neck are also at risk. Following assessment of the patient's airway, circulation, and breathing, a cervical collar may be placed if there is suspicion of trauma to the neck. This is because it helps restore a certain balance in pressures that are impeding the lungs' ability to inflate and thus exchange vital gases that allow the secondary survey for evidence of cranial trauma, such as bruises, contusions, lacerations, and abrasions, continues the evaluation of blunt head trauma. A comprehensive neurologic examination is typically carried out to check for brain damage in addition to noting any external injuries. A CT scan of the skull and brain may be ordered depending on the examination and injury mechanism. 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. This is typically done to check for blood within the skull or a fracture of the skull bones. In patients under the age of 25, it is the leading cause of death. There is a significant correlation between the severity of the initial insult as well as the level of neurologic function during the initial assessment and the level of lasting neurologic deficits. Initial treatment may be targeted at reducing the intracranial pressure if there is concern for swelling or bleeding within this skull, which may require surgery such as a hemicraniectomy, in which part of the skull is removed. Blunt trauma to extremities Injury to extremities (like arms, legs, hands machine or tool use is the most common cause of injuries to the upper extremities alone. The injured extremity is examined for four major functional components, which are soft tissues, nerves, vessels, and bones. Vessels are examined for expanding hematoma, bruit, distal pulse exam, and signs/symptoms of ischemia, essentially asking, does blood seem to be getting through the injured area in a way that enough is getting to the parts past the injury.