When you think of trauma think of blunt force. Trauma tends to come on all at once and be quite serious. Someone who experiences trauma will have either a traumatic injury or traumatic distress. Try not to use this term lightly. If you say that having to wait twenty minutes for a burger was a trauma, people will rightly accuse you of drama.
Trauma is defined as a physical injury or wound caused by an external force of violence, which may cause death or permanent disability. The word is also used to describe severe emotional or psychological shock or distress.
Most of us recognize a traumatic injury or a person in distress when we see one, and we are able to call for immediate medical assistance. But, what about those injuries and illnesses we are not sure qualify as traumas or emergencies? It is important to learn and recognize when immediate medical care is necessary and when the condition can be managed ourselves.
Being prepared and knowing how to react ahead of time could prevent a situation from becoming an emergency. And, learning how to respond to conditions and illnesses properly could make the difference between a potentially fatal outcome and a treatable, manageable situation.
Injured patients need treatment at the hospital best staffed and equipped to meet their special needs. Maryland’s system of care ensures that patients promptly get to the most appropriate hospital in an effort to decrease morbidity and mortality.
The trauma centers within the Maryland EMS System are:
Primary Adult Resource Center
Pediatric Trauma Centers
Pediatric Trauma Center/The Johns Hopkins Children’s Center, Baltimore City
Pediatric Trauma Center/Children’s National Medical Center, Washington, DC
Level I Trauma Center
The Johns Hopkins Hospital Adult Trauma Center, Baltimore City
Level II Trauma Centers
Level III Trauma Centers
What is a soft tissue injury?
Soft tissue injuries (STI) are when trauma or overuse occurs to muscles, tendons or ligaments. Most soft tissue injuries are the result of a sudden unexpected or uncontrolled movement like stepping awkwardly off a curb and rolling over your ankle. These are injures we see every day at our Edinburgh physiotherapy and sports injury clinics. However, soft tissue damage can also occur from excessive overuse or chronically fatigued structures, especially muscles and tendons. For example, if you were to do a long run when already fatigued (from a previous run or exercise), then it is possible to cause trauma or a strain to key running musculoskeletal structures like your calf muscles or achilles tendons, also see: “How to prevent running injuries”.
What is the difference between a strain and a sprain?
Tendons are fibrous bands that attach muscles to bone. Trauma to muscles or tendons due to overstretching is referred to as a ‘strain’. Ligaments are also fibrous bands that hold bones together. Trauma by over-stretching of ligaments is referred to as a ‘sprain’. Strains and sprains are both very common, and can occur from accidents during sport, at home or at work.
There are three levels or grades of severity:
Grade 1 strain or sprain (mild)
- Minimal over-stetching. Possible minor microscopic tearing of fibres
- Mild tenderness and minimal swelling
Grade 2 strain or sprain (moderate)
- Partial tear of fibres
- Moderate pain, tenderness and swelling
- Unable to apply loading to injured area without pain
Grade 3 strain or sprain (severe)
- Complete rupture of structure
- Significant pain and swelling
- Inability to use the injured structure
- Instability of the affected joint
What are the symptoms of soft tissue injuries?
When soft tissue is damaged, there is usually immediate pain along with immediate or delayed swelling (excessive swelling can slow the healing process – see treatment below). Stiffness is also very common as a result of the trauma and swelling. Bruising may also develop after 24-48 hours.
In the case of moderate to severe soft tissue injuries of muscles, tendons and ligaments around a joint, there may be instability experienced, especially to weight-bearing joints like the hip, knee and ankle.
The Relationship Between Contusions and Concussions
Because both contusions and concussions are a type of traumatic brain injury (TBI), and because both are often the result of a fall or blow to the head, it’s easy to confuse the two. Even more confusing is the fact that you can have both at the same time. A contusion does not mean you have a concussion, but some contusions are due to head trauma so severe that the damage affects a larger portion of your brain. Likewise, a concussion does not necessarily indicate a contusion, since shaking and other brain injuries can produce the brain damage a concussion causes.
The difference between the two ultimately comes down to a simple distinction:
- A contusion is a localized injury, comparable to the bruises you get when you hit your shin. And just like other bruises, contusions range from relatively minor to life-threatening. Because the blood must clot to stop the bleeding a bruise results from, contusions also increase cardiovascular risks.
- A concussion is a wider-reaching injury due to broad scale brain trauma. It’s analogous to a sprain or broken bone in that it is not microscopic and affects more regions of the brain.
Coup and Countrecoup
Coup-Contrecoup Injury– damage to the brain on both sides: the side that received the initial impact (coup) or blow and the side opposite the initial impact (countrecoup). This occurs when the force of the initial blow is great enough to cause brain damage at the site of initial impact between the skull and brain and is also great enough to cause the brain to move in the opposite direction and hit the opposite side of the skull, causing damage at that site.
Direct and Indirect Brain Injuries
Any force that penetrates or fractures the skull may cause severe brain injury as destructive shock waves are sent through the brain matter. Displaced fractures of the skull can also push bone into the brain, causing tissue damage.
Direct trauma to the brain can occur when the skull strikes, for example, the floor in a fall accident or strikes a steering wheel in a car accident. Although the skull may not be penetrated or fractured in these types of accidents, the forces imparted to the brain can cause the brain to collide against the inside of the hard skull. When a moving head comes to a quick stop, the brain continues in its movement, striking the interior of the skull. This can cause bruising of the brain (a contusion) and bleeding (hemorrhage). Injury in these types of accidents occurs in parts of the brain closest to the point of impact, quite often the tips of the frontal and temporal lobes. In cases of blunt head trauma the brain can also be injured directly opposite the site of trauma — on the other side of the brain, an injury known as contrecoup. This injury typically occurs when a moving head strikes a stationary object like the windshield. At impact the brain opposite the site of impact is pulled away from the skull, injuring the brain there.
Medical research has discovered another mechanism of brain injury besides direct blunt trauma to the skull. The well-known phenomenon of the Shaken Baby Syndrome is an example. Severe shaking greatly stretches and damages delicate nerve cells, at times causing very significant injury or even death. In adults, severe whiplash can involve severe forces that may shake or rotate the brain enough to cause permanent brain damage.
What is a hematoma?
A hematoma is an abnormal collection of blood outside of a blood vessel. It occurs because the wall of a blood vessel wall, artery, vein, or capillary, has been damaged and blood has leaked into tissues where it does not belong. The hematoma may be tiny, with just a dot of blood, or it can be large and cause significant swelling.
The blood vessels in the body are under constant repair. Minor injuries occur routinely and the body is usually able to repair the damaged vessel wall by activating the blood clotting cascade and forming fibrin patches. Sometimes the repair fails if the damage is extensive and the large defect allows for continued bleeding. If there is great pressure within the blood vessel, for example, a major artery, the blood will continue to leak through the damaged wall and the hematoma will expand.
What causes a hematoma?
Trauma is the most common cause of a hematoma. When people think of trauma, they generally think of car accidents, falls, head injuries, broken bones, and gunshot wounds. Trauma to tissue also may be caused by an aggressive sneeze or an unexpected twist of an arm or leg. When a blood vessel is damaged, blood leaks into the surrounding tissue; this blood tends to coagulate or clot. The greater the amount of bleeding that occurs, the larger the amount of clot (hematoma) formation.
Open Head Injury Signs and Symptoms
(1) Consideration of mechanism of injury
(a) Deformity of windshield
(b) Deformity of helmet
(2) Contusions, lacerations, hematomas to the scalp
(3) Deformity to the skull
(4) Penetrating injury: do not remove impaled objects in the skull
(5) Soft area or depression upon palpation
(6) Exposed brain tissue
(7) Bleeding from the open bone injury
(8) Blood or fluid (cerebrospinal fluid) leakage from the ears and nose
(9) Bruising (discoloration) around the eyes
(10) Bruising (discoloration) behind the ears (mastoid process)
(11) Nausea and/or vomiting
(12) Possible signs and symptoms of a closed head injury may exist if brain injury has occurred.
Emergency medical care of an open chest wound
- Occlusive dressing to open wound
- Administer oxygen if not already done
- Position of comfort if no spinal injury suspected
Emergency medical care for an open abdominal injury
- Do not touch or try to replace the exposed organ.
- Cover exposed organs and wound with a sterile dressing, moistened with sterilewater or saline, and secure in place.
- Flex the patient’s hips and knees, if uninjured.
Emergency medical care of amputations
- Wrap the amputated part in a sterile dressing.
- Wrap or bag the amputated part in plastic and keep cool.
- Transport the amputated part with the patient.
- Do not complete partial amputations, immobilize to prevent further injury.
Emergency Medical Care of Burns
- Stop the burning process, initially with water or saline.
- Remove smoldering clothing and jewelry.
- Use body substance isolation.
- Continually monitor the airway for evidence of closure.
- Prevent further contamination.
- Cover the burned area with a dry sterile dressing.
- Do not use any type of ointment, lotion or antiseptic.
- Do not break blisters.
- Know local protocols for transport to appropriate local facility.
Treatment of Injuries to Bones and Joints
- Body substance isolation
- Administer oxygen if indicated.
- After life threats have been controlled, splint injuries in preparation for transport.
- Application of cold pack to area of painful, swollen, deformed extremity to reduce swelling.
- Elevate the extremity.
General Rules of Splinting
- Assess pulse, movement, and sensation distal to the injury prior to and following splint application and record.
- Immobilize the joint above and below the injury.
- Remove or cut away clothing.
- Cover open wounds with a sterile dressing.
- Align with gentle traction before splinting if there is a severe deformity or the distal extremity is cyanotic or lacks pulses.
- Do not intentionally replace the protruding bones.
- Pad each splint to prevent pressure and discomfort to the patient.
- Splint the patient before moving.
- When in doubt, splint the injury.
- If patient has signs of shock (hypoperfusion), align in normal anatomical position and transport.