Blunt trauma
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Blunt injury; non-penetrating trauma; blunt force trauma.
Overview
In medical terminology, blunt trauma refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack; the latter usually being referred to as blunt force trauma. The term itself is used to refer to the precursory trauma, from which there is further development of more specific types of trauma, such as contusions, abrasions, lacerations, and/or bone fracturing.
Variations
Abdominal Trauma (BAT)
Blunt abdominal trauma is often referred to as the most common type of trauma, representing around 50 to 75 percent of blunt trauma. The majority of BAT is often attributed to car-to-car collisions, in which rapid deceleration often propels the driver forwards into the steering wheel or dashboard, causing contusions in less serious cases or rupturing of internal organs due to briefly increased intraluminal pressure in more serious cases where speed or forward force is greater.[2]
Abdominal trauma caused by deceleration and impact shows a similar effect to trauma to any other part of the body; namely the rupturing or damage of free and relatively fixed objects, a classic example of such an injury would be a hepatic tear along the ligamentum teres followed with injuries to the renal arteries.
As with most trauma, blunt abdominal trauma is often the case of further injury, depending upon the severity of the accident. In the majority of cases, the liver and spleen (see Blunt splenic trauma) are most severely affected, followed by damage to the small intestine. Recent studies utilizing CT scanning have suggested that hepatic and other concomitant injuries may develop from blunt abdominal trauma.[3]
In rare cases, BAT has been attributed to several medical techniques such as the heimlich maneuver, attempts at cardiopulmonary resuscitation, and manual thrusts to a clear an airway. Although these are rare causes of blunt abdominal trauma, it is often thought that they are caused by applying unnecessary pressure when administering such techniques.[4]
Diagnosis
Although blunt trauma is a condition in itself, the main emphasis on the diagnosis of blunt trauma is to ascertain the cause of the accident, any further injury and its correlation with the medical, dietary, and physiological history of the patient gathered from various sources, such as family and friends, or previous physicians, in order to establish the most swift path to recovery. This method is given the mnemonic "SITEMAP"; [5]
- Social history and/or evidence of substance abuse
- Immunization history
- Time of last meal or sign of nutrient intake
- Events leading to the accident or incident
- Medication status, history
- Allergies
- Past surgical and medical treatment history
Usually, in the case of examination, areas such as the head or those linked with the respiratory system have a higher priority, and are examined before the abdomen, so as to administer, if necessary, medical treatments which will immediately limit the amount of progressive damage which could be caused from such injuries. The amount of time spent on diagnosing abdominal injury should be minimal, and expedited by using relatively quick methods of determining the extent of such injury, such as by identifying free intra-abdominal fluid through diagnostic peritoneal lavage (DPL) before recommending a laparotomy if the situation requires one. [6]
Treatment
Whenever any blunt trauma is sustained to the body, it is normal to ensure first that there is no bleeding, internal or back injury, or breathing problems before administering any type of rehabilitative care to the patient. In cases of car accidents, or where a patient has had some form of accelerated impact, the likelihood is that there will be progressive damage to internal organs, as well as the fracturing of bones, both of which are dealt with by splinting fractures and controlling external hemorrhaging. Most cases require IV therapy along with other methods of stabilisation such as securing the airway or providing a respirator. [7]
Related Chapters
References
- Corey, T. S., Payne-James, J., Byard, R. W., Henderson, C. (2005) Blunt Injury in Encyclopedia of Forensic and Legal Medicine Elsevier Academic Press, Oxford, ISBN
- Spitz, W. U, Thomas, C. C, (1993) Blunt Force Injury in Spitz and Fisher's Medicolegal Investigation of Death ISBN .
Notes
- ^ Abdominal Trauma, Blunt States that 50-75% of trauma is blunt abdominal trauma which is caused mostly in car accidents; referred to as auto-to-auto accidents.
- ^ Abdominal Trauma, Blunt States that rarely, blunt abdominal trauma is caused by medical techniques such as cardiopulmonary resuscitation (chest-pumping), the heimlich maneuver, and manual thrusts to clear the airway.
- ^ Abdominal Trauma, Blunt lists procedures used in Abdominal injuries in car accidents.
- ^ Abdominal Trauma, Blunt lists the most damaged internal areas with respect to BAT. Also lists that there has been some body of research that suggests CT scanning of such injuries can lead to development of further concomitant injury.
- ^ Abdominal Trauma, Blunt describes methods used for identifying further abdominal injury, and the priorities in the examination of patients, particularly those in CTCC.