Blunt abdominal trauma Blunt abdominal trauma (BAT) represents 75% of all blunt trauma and is the most common example of this injury. Seventy-five percent 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 serious cases, or rupture of internal organs from briefly increased
intraluminal pressure in the more serious, depending on the force applied. Initially, there may be few indications that serious internal abdominal injury has occurred, making assessment more challenging and requiring a high degree of clinical suspicion. There are two basic physical mechanisms at play with the potential of injury to intra-abdominal organs:
compression and
deceleration. 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 leading to rupture. In rare cases, this injury has been attributed to medical techniques such as the
Heimlich maneuver, attempts at
CPR and manual thrusts to clear an
airway. Although these are rare examples, it has been suggested that they are caused by applying excessive pressure when performing these life-saving techniques. Finally, the occurrence of splenic rupture with mild blunt abdominal trauma in those recovering from
infectious mononucleosis or 'mono' (also known as 'glandular fever' in non-U.S. countries, specifically the UK) is well reported.
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. It is also crucial to recognize the potential for developing blood loss and to react accordingly. Blunt injuries to the
kidney from helmets, shoulder pads, and knees are described in American football, 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
chest. Broadly, this also includes damage caused by direct blunt force (such as a fist or a bat in an assault), acceleration or deceleration (such as that from a rear-end automotive crash),
shear force (a combination of acceleration and deceleration),
compression (such as a heavy object falling on a person), and
blasts (such as an
explosion of some sort). Common signs and symptoms include something as simple as
bruising, but occasionally as complicated as
hypoxia,
ventilation-perfusion mismatch,
hypovolemia, and reduced
cardiac output due to the way the
thoracic organs may have been affected. Blunt thoracic trauma is not always visible from the outside and such internal injuries may not show
signs or
symptoms at the time the trauma initially occurs or even until hours after. A high degree of clinical suspicion may sometimes be required to identify such injuries, a
CT scan may prove useful in such instances. Those experiencing more obvious complications from a blunt chest injury will likely undergo 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. Only 10–15% of thoracic traumas require surgery, but they can have serious impacts on the
heart,
lungs, and
great vessels. The most immediate life-threatening injuries that may occur include
tension pneumothorax, open pneumothorax,
hemothorax,
flail chest,
cardiac tamponade, and
airway obstruction/rupture. 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. In certain dire circumstances an emergent
thoracotomy may be employed.
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,
orbits, and neck are also at risk. Most patients with more severe traumatic brain injury have a combination of intracranial injuries, which can include
diffuse axonal injury,
cerebral contusions, and intracranial bleeding, including
subarachnoid hemorrhage,
subdural hematoma,
epidural hematoma, and
intraparenchymal hemorrhage.
Falls are the most common
etiology, making up as much as 30% of
upper and 60% of
lower extremity injuries. The most common mechanism for solely upper extremity injuries is machine operation or tool use. Work-related accidents and vehicle crashes are also common causes. The injured extremity is examined for four major
functional components which include
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?" When it is not obvious that the answer is "yes", an injured extremity index or
ankle-brachial index may be used to help guide whether further evaluation with
computed tomography arteriography. This uses a special scanner and a substance that makes it easier to examine the vessels in finer detail than what the human hand can feel or the human eye can see. Soft tissue damage can lead to
rhabdomyolysis (a rapid breakdown of injured
muscle that can overwhelm the
kidneys) or may potentially develop
compartment syndrome (when
pressure builds up in
muscle compartments damages the
nerves and vessels in the same compartment). Bones are evaluated with
plain film X-ray or computed tomography if deformity (misshapen), bruising, or joint laxity (looser or more flexible than usual) are observed.
Neurologic evaluation involves testing the major nerve functions of the
axillary,
radial, and
median nerves in the
upper extremity as well as the
femoral,
sciatic,
deep peroneal, and
tibial nerves in the
lower extremity. Depending on the extent of injury and involved structures,
surgical treatment may be necessary, but many are managed nonoperatively.
Blunt pelvic trauma The most common causes of blunt pelvic trauma are
motor vehicle crashes and multiple-story falls, and thus pelvic injuries are commonly associated with additional traumatic injuries in other locations. In the pelvis specifically, the structures at risk include the
pelvic bones, the
proximal femur, major blood vessels such as the
iliac arteries, the
urinary tract,
reproductive organs, and the
rectum. If pelvic trauma is suspected, emergency medical services personnel may place a
pelvic binder on patients to stabilize the patient's pelvis and prevent further damage to these structures while patients are transported to a hospital. During the evaluation of trauma patients in an emergency department, the stability of the pelvis is typically assessed by the healthcare provider to determine whether a fracture may have occurred. Providers may then decide to order imaging such as an
X-ray or CT scan to detect fractures; however, if there is concern for life-threatening bleeding, patients should receive an X-ray of the pelvis. Following initial treatment of the patient, fractures may need to be treated surgically if significant, while some minor fractures may heal without requiring surgery.
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
heart is well-protected by the
rib cage and
sternum, the majority of patients are asymptomatic. Clinical presentations may range from minor, clinically insignificant changes to heartbeat or may progress to severe
cardiac failure and
death. Oftentimes, chest wall injuries are seen in conjunction with BCI, which confounds the presence of
chest pain experienced by most patients. To evaluate the spectrum of cardiac injury, the American Association for the Surgery of Trauma (AAST) organ injury scale may be used to aid in determining the extent of the injury (see Evaluation and Diagnosis below). BCI may be broken down into
pericardial injury, valvular injuries,
coronary artery injuries,
cardiac chamber rupture, and
myocardial contusion. == Evaluation and diagnosis ==