Type of Trauma
Type of Trauma
Blunt Trauma usually is the result of a fall or vehicle accident. The sudden acceleration and stop cause vital organs to be damaged. Tearing of the vessel walls, compression, and disruption of an organs' functional capacity lead to a life-threatening situation. Blunt trauma injuries are not easily detected because the healthcare provider cannot see the internal damage, and initial vital signs seem reasonable. As time elapses and bleeding continues, the vital signs deteriorate, thus the need for frequent assessment of the patient is vital. Suspicion of hemorrhage and respiratory impairment must always be top priorities.
Sometimes blunt trauma can cause a contusion in an area where one least expects a problem until signs and symptoms of the problem develop. Capillary damage leads to hematoma formation in a closed compartment, (i.e. the cranium or muscle). The hematoma slowly expands, causing a rise in pressure in the closed space. The rise in pressure decreases the flow of blood into the space, and ischemia occurs. Releasing the pressure in the space is the only solution to remedy the ensuing ischemia and tissue death. A fasciotomy for a compartment syndrome in the leg or arm will relieve the pressure. In the brain, the development of a subdural hematoma may require an invasive procedure.
Penetrating trauma is usually identified by the visible hole left in the skin. Stab wound, bullets, and other items cut through the skin and any organ, tissue, blood vessel, nerve, etc., in an inward path. It is difficult to accurately know what structures or organs may be involved. Blood loss is always expected and can quickly extinguish life. When patients have a single penetrating wound or multiple trauma with no blood pressure or heart rate detected by usual monitors, (i.e. arm blood pressure and finger on the pulse), there is not time for the usual workup. The patient must be taken to the operating room immediately; the wound explored to find and stop the bleeding site, and fluid/blood resuscitation done.
Sometimes a penetrating injury does not have a rapid onset of hypotension and tachycardia because the object of penetration is still present. Occasionally someone is stabbed, hit with an axe, or a flying object imbeds itself in the body. The object cuts a vessel in an inward path but the vessel does not bleed until the object is removed. Take these patients to the operating room with the object in place and remove only when everything is ready for a surgical repair.