Blunt trauma

Blunt trauma is physical trauma to a body part, either by impact, injury or physical attack. The latter is usually referred to as blunt force trauma. Blunt trauma is the initial trauma, from which develops more specific types such as contusions, abrasions, lacerations, and/or bone fractures. Blunt trauma is contrasted with penetrating trauma, in which an object such as a projectile or knife enters the body. Blunt trauma is physical trauma to a body part, either by impact, injury or physical attack. The latter is usually referred to as blunt force trauma. Blunt trauma is the initial trauma, from which develops more specific types such as contusions, abrasions, lacerations, and/or bone fractures. Blunt trauma is contrasted with penetrating trauma, in which an object such as a projectile or knife enters the body. Blunt abdominal trauma (BAT) represents 75% of all blunt trauma and is the most common example of this injury. The majority occurs in motor vehicle accidents, 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 lead to rupture. Deceleration, on the other hand, causes stretching and shearing at the points where mobile contents in the abdomen, like bowel, are anchored. This can cause tearing of the mesentery of the bowel and injury to the blood vessels that travel within the mesentery. Classic examples of these mechanisms are a hepatic tear along the ligamentum teres and injuries to the renal arteries. When blunt abdominal trauma is complicated by 'internal injury,' the liver and spleen (see blunt splenic trauma) are most frequently involved, followed by the small intestine. 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’ is well reported. The term blunt thoracic trauma or, put in a more familiar way, 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 accident), 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, airway obstruction/rupture. The injuries may necessitate a procedure, with the most common being the insertion of an intercostal drain, more commonly referred to as a chest tube. This tube is typically placed because it helps restore a certain balance in pressures (usually due to misplaced air or surrounding blood) that are impeding the lungs ability to inflate and thus exchange vital gases that allow the body to function. 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.