Trauma Center: Treating Patients with Blunt Trauma Injuries

Blunt trauma, also called non-penetrating trauma or blunt force trauma, is an injury to the body caused by forceful impact, injury, or physical attack with a dull object or surface. It is in contrast to penetrating trauma, in which an object or surface pierces the body, causing an open wound.

In the United States, blunt trauma as the result of a car accident is 1 of the leading causes of death in children and adults under the age of 35. Typically, victims are taken by ambulance or airlifted to the closest trauma center for emergency treatment.

Examples of Blunt Trauma

Blunt trauma most often occurs in:

• Car accidents, when rapid deceleration pushes the body into the dashboard, steering wheel, or seatbelt
• Collision between a pedestrian or bicyclist and a motor vehicle
• Contact collisions in sports
• Physical assaults, such as a punch to the body
• Falls, especially from a great height

The resulting injuries may include:

• Contusions
• Abrasions
• Lacerations
• Bone fractures
• Rupture or damage to internal organs

Trauma Centers

Trauma centers require a coordinated, multidisciplinary approach to stabilize and care for the patient. A Level I trauma center, for instance, has well-established treatment protocols in place and certain types of healthcare professionals on duty 24 hours a day, 7 days a week. These professionals have advanced training in triage and critical care, including:

• Surgeons, with specialties in:
  • Orthopedics
  • Cardiothoracics
  • Neurosurgery
  • Vascular surgery
  • Ophthalmic surgery
  • Plastic surgery
• Emergency physicians
• Anesthesiologists
• Radiologists
• Gerontologists
• Nurses
• Respiratory therapists

In addition, many trauma centers include other on-site resources, such as:

• Helipads that allow victims to be airlifted to the hospital for faster treatment
• 24-hour trauma resuscitation area in the ER
• Operating rooms
• Lab testing
• Diagnostic testing
• Blood bank
• Pharmacy

Emergency Medical Technicians (EMTs), also called paramedics, often decide the initial level of treatment that the injury necessitates. For people with the most critical blunt trauma injuries, immediate transport to a high-level trauma center and rapid assessment of their injuries are shown to vastly improve the chances of their survival and recovery.

Diagnosing Blunt Trauma

In the trauma center, the trauma team preps for the patient's arrival as soon as they get a call from the EMTs that they are en route. When the patient arrives, the most immediate concern is to assess whether he or she has a life threatening condition. To establish whether resuscitation or other immediate treatment is needed, members of the trauma team first check what is known as the ABCDEs:

• Airway — Does the patient have an open airway?
• Breathing — Is the patient breathing?
• Circulation — What is the patient's pulse, blood pressure, and heart rate?
• Disability — What is the patient's neurological status?
• Exposure — The patient's clothing is cut off and all orifices, soft tissues, and bones are examined for any sign of trauma.

Blunt trauma can impact any part of the body. As a result, once the ABCDEs are checked and the patient is stabilized, trauma personnel will perform a more thorough head-to-toe examination and assess any wounds for:

• The type of wound--laceration, abrasion, bruise
• The overall size of the wound--length, width and depth
• The overall area of tissue damage caused by the force of the impact

The trauma team diagnoses the injury as quickly as possible using Information from witnesses about how the incident occurred, as well as any medical history available on the patient. In addition, diagnostic imaging and other medical tests can assist in making a rapid diagnosis. These may include:

• Diagnostic Peritoneal Lavage (DPL)--determines if there is fluid in the abdominal cavity
• Bedside Ultrasound--allows physicians to see in real time if there are any internal injuries to the abdomen or chest
• CT (CAT) Scan--uses computers and x-rays to see inside of the body and can help assess injuries to the brain, neck, chest, abdomen, and pelvis
• Blood or urine tests

These tests allow for a faster diagnosis, grading of the severity of the injury, and developing a treatment plan. Diagnostic tests are especially important for patients who may have injuries that are not visible, such as damage to their internal organs or internal bleeding.

Treating Blunt Trauma

Once a diagnosis is made, trauma personnel may:

• Replace fluids, such as saline solution for dehydration and blood for blood loss
• Clean the wound
• Take steps to prevent infection
• Perform a laparotomy, a large incision in the abdomen to provide access to the abdominal cavity in order to assess internal injury or prepare the patient for surgery

In some cases, surgery is not deemed immediately necessary and the patient will continue to be closely observed. Their vital signs will be monitored and frequent physical examinations will be performed to look for any changes in their condition.