One of the most common patient visits to Emergency Room for clinical evaluation and investigation is injuries following car accidents. Auto accident can cause minor or major injuries to any part of the body. Severity of injury depends on driver’s awareness of surrounding, severity of impact and physical conditions of occupants in the vehicle. Major injuries can be life threatening. Auto accident may result in minor or major injuries to driver and passenger. Severity of injuries in many cases is not interconnected to obvious damage of the car.
Injuries such as profuse external bleeding, abdominal trauma, internal bleeding, head injury, neck injury and compound fracture are considered serious injuries. These patients are transferred to hospital ER immediately by ambulance after initial resuscitation and airway management. Initial clinical assessment is often done by pre-med accompanying ambulance and fire truck. Patient is examined by physician in the ER and may be advised to undergo multiple investigations. ER physician will consult specialist depending on outcome of clinical examination and findings of investigation. Transfer to emergency room (ER) is always at the closest hospital.
6 Major Life Threatening Injuries Following Blunt Trauma in Car Accident are
- Blunt and Penetrating Head injury.
- Blunt and Penetrating Neck Injury.
- Penetrating Chest Injury.
- Penetrating Abdominal Injury.
Serious head injury may result from blunt or penetrating trauma. Severe impact or penetrating head injury often results in brain damage and bleeding. Continuous bleeding can cause blood clot formation resulting in brutal pressure over soft brain tissue.
- Brain Injury- Laceration of the brain is most detrimental injury and may result in death or permanent brain damage.
Head injuries following blunt or penetrating impact to head are-
- Concussion of the brain
- Contusion of the brain
- Laceration of the brain.
- Bleeding-Intracerebral and epidural bleeding can cause severe damage. Injured patient may end up with quadriplegia (paralysis of all four limb), paraplegia (paralysis of two limbs) or hemiplegia (paralysis of one side of body).
- Intracerebral bleeding- bleeding inside brain.
- Epidural or subdural bleeding- bleeding outside brain.
Neck injury is the second common trauma observed following automobile accident.
Common Neck injury observed following car accidents are
- Disk bulge and herniation
- Facet joint injury
- Subluxation of vertebrae
Penetrating Chest Injury
Penetrating chest injury can lacerate or injure lungs, heart or major blood vessels.
- Pneumothorax- Pneumothorax is caused by penetrating injury lacerating the pleura. Pneumothorax is a trapped air pocket out side lung. Pneumothorax prevents lungs from expanding and patient cannot breath air. Patient slowly runs out of oxygen and condition become life threatening. Emergency removal of air from trapped air pocket outside lung can save the life.
- Lung Laceration And Slash- Lung laceration or slash causes bleeding within lung and outside lung. Injured patient suffer with difficulties to breath. Most of the cases need emergency surgery.
- Penetrating Wound of Heart- The condition is life threatening and time is essential to save the life. It is preferred not to remove the object penetrated in the chest wall until patient is in the hospital. The removal of object may turn active oozing to active life threatening bleeding.
- Tear or Slash of Major Blood Vessels- Penetrating chest wall injury may cause tear or slash of the aorta resulting in life threatening bleeding. Penetrating object may prevent severe bleeding if wedged within the aorta and left in place until patient is in operating room.
Penetrating Abdominal Injury
Penetrating abdominal injuries are less life threatening than penetrating chest injuries. Laceration or slash of abdominal aorta is often result in life threatening condition.
- Tear or Laceration of Viscera- Abdominal viscera such as stomach, intestine, liver, spleen, kidney and pancreas may be severely damage by penetrating injury causing laceration or tear. The tear of viscera causes continuous bleeding, which could be life threatening if not treated within first few hours after accident.
- Tear or Slash of Major Blood Vessels- Penetrating posterior (from back) abdominal injury cause tear or slash of the abdominal aorta resulting in life threatening bleeding. Penetrating object may prevent severe bleeding if wedged within the aorta and left in place until patient is in surgery.
Fracture of Skull, Ribs and Extremities
Blunt trauma, severe twist of body and leg as well as penetrating wound of extremities can cause fracture of skull, ribs or extremity bones.
- Skull Fracture- Skull fracture causes concussion or laceration of brain and bleeding secondary to laceration or tear of meningeal blood vessels. Bleeding in skull fracture often observed oozing of blood externally.
- Rib Fracture- Chest wall injury following blunt trauma often results in contusion or fracture of ribs. Chest wall injury following blunt trauma in car accident results in multiple rib fracture.
- Fracture of Extremity Bones- Fracture of lower or upper extremities occasionally associated with severe bleeding because of rupture or tear of major blood artery or veins. Life threatening condition develops only if blood loss is enormous. Application of tourniquet to extremity immediately following accident by ambulance specialist can prevent continuation of severe bleeding.
Blunt trauma, the severe twist of body and leg as well as penetrating wound of extremities can cause fracture of skull, ribs, or extremity bones.
Dislocation of Major Joint
Automobile accident may cause dislocation of major or minor joint. Major joints often dislocated in car accident are hip, knee, ankle, shoulder, elbow and wrist joint.
- Severe intractable pain.
- Severe headache.
- Profound Confusion.
- Inappropriate answers to verbal command.
- Loss of memory.
- Blurring vision.
- Ringing in the ear.
- Semiconscious or unconscious.
- Convulsion or seizure.
- Vomiting blood.
- Coughing blood with sputum.
- Blood in stool.
- Blood in Urine.
- Vaginal bleeding.
- Pale skin.
- Cyanotic or bluish skin.
- Low blood pressure.
- Rapid heart rate.
- Difficulties in breathing.
- Gasping for air.
- Unable to stand or sit.
- Unable to lift arms or legs.
- Unable to follow instruction to carry verbal command like touch nose or toes.
- Signs of penetrating wound.
- Signs of bleeding.
- Signs of fracture or dislocation of the joint.
- Signs of weakness or paralysis of extremities: One or all four extremities.
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