Traumatic Injury . part 2

Traumatic Injury

Is Defined As Tissue Damage Caused By External Force Or Violence. Acute Injury Results From The Rapid Transfer (As Little As A Few Seconds Or Less) Of Excessive Amounts Of One Of The Five Forms Of Energy (Kinetic, Thermal, Chemical, And Electrical Energy And Radiation) Or The Excessive Removal Of One Of These Forms (For Example, In Asphyxiation Or Hypothermia). Acute Injury Can Be Intentional, Such As Injuries Resulting From Assaults Or Self-Infliction. Unintentional Injuries Result, For Example, From Falls. Injuries May Be Fatal Or Nonfatal. Kinetic Injuries Are Often Classified As Penetrating (Passing Into The Body), Such As A Stab Wound Or Gunshot Wound, Or Blunt (Striking The Outside Of The Body), Such As Internal Injuries Resulting From A Fall.

This Definition Differentiates Traumatic Injury From Overuse Injuries Such As Carpal Tunnel Syndrome And From Chronic Disease, In Which Tissue Damage Occurs Over A More Extended Time.

In General, There Is Wide Agreement On The Types And Severity Of Injuries That Should Be Treated In The Hospital. Although Severity Of Injury Is The Main Factor In Determining Whether A Patient Is Hospitalized, Some Patients, Such As Those With Mild Head Injuries Or An Altered Mental Status, Who May Not Need Hospitalization For Their Primary Injury, Are Sometimes Hospitalized For A Short Time For Observation. Social Factors, Such As Lacking Caregiver Supports And Being Homeless, Sometimes Play A Role In The Decision To Hospitalize, Although This Decision Is Becoming Increasingly Difficult Because Of Stringent Admission Criteria Set By Third-Party Payers. In General, Hospitalized Trauma Patients Are Those With Moderate To Severe Injuries Requiring Specialized Evaluation And Treatment.

The Trauma Patient In The Opinion Of The Doctors At E.R

Clinically, Trauma Patients Can Be Viewed In Several Ways. Physicians Focus On The Patients' Immediate Needs, According To The Physicians' Specialties. Because These Patients Are Often Near Death Or In Danger Of Sustaining Permanent Disability From Conditions Needing Immediate Treatment, Views Of Them Are Often Narrow And Necessarily Focused On The Injury. The Emergency Department Physician And Staff, As Well As The Trauma Physician, Generally See The Patient From The Perspective Of The Mechanism Of Injury, Which Alerts Them To Look For Particular Types Of Injuries.

Neurosurgeons Or Orthopedic Surgeons Mainly View The Patient From The Perspective Of The Organ Or Organ System Injured. For Example, To A Specialist Called In To Deal With The Patient's Brain Injury Or Shattered Hip Bone, The Mechanism Of Injury Is Not As Important As The Site Of The Injury And The Type Of Injury. Similarly, Physical Rehabilitation Specialists May Focus On Restoring The Patient's Muscle Strength Or Range Of Limb Movement Or Independent Functioning.

As Can Be Seen, These Views Of The Trauma Patient Begin With The Point Of Injury And Focus On The Outcomes Of The Traumatic Event. This Approach Can Be Fragmented And Does Not Result In A Holistic Picture Of Trauma Patients. In Terms Of Injury Prevention, These Views Of Trauma Patients Have Served Them Poorly.

To Be Continued Next Week In Part 3 With Different Views Of Trauma

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DR FIRAS ALKURDI
EMTM, MBBS.

trauma

Trauma

Trauma patients are people from all age groups, geographic areas, and socioeconomic classes: the elderly woman who falls and breaks her hip, the middle-aged pedestrian who is hit by a car while walking his dog on a familiar road or struck by lightning on the golf course, the adolescent with a gunshot wound or a neck injury from diving, the young adult metal worker or farm worker whose hand is injured in heavy machinery, or the child burned in a fire -- these people sustain traumatic injuries

The main purpose of this issue is to familiarize persons in the alcohol and other drug (AOD) treatment field with hospitalized trauma patients, including the types of injury they sustain, the physical and psychological effects of these injuries, and the typical course of treatment for trauma patients—from acute emergency treatment in hospitals and trauma centers through rehabilitation and return to the community.

The purpose of this issue is to familiarize persons in the AOD treatment field with hospitalized trauma patients, including the types of injury they sustain, the physical and psychological effects of these injuries, and the typical course of treatment for trauma patients.

A variety of factors increase the likelihood that a person will sustain a traumatic injury, and this article presents a model for conceptualizing these factors and their relation to injury. In this view, a traumatic injury is seen not as an "accident" but as a condition resulting from the interaction of many factors. An assumption of this view of injury as a public health problem is that, like heart disease, it can to a large extent be prevented when risk factors are reduced.

This report does not attempt to provide a comprehensive description of traumatic injuries and their treatment. Only the major types of traumatic injury are described in detail, while others are highlighted. Particular points covered about each type of traumatic injury include its major causes, its incidence in the general population, and the proportion of patients for whom AOD use and dependence contribute to the injury.

It is hoped that when reading this chapter, persons in the AOD treatment field begin to consider this diverse patient population in terms of identifying and treating the AOD-abusing and -dependent individual. This population is similar to other AOD treatment populations with co-morbidity conditions, such as persons with dual diagnoses (mental illness and AOD use disorders) or with serious, chronic medical conditions. Both conditions must be treated for the overall prognosis to improve. It is hoped that models or strategies for working with this patient group will suggest themselves to readers.

 

Traumatic injury has been recognized as a leading public health problem, and policymakers at all levels have attempted to implement injury-prevention measures. As discussed and will be addressed in more detail later in this report, alcohol-and-other- drug use plays a major role in traumatic injury. Persons with untreated AOD problems who have sustained one traumatic injury are at increased risk of re-injury. Because of the growing emphasis on injury prevention, it is likely that hospitalized trauma patients will come increasingly to the attention of the AOD treatment field

To be continued next week with different views of trauma definition ,type and management

DR FIRAS ALKURDI
EMTM, MBBS.