CHAPTER 30 Case Study

Trauma Systems
and Mechanism
of Injury

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Part 1 (1 of 3)

Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
You are dispatched to 1601 South Main Street for “man fallen from a roof.” This
address is located in the business district of your service area. En route to the
call, you learn that this man had been running from police and had come from a
building in the downtown area. The patient is in police custody, and the scene is
considered safe.
You arrive but are unable to assess much because the patient is combative and
unwilling to answer your questions. You can see that his skin is slightly moist and
a bit pale.
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Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Primary Assessment Recording Time: 0 minutes

Appearance Grimacing, screaming, punching

Level of
A (Alert to person, place, and day)
consciousness

Airway Patent

Breathing Rapid and deep

Unable to assess other than skin

Circulation
due to patient combativeness
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1. What does mechanism of injury mean, and what is the reported mechanism in
this case?
2. What kinetic principles apply in this case?
3. What other factors might affect the amount and location of injuries from a fall?
Part 2 (1 of 3)

Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
The police officers advise you that the patient was probably under the influence of
PCP (phencyclidine hydrochloride), and in his attempts to avoid arrest, he
climbed up a fire escape and fell about 20 feet. He landed on his hands and feet,
stumbled for a few steps, and continued to try to run away unsuccessfully.
Part 2 (2 of 3)

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Vital Signs Recording Time: 5 minutes

Level of
V (Responsive to verbal stimuli)
consciousness
Skin Slightly moist, slightly pale, and cool
Carotid (unable to access radial pulses
Pulse because patient is being restrained); rapid
(142 beats/min)
Blood pressure 168 by palpation

Respirations 60 breaths/min
SaO2 99% while breathing room air
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4. What types of injuries might you expect could occur in this patient based on
the information you have so far?
5. What complicating factors make it more difficult to assess this patient?
6. Is this patient in shock?
Part 3 (1 of 3)

Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
The police officers restrain the patient so you can perform your primary
assessment and a rapid exam, all while taking spinal stabilization precautions.
You are able to apply a cervical collar and minimize his movement by restraining
him on a backboard. During your rapid trauma assessment, you find that he has
deformity of both legs below the knees. He also has some abrasions to both
hands and arms. It appears most of the force was absorbed by the legs during
the fall.
Part 3 (2 of 3)

Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Reassessment Recording Time: 10 minutes
Level of
V (Responsive to verbal stimuli)
consciousness
Skin Slightly moist, slightly pale, and cool
Carotid (unable to access radial pulses as
Pulse
patient is being restrained); rapid
Blood pressure 164 by palpation
Respirations 60 breaths/min

SaO2 98% while breathing room air; patient

noncompliant with nonrebreathing mask
 Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
7. What are your treatment priorities at this point?
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Part 4 (1 of 2)

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After the patient is placed on the backboard, you load the patient into the
ambulance where you attempt splinting of injured extremities, as well as
establishing vascular access, and administering a 500-mL bolus of normal saline
en route to the hospital. You also place the patient on the cardiac monitor, which
has noninvasive blood pressure capability, making it easier to evaluate BP. You
alert the hospital staff to the need for security personnel on your arrival at the
emergency department as well as a possible need for the trauma team.
Part 4 (2 of 2)

Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Reassessment Recording Time: 15 minutes
Level of
V (Responsive to verbal stimuli)
consciousness
Skin Slightly moist, slightly pale, and cool
Pulse 136 beats/min
Blood pressure 160/88 mm Hg
Respirations 34 breaths/min

SaO2 98% while breathing room air; patient

noncompliant with nonrebreathing mask
Sinus tachycardia with occasional unifocal
ECG
premature ventricular contractions