Introduction
Blunt force trauma incidences occur where the person’s head or body has impact with a dull, firm surface of a dull object. There are several kinds of blunt trauma that lead to death. These are traumas to the chest, abdomen and the head. Causes of death in blunt force trauma are internal excessive bleeding either in the head, chest or the abdomen. Most of the blunt force trauma is caused by motor vehicle accidents. Other major causes are accidents at the workplace and falls from buildings. There are certain cases of internal bleeding caused by blunt force trauma that ends up killing people as it was not detected and treated quickly.
Chest Trauma
It is estimated that 20% of chest trauma conditions lead to death. One of the major causes of chest trauma is the motor vehicle accidents. Other causes of chest trauma are falls from buildings, work or recreational related crushes and assaults. One of the common causes of death in blunt chest trauma is the rupture of the thoracic aorta. At the scene of the accident, 70-90% of the people who have this injury die on the spot. Of those who survive long enough to be taken to the hospital, 30% of them die will die within the first 6 hours, 40% of them succumb to death within the next 24 hours while the rest lose their lives within the four months unless they are diagnosed properly and receive appropriate treatment in time.
Over 90% of the thoracic aorta injuries are caused by penetrative mechanisms however over the recent years the number of people suffering from these injuries due to blunt
trauma has been increasing. These injuries are caused mostly by high speed deceleration and at times from chest compression. The injuries can also be caused by the compression of the vessels between the sternum and the spine or where an individual has a profound intraluminal hypertension. Where there is rapid deceleration, the ascending and the descending parts of the aorta move to the the transverse aortic arc. 80% of the injury occurs at the ligament arteriosum while about 20% occurs in the descending aorta ( Chiesa & Ruettimann, 2003).
When the aorta, which is the largest artery in the body, is torn or ruptured, it causes severe bleeding which may lead to death. The aorta is a blood vessel that branches directly from the heart to supply the rest of the body with blood. It therefore has a lot of pressure. Blood spilling from a tear may lead to shock and eventually to death. Most of the times aorta trauma is given less priority when the individual is suffering from head injuries, spinal cord complications and respiratory conditions. The repercussions of delayed treatment however are high as these injuries can lead to expanding mediastina area, increasing haemothorax and anuria. The condition may also go unnoticed since the patients may not be exhibiting any symptoms or the patient is suffering from other serious conditions. There are times the patient shows symptoms of the conditions such as shortness of breath, difficulty in breathing or speaking or chest and upper back pain.
Head Trauma
Another fatal blunt trauma occurs where an individual has head trauma. Traumatic brain injury (TBI) is a leading cause of death. It can be caused by blunt object hitting the head or penetrative injuries. Blunt head trauma leading to traumatic brain injury is usually caused by transportation accidents, sports injuries or recreational injuries. Over 50% of the TBI are caused by transportation accidents in the people who are less than 75 years of age. These transportation accidents may involve motor vehicles, pedestrians, bicycles and motorcycles. In the people who are aged over 75 years, the TBI is caused by falls. There are traumatic brain injuries that are caused by violence such as firearm assault and child abuse. 3% of the traumatic brain injuries occur during sports events.
The injury may be focused on one area of the brain or may affect several parts of the brain. A TBI may be mild or severe. The symptoms may appear immediately after the accident while other symptoms may only appear several days or weeks after the accident. Mild TBI patients usually experience unconsciousness for a few minutes, headache, confusion, ringing in the ears, tired eyes, fatigue and behavioural changes. Other symptoms are change in sleep patterns, dizziness, light headedness and bad taste in the mouth.
Where a person has severe TBI which may lead to death, the person shows the same symptoms for mild TBI however there are other more serious symptoms. The person may have a headache that does not subside, repeated vomiting and incidences of nausea, convulsions, dilation of pupils, inability to wake up from sleep and slurred speech. The individual may also display loss of coordination, restlessness or agitation and high levels of confusion. There are different kinds of TBI.
A concussion is a mild form of TBI. It is exhibited by a short loss of consciousness. It is a minor head injury. Severe TBI include skull fractures, contusion, hematoma and anoxia. Skull fractures occur when the skull bones break and the broken pieces begin to press into the tissues of the brain. The pressure from the broken pieces causes the brain tissue to bruise leading to contusion. This part of the brain tissue begins to swell as the blood vessels in the area have also broken. There may also be a contrecoup where the brain starts to shake within the confines of the skull. This usually occurs when a motor vehicle accident occurs where the cars had been travelling at high speeds. It can lead to diffuse axonal injury where the individual nerve cells are damaged. There may be loss of connection between the neurons in the brain leading to complete breakdown of communication (Hsiao, Hsiao & Weng, 2008).
Where there is injury to a major blood vessel in the brain it leads to haematoma. This is a condition where there is heavy bleeding in the brain either between the skull and dura, the area between the dura and between the dura and arachnoid membrane. There are patients who suffer from anoxia where the brain is deprived of oxygen. An individual may suffer from significant loss of blood which leads to lesser blood flow to the brain.
Abdominal Trauma
The third type of blunt trauma injury that may lead to death is abdominal trauma. There are certain organs in the stomach which get affected the most which are the spleen, the liver and the kidney. . There are certain signs that can show the physician that there has been abdominal trauma. The symptoms of blunt abdominal trauma are pain, tenderness in the abdomen and outer bruising of the external abdomen. There may also be abdominal guarding where the abdominal walls tense so as to guard the injured organs in the stomach. Where the patient has gas in the abdominal wall or pneumoperitoneum, this shows that the patient has a hollow organ. These injuries in the abdomen are usually caused in motor vehicle accidents.
The danger with blunt abdominal traumas is that it may not be detected yet it may lead to severe bleeding, infection and even death. The seat belt is great as it aids in protecting an individual from head and chest trauma however in these accidents, the abdomen may get injuries. When the car stops suddenly, the seat belt traps the viscera against the spine causing compression and shearing injuries to both the gut and the mesentery. The bowel wall may rupture and haemorrhage of the abdominal wall. There may also be mesenteric hematoma and devascularisation of the bowel. The main cause of death in abdominal trauma is exsanguination where the patient bleeds to death internally.
If a person has fractured between 10 to 12 ribs, there may be spleen injury. There may be laceration of the capsule or parenchymal laceration. There may also be a non-expanding hematoma or raptured sub capsular hematomas. Blunt trauma may also lead to severe spleen injuries such as a fractured spleen or vascular tear that causes splenic ischemia and severe blood loss. The massive blood loss can lead to shock and even death.
The liver is the most vulnerable organ in the abdomen due to its location. It is found in the upper right part of the abdomen. Two characteristics of the liver make it a dangerous place to suffer from blunt force trauma. First of all the tissue is very delicate. It also has
receives a large supply of blood and can store large amounts of blood. In the event an individual starts bleeding from the liver, it may require a surgery to stop the bleeding (Blank-Reid, 2007).
If the patient has fractures in the lumbar vertebrae or posterior ribs, he may be suffering from blunt trauma to the kidneys. There may be laceration or contusion of the renal parenchyma. These are caused by shearing and compression forces. The deeper the laceration the more bleeding the patient will suffer from. Bloody urine is a sign of blunt trauma to the kidneys. This type of abdominal blunt trauma is common in children. It is not as common as the liver and spleen trauma because it is mostly protected by the ribs.
Conclusion
It is sad to think of the number of people who die from excessive bleeding from blunt force trauma that was not detected. It is important that the people who have been involved in accidents especially motor vehicle forces to go to hospital for head and chest scans to ensure there is no internal bleeding caused by deep lacerations and ruptures. This will end up saving lives. People ignore going for a scan yet it could have saved their lives.
There have been advances in medical science and there are now a lot of appropriate treatments for the different kinds of trauma. Educating people on the danger of blunt force trauma is one way to ensure that people do not dismiss going to the hospital where they have no external injuries. Physicians can also be trained in checking and confirming that the patient has no trauma.
References
Blank-Reid, C. (2007). Abdominal trauma: Dealing with the damage. Nursing, 37(4),
4-11.
Chiesa, R. & Ruettimann, M. (2003). Traumatic Rupture of the Thoracic Aorta. Acta chir
belg, 103, 364-374.
Hsiao, K. Hsiao, C. & Weng,H. (2008). Factors predicting mortality in victims of
blunt trauma brain injury in emergency department settings. Emerg Med J, 25:670–673.
