What a great question.
I would be happy to answer your questions in detail as I am a trauma nurse in an intensive care unit in St. Louis and I work with these types of patients all the time. Please contact me by email at firstname.lastname@example.org or on my blog at www.imhotb.com and I can take the time to answer all of your questions with a detailed response. Injuries, complcations, signs and symptoms, treatments, prognosis, medical jargon, etc.
here is what I came up with. if you can give me some more details of what happened, I could help tailor the details to fit. hope this helps.
- What are the most common injuries for car crash victims (both for pedestrians and passengers)
For injuries some of the most common are:
1. Broken bones. Extremities are commonly affected. Facial fx from impact with a seat back or dashboard are common as well. In more serious accidents, spinal fx are common. They can have cord involvement (paralysis or loss of motor/sensory function) or no cord involvement (0 paralysis or loss of motor/sensory function). Pelvic fractures can occur which could be a source of massive internal bleeding because the pelvic bones are highly vascular. Rib fractures are another common type of fracture. They can be very painful and the pain can prevent patients from breathing deeply. This can lead to poor oxygenation and pneumonia.
2. Closed head injuries can be common as well. They can be simple such as a concussion or a contusion which is basically a bruising of the brain. They can be more serious such as a brain bleed and what is know as DAI (Diffuse Axonal Injury) These injuries can be quite serious and symptoms can range from 0 noticeable impairment with a small bleed to agitation and confusion, decreased levels of consciousness and coma all the way to brain death. There is a scale called the Glasgow Coma Score which is used to assess the neurological status of a patient with a neurological injury and they are done quite often in the hospital. Sometimes up to every hour or more.
3. Internal injuries are common as well. Lacerations to the liver and spleen are commonly seen. These injuries can result in massive bleed or can begin to bleed hours after the initial injury causing a rapid deterioration in the patients condition and requiring an emergent trip to the OR. These patients should be monitored closely with frequent labs to ensure that they are not bleeding. Air or blood in the lung (pneumothorax or hemothorax respectively)or heart cavities (cardiac tamponde) are a very common occurrence. They can significantly impair the patients ability to breath and require the immediate insertion of a chest tube to relieve pressure and re inflate the lung. Often times injuries the the bowels from the force of impact will cause the bowel contents to spill into the abdomen causing a massive infection. If this occurs the patient has a very poor prognosis. This type of infection is known as sepsis and as a result of the physiological processes which occur during sepsis the patients blood pressure will drop significantly. The blood pressure must be maintained through artificial means (drugs) otherwise the low blood pressure will make it impossible for all of the vital organs to receive the blood that they need. Organ death can and does occur commonly with this diagnosis.
4. Skin injuries. For pedestrians in particular road rash is a significant problem. They usually heal with no major after affects. (just an unsightly scar) but it is VERY painful. So pain control and preventing infection is critical in these patients.
- When the patients arrive in A&E, what procedures are performed before they are sent to the wards?
1. When a patient is brought to the emergency room (I am assuming that is what you mean by A&E) they perform a primary survey and after that a secondary survey.
Primary Survey: A - Airway. Check patients airway for obstruction.
B - Breathing. Ensure patient is able to effectively move air. This can be
impaired by neuro injuries or pneumo/hemothorax or cardiac arrest.
C - Circulation. Ensure patient’s heart is able to pump blood through the body
and that there is blood to pump (massive bleeding internally or externally)
D - Disability (neuro damage). Check GCS. Commonly it is said GCS less than
8 you intubate (breathing tube) to breath for a patient which goes back to B.
Also check to see if patient has movement and sensation throughout body. If
not this could indicate brain or spinal cord injury.
E - Exposure. Take off all clothing to inspect entire body from head to toe to
ensure no obvious injury has been missed.
Secondary survey. I won’t go much into this but you would do a more through investigation of all the systems of the body. CT scans, X-Rays, Ultrasounds of the abdomen. Depending on the results of the primary and secondary survey the patient may go to the OR for further explorational surgery or fixing of what is broken. (bones, bleeding vessels, etc. ) If no surgery is required, depending of their injuries and level of care required they will either be sent home, to a floor, or to the intensive care unit.
Typically, what medication/painkillers are they prescribed?
Pain meds usually depend on how severe the injury and how severe the pain. For a minor injury it can range from tylenol or percocets to moderate injury/pain with a PCA pump which is patient controlled analgesia. This is an IV infusion of pain medication (morphine, fentanyl, or dilaudid) which the patient pushes when they need it. It has safety features to ensure that the patient does not get too much. For severe pain and massive injuries where the patient is chemically sedated to keep them comfortable a combination of a continuous fentanyl infusion with either Ativan, versed, or propofol (the drug that killed Michael Jackson) to control both pain and induce amnesia so that the patient does not remember the unbearable parts of recovery. The continuous infusion of pain and sedation meds are only done in the intensive care units for safety.
- Are drains often inserted into their wounds?
Drains are inserted into wounds that have a collection of blood, fluid, or infection. It would be common to see a drain to remove blood from a fracture which has a lot of bleeding around it after it has been fixed surgically. For example a femur fx. The type of drain typically used is called a hemovac drain. For a site in the abdomen which has fluid or blood you might see what is called a Jackson-Pratt drain or JP drain for short. Going back to the pneumo/hemothorax, a chest tube drainage system is very common to remove air and or blood. It consist of a large bore clear plastic tube which is inserted into the chest cavity usually on the side. It will be hooked up to a device which provides suction to pull out the air and fluid and collect it to measure how much is being produce. Large, increasing amounts of bright blood may indicate active bleeding which will require some type of intervention.
- What administration is required when they reach the ward?
- Typically, how long would patients of a relatively severe car crash (who have full chance of recovery) stay in the ward before going home?
Depending on the extent of the injury a few days to months. Broken bones usually can be fixed quickly (immediately to a week if there is a lot of swelling around the site and surgery is required). Internal injuries sometimes take a little bit longer especially if infection is involved. (days to weeks). Closed head injuries can take quite a while to heal in some cases. If there is bleeding or a DAI, it can takes days to weeks to come back to a level of consciousness where they can breath without the use of a machine. (these patients will typically have a tracheostomy and a perctaneous gastrostomy tube or PEG tube place within the first few days if prognosis is poor to provide a stable airway and route for food as the decreased level of consciousness prevents them from doing either one effectively. After that intensive rehab for months and years may bring back some function or none at all. The key to remember with healing time is that youth is key, especially for head injuries. The body is under a lot of stress when healing and older bodies can not handle it well which causes further deterioration and delayed healing.
- What complications typically arise in their treatment?
Bleeding and sepsis (widespread infections) are the two most common and can significantly delay healing
- And finally, can you think of any instances where the patients seemed to be recovering well, but then very suddenly developed some sort of complication (e.g. internal bleeding, hemorrhage, etc) that caused fatality?
Pulmonary embolisms are one of the best for awake, healthy looking patients who suddenly code and die. It occurs when a blood clot travels from a part of the body, usually the legs, to the lungs. Spinal shock could be another. Often times patient who are newly quadriplegic will be awake, alert, vital signs stable and within 48 hours or so they will go into spinal shock. They will be unable to maintain their blood pressure and their heart rate will drop dangerously low to the point where often times their heart will stop completely. They will require intensive care with drugs to maintain their blood pressure and heart rate until the spinal shock subsides.