Photo Case: Injury Following A Motor Vehicle Accident

[Reasonable Rascal]

http://www.emedicine.com/shared/pub/cotw/0017.jpg

Arm Injury After a Motor Vehicle Collision

This patient presented to the hospital after being involved in a low-speed motor vehicle collision that caused moderate damage to the car. The patient experienced no loss of consciousness and was not short of breath. Furthermore, the patient claims to have been driving only 30 miles per hour. What was the mechanism of injury?

What was the mechanism of injury and what are the injuries themselves?

RR

[MIKETM]

How old is the dude and how much of his story is baloney? ETOH?.........Did he come in by ambulance? It looks like an abrasion,Pulse, motor, sensation? Was he supposting that thing with his other arm when he came in? What's it look like compared to the other arm? Deformity? What the hell is that white area? Am I reading too much into this? (yes). Did he just abrade it on the steering wheel. I gotta know how much damage the guy had to his car. I'd re-question the guy, get an initial impression, re-vital, Sling it and swath it if I had to, C-collar the dude if he had any neck pain. Maybe put an IV in his right arm before he goes to X-ray. The great thing about being the paramedic is that you just give the Doc and nurses your initial impression followed by your impression after assessment in ambulance, then you split to do the next call.......

[cayoung]

Dear Rascall,
I did think about this for several minutes. The lower edge of his arm, about half way back, looks abraded as though his arm was caught between something and something else. And that he gave a big yank to get it freed.
His hand is a bit red and swollen, also.
My best guess is that this fellow had his arm jammed between the door and the steering wheel, and that he freed hismelf with a big yank.
Consider the source, I'm probably mistaken.

[outreachmedic]

If you ask me it looks like its all blanched out like some sort of crush inj. But, it also appears slightly deformed, possibly from some sort of twisting type mechanism. I give up....somebody fill me in.

[RESQDOC]

With no other info I would have to say airbag abrasion, given the typical markings and forearm location.

These things come out quite fast and are not as smooth as you would expect. Some of the propellant gases and dry lubricating powders can be irritating also. Interestingly, the explosive charge used to deploy these is IIRC, quite similar to picric acid and can be adapted as an improvised initiation charge (or so they say).

Do tell RR.

[nego_metuere]

I'm with Resqdoc on that. I can't comment on the improvised munitions though.....

[RESQDOC]

OK RR, cough up the answer.

[Reasonable Rascal]

Sorry, I was delinquent, and gone off enjoying myself for a few days. :razz:

The patient did indeed suffer an airbag injury. These included abrasions and burns as well as contusions to the forearm.

The velocity of the standard airbag approaches 200 MPH, and the effect of the material effectively sliding over the surface of the skin at that speed is directly responsible for the injuries not infrequently seen.

Forearm fractures in instances where the victim has a firm grip on the steering wheel are not unkown as the bag can deploy faster that the victim can loosen their grip. This may result is both radial and ulner fractures.

Facial injuries are also not uncommon, particularly to the nose and forehead. Minor burns also occur. As noted the bags use an explosive charge to propell them, thus generating a very brief but significant amount of heat.

For the record I missed the call on the injuries myself, and I have seen and treated a number of airbag-related injury cases over the years. Virtually all involved facial and forearm abrasions and burns. Sometimes being there to see the injuries in person makes all the difference as opposed to seeing one view.

R