Traumatic Injuries

Traumatic Injuries

Traumatic injuries cause damage to tissues. The incidental rupturing of ancillary and primary blood vessels supplying these tissues causes internal bleeding at the site of injury. The blood supplies normally bring nutrients and oxygen to the tissues and remove waste materials along with metabolic by-products from tissues. With damage though, the delicate piping systems of vessels burst at smaller capillary, arteriole, or venule vessels--or even in larger vessels causing heavy bleeding.

This bleeding is what causes swelling at the site of the person’s injury. The injury is enclosed within the skin, creating increased fluid and blood pressure inside the body at the injured site. When the trauma site fills and expands with bleeding, it tamponades the traumatic site. This may depress or cut off circulation. This occurs by increasing the site’s inner body pressure at or above the person’s normal blood pressure. This pressure is what naturally stops the bleeding at the site.

The heart pumps blood out to the tissues by way of the arteries. About 99% of all blood pumped out of the heart is returned by the venous return system. Being an enclosed plumbing system, the arterial pressure within the capillary bed drives the blood back to the heart by the pressure in the enclosed venous system. The generally low right-sided heart pressure allows naturally decreased pressures to direct blood from the venous systems back into the heart. This, in turn, allows the blood to be re-circulated and be pumped again and again back to the heart. The remainder of blood plasma is returned by the lymphatics.

In addition to the heart, artery, and venous systems, there is a passive lymphatic pipe system carrying the tissue fluids back to the heart. This lymphatic system acts as a cleaning sewage system allowing extra fluid to drain from the capillary beds and injured sites, via the venous system and then to the heart. Lymphatic vessels, like veins, have one-way valves which act as pumps. Passive pumps called lymph nodes are located behind joints or at sites of pressure from physical movement. They are much like a hose with a bulb and a valve attached to another hose. When the bulb is squeezed, the system pumps fluid in one direction only: towards the heart. When a joint is flexed and extended, the bulb is naturally compressed and it pumps moving fluids from the extremity towards the heart. This naturally removes blood, fluid, and potential infections fluid from the site of the injury. This reduces the on-site pressure after bleeding is stopped to allow new circulation and healing.

The elevation of a traumatic point is applied by measuring from the floor directly vertical to the heart, and then measure from the floor directly vertical to the site of injury. This means that the point of injury should be elevated approximately 12-16 inches higher than the position of the heart at any time and from any position, i.e. sitting in the chair with your foot on an ottoman if the foot is the site of injury, is not elevated. The distance to the floor from the foot must be less than the heart to the floor by 16” or more. Laying flat on a couch with your foot up high on the back of the couch at the head level is elevation of a traumatic site, decreasing pain and removing the fluids for healing.
John Drew Laurusonis, M.D.
Doctors Medical Center