General Principles of Trauma and Wounds

Question 1

Definition of trauma

Answer 1

injury to the body caused by physical or chemical factors, resulting in wounds and possible complications

Question 2

Definition of a wound

Answer 2

The disruption of the anatomical continuity of tissue caused by the application of force

Question 3

Physical factors that can cause injury

Answer 3

• mechanical force
• thermal elements
• electrical current
• barotrauma
• irradiation
• ultrasound

Question 4

The natures and extent of wounds depends on

Answer 4

• the object or instrument causing the wound
• the amount of energy discharged during impact
• the conditions under which the energy is discharged
• the nature of the affected tissue
• condition of the target

Question 5

How can immersion in cold water kill?

Answer 5

• sudden death by neurogenic cardiac arrest

- hypothermia after prolonged immersion

Question 6

Definition of an abrasion

Answer 6

Destruction of superficial layers of skin that may be caused by compression or friction

Question 7

Types of abrasions

Answer 7

• tangential/ graze/ brush
• scratches
• impact
• friction

Question 8

Definition of a bruise

Answer 8

Extravasation of blood into soft tissue spaces due to the breaking of vessel walls caused by blunt force

Question 9

Extent of bruising depends on:

Answer 9

• amount of force

- type of tissue

Question 10

Complications of lacerations

Answer 10

• haemorrhage

- infections

Question 11

Definition of an incised wound

Answer 11

A superficial wound in which the size of the wound on the surface is larger than the depth of the wound

Question 12

Definition of a stab wound

Answer 12

A penetrating wound caused by a sharp or blunt instrument in which the depth of the wound is greater than the length

Question 13

How to describe a sharp force wound

Answer 13

• site
• shape
• length
• depth
• structures damaged

Question 14

Complications of incised wounds

Answer 14

• harmorrhage
• infection
• paralysis

Question 15

Types of haemorrhage

Answer 15

• primary
• reactionary
• secondary

Question 16

Classification of shock

Answer 16

• cardiogenic
• hypovolaemic
• septic
• neurogenic

Question 17

Types of embolisms

Answer 17

• thrombo-embolism
• air embolism
• amniotic fluid embolism
• fat embolism
• foreign body embolism

Question 18

Microscopic features that can help you to age wounds

Answer 18

• capillary vasodilatation
• margination and diapedesis of polymorphonuclear white cells
• scab formation
• re-epithelialisaiton
• fibroblastic proliferation
• healing and scar formation
• haemosiderin may be present from 24hrs

Question 19

Definition of a laceration

Answer 19

A tear in tissue produced by blunt force injury such that tissue is stretched, crushed, sheared or avulsed

Question 20

General features of lacerations

Answer 20

• common over bony prominences
• characterised by tissue bridges
• linear lacerations produced by long thin objects
• irregular or Y-shaped produced by flat objects or surfaces

Question 21

Where are defensive incised wounds found?

Answer 21

• palms
• backs of hands
• forearms
• upper arms

Question 22

Factors determining the skin appearance of a stab wound

Answer 22

• shape of the weapon
• angle of thrust
• movement of the blade
• skin tension
• Langer’s lines

Question 23

Stages of shock

Answer 23

• non-progressive (compensated)
• progressive
• irreversible

Question 24

Possible effects of shock (findings on PM)

Answer 24

• hypoxic-ischaemic encephalopathy
• subendocardial harmorrhage
• shock lung
• shock kidneys (ATN)
• centrilobular necrosis of liver
• adrenal gland haemorrhage
• gastric and duodenal ulceration (Curling’s and Cushings)

Question 25

Results of wound infection

Answer 25

• local sepsis
• septicaemia
• gas gangrene
• tetanus

Question 26

Major disorders associated with DIC

Answer 26

• trauma (crush, burns)
• obstetric (abruption, embolism)
• infections
• neoplasms (leukaemia)
• miscellaneous (snake bite)

Question 27

Definition of an embolism

Answer 27

An intravascular solid, liquid or gaseous material that is carried in the circulation and lodges within a blood vessel distant from its site or origin or point of entry into the circulation

Question 28

Origin of PE

Answer 28

• lower extremity
• right heart
• pelvic

Question 29

Mechanisms of air embolism

Answer 29

• trauma
• dysbarism
• therapeutic and diagnostic procedures
• obstetric

Question 30

Mechanisms of death in air embolism

Answer 30

• blockage of vessels
• acute right heart failure
• DIC

Question 31

Sources of fat embolism

Answer 31

• bone injuries
• soft tissue trauma
• burns
• pancreatitis

Question 32

Types of ballistics

Answer 32

• internal
• external
• terminal