Penetrating Trauma

Question 1

How many deaths occur each year in Canada from shootings

Answer 1

1300

Question 2

factors affecting energy exchange between a projectile and body tissue

Answer 2

velocity
profile
stability
expansion and fragmentation
secondary impacts
shape

Question 3

What is a Handgun

Answer 3

A hand gun is a small-caliber, short-barreled, medium-velocity firearm that is most effective at close range. The severity of injury is usually related to organs directly damaged by the bullets passage.

Question 4

What is a Rifle

Answer 4

A rifle is a high energy firearm which travel much farther with greater accuracy. This will result in extensive wounds with injuries that extend beyond the projectiles immediate track. The energy carried by a rifle bullet is extremely damaging because of its heavier weight and very high velocity

Question 5

What is an Assault Rifle

Answer 5

different than the domestic hunting rifle. it has larger magazine capacity. the energy is not as severe as with domestic hunting ammunition.

Question 6

What is a Shotgun

Answer 6

A shotgun expels a single projectile or numerous spheres at a medium velocity. the larger the shot, the smaller the number of projectiles. Injuries sustained at close range can be very severe or lethal.

Question 7

Factors associated with the damage pathway of a projectile wound

Answer 7

direct injury
pressure shock wave
cavitation

Question 8

Direct Injury

Answer 8

the damage done as the projectile strikes tissue, contuses and tears that tissue, and pushes the tissue out of its way.

Question 9

Pressure Shock Wave

Answer 9

when a high-velocity, high-energy projectile strikes human flesh, it creates a pressure shock wave. it travels very well through fluid, such as blood and may injure blood vessels distant from the projectile pathway. air filled cavities such as the small air sacs (alveoli) of the lung, compress very easily and absorb the pressure, quickly limiting the shock wave and the resulting temporary cavity. solid and dense organs such as the liver and spleen suffer greatly as the pressure wave moves through them, causing internal hemorrhage and in extreme cases fracture

Question 10

Cavitation

Answer 10

temporary - a space created behind the high-energy bullet as tissue moves rapidly away from the bullets path. Cavitation also produces a sub-atmospheric pressure within the cavity as it expands. this means that air is drawn in from the entrance wound and the exit wound (if one exists)
Permanent - the movement that creates the temporary cavity crushes, stretches and tears the affected tissues. these processes seriously damage the area in and adjacent to the bullets path and may also damage the tissues elasticity.
Zone of Injury - associated with most projectile wounds that extends beyond the permanent cavity. this zone contains contused tissue that does not function normally and may be slow to heal because of cell and tissue damage, disrupted blood flow, and infection.

Question 11

A hollow organ in a penetrating trauma

Answer 11

hollow organs such as the bowel, stomach, urinary bladder and heart are muscular containers holding fluid if damaged can cause leakage of is contents. if this occurs with the heart it may produce pericardial tamponade or moderate and slowly life-threatening hemorrhage.

Question 12

pericardial tamponade

Answer 12

filling the pericardial sac with fluid, which in turn, limits the filling and function of the heart.

Question 13

body regions deserving special attention with penetrating trauma

Answer 13

extremities, abdomen, thorax, neck, head

Question 14

critical structures in which the seriousness of a bullet’s impact is increased

Answer 14

brain, great vessels, heart, liver, kidneys and pancreas.

Question 15

Any penetrating projectile injury to the abdomen is considerd

Answer 15

serious and to have the potential to cause severe hemorrhage

Question 16

The entrance wound is often …

Answer 16

the same size as the projectiles profile and may demonstrate some bruising on the inner border or the wound

Question 17

The exit wound may…

Answer 17

more accurately reflect the potential damage caused by a bullets passage through the body than an entrance wound

Question 18

What is the first thing you should make sure of when coming onto scene involving a stabbing/shooting

Answer 18

have police secure it before entering and consider the possibility the patient may be carrying a weapon and have the police search the patient if necessary

Question 19

provide rapid transport to patients with bullet wounds to the …

Answer 19

head, chest, or abdomen and treat aggressively for shock

Question 20

Anticipate a developing tension pneumothorax if…

Answer 20

your assessment reveals frothy blood in a patient with a bullet wound to the chest

Question 21

how do you seal open chest wounds

Answer 21

with a three sided dressing or Asherman chest seal and ensure adequate respiration’s

Question 22

An object that has twice the mass of another object traveling at the same speed has:

Answer 22

twice the kinetic energy.

Question 23

The diameter of a projectile is referred to as its

Answer 23

calibre

Question 24

When compared to rifle bullets, handgun bullets are:

Answer 24

a blunter shape

Question 25

The region filled with disrupted tissues, some air, fluid, and debris in the projectile injury process is the:

Answer 25

permanent cavity

Question 26

The tissue structures that are very dense and usually sustain significant damage with the passage of a projectile are the

Answer 26

solid organs

Question 27

The tissue structures that are very resilient and usually sustain the smallest amount of damage associated with the passage of a projectile are the

Answer 27

lungs

Question 28

The abdominal organ rather tolerant to the passage of a projectile is the

Answer 28

bowel

Question 29

Generally, ‘burns’ and tattooing around the entrance of a wound suggest use of a(n)

Answer 29

gun at close range

Question 30

Exit wounds are frequently associated with:

Answer 30

a blown-out appearance

Question 31

The study of the characteristics of projectiles in motion and their effects on objects they strike is called:

Answer 31

ballistics

Question 32

High-velocity projectiles create a shock wave and a temporary vacuum-like cavity in body tissues referred to as

Answer 32

cavitation

Question 33

The energy exchange surface of a projectile is the:

Answer 33

profile

Question 34

Due to a rifle bullet’s centre of mass and energy, when it hits human tissue the rifle bullet generally

Answer 34

rotates 180 degrees and continues to travel base first

Question 35

A projectile’s diameter increases as it contacts the target because the

Answer 35

nose of the bullet mushrooms

Question 36

To create less lethal blunt trauma, many emergency service providers wear body armour made of KevlarTM or use:

Answer 36

ceramic inserts

Question 37

Handgun ammunition is more resistant to travel through human tissue, and releases kinetic energy:

Answer 37

more quickly

Question 38

If a bullet fragments, the projectile will give up its energy:

Answer 38

more rapidly than if it was to stay intact.

Question 39

The damage potential associated with automatic weapons is increased because of the:

Answer 39

likelihood of multiple impacts.

Question 40

Domestic hunting ammunition is especially lethal because it is often designed to:

Answer 40

expand dramatically on impact

Question 41

The assault rifle differs from the domestic hunting rifle in that it generally has:

Answer 41

a larger magazine capacity

Question 42

The weapon that expels a single projectile with numerous pellets at a medium velocity is a(n):

Answer 42

shotgun

Question 43

Knife and arrow wounds are often difficult to assess because:

Answer 43

the depth of the wound is difficult to estimate

Question 44

The damage done as the projectile strikes tissue, contuses, and tears that tissue is the:

Answer 44

direct injury.

Question 45

The space created behind the high-energy bullet as tissue moves rapidly away from the bullet’s path is the

Answer 45

temporary cavity

Question 46

Most of the human organs are contained in the largest body cavity known as the

Answer 46

abdomen