Penetrating Trauma Flashcards
How many deaths occur each year in Canada from shootings
1300
factors affecting energy exchange between a projectile and body tissue
velocity profile stability expansion and fragmentation secondary impacts shape
What is a Handgun
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.
What is a Rifle
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
What is an Assault Rifle
different than the domestic hunting rifle. it has larger magazine capacity. the energy is not as severe as with domestic hunting ammunition.
What is a Shotgun
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.
Factors associated with the damage pathway of a projectile wound
direct injury
pressure shock wave
cavitation
Direct Injury
the damage done as the projectile strikes tissue, contuses and tears that tissue, and pushes the tissue out of its way.
Pressure Shock Wave
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
Cavitation
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.
A hollow organ in a penetrating trauma
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.
pericardial tamponade
filling the pericardial sac with fluid, which in turn, limits the filling and function of the heart.
body regions deserving special attention with penetrating trauma
extremities, abdomen, thorax, neck, head
critical structures in which the seriousness of a bullet’s impact is increased
brain, great vessels, heart, liver, kidneys and pancreas.
Any penetrating projectile injury to the abdomen is considerd
serious and to have the potential to cause severe hemorrhage
The entrance wound is often …
the same size as the projectiles profile and may demonstrate some bruising on the inner border or the wound
The exit wound may…
more accurately reflect the potential damage caused by a bullets passage through the body than an entrance wound
What is the first thing you should make sure of when coming onto scene involving a stabbing/shooting
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
provide rapid transport to patients with bullet wounds to the …
head, chest, or abdomen and treat aggressively for shock
Anticipate a developing tension pneumothorax if…
your assessment reveals frothy blood in a patient with a bullet wound to the chest
how do you seal open chest wounds
with a three sided dressing or Asherman chest seal and ensure adequate respiration’s
An object that has twice the mass of another object traveling at the same speed has:
twice the kinetic energy.
The diameter of a projectile is referred to as its
calibre
When compared to rifle bullets, handgun bullets are:
a blunter shape
The region filled with disrupted tissues, some air, fluid, and debris in the projectile injury process is the:
permanent cavity
The tissue structures that are very dense and usually sustain significant damage with the passage of a projectile are the
solid organs
The tissue structures that are very resilient and usually sustain the smallest amount of damage associated with the passage of a projectile are the
lungs
The abdominal organ rather tolerant to the passage of a projectile is the
bowel
Generally, ‘burns’ and tattooing around the entrance of a wound suggest use of a(n)
gun at close range
Exit wounds are frequently associated with:
a blown-out appearance
The study of the characteristics of projectiles in motion and their effects on objects they strike is called:
ballistics
High-velocity projectiles create a shock wave and a temporary vacuum-like cavity in body tissues referred to as
cavitation
The energy exchange surface of a projectile is the:
profile
Due to a rifle bullet’s centre of mass and energy, when it hits human tissue the rifle bullet generally
rotates 180 degrees and continues to travel base first
A projectile’s diameter increases as it contacts the target because the
nose of the bullet mushrooms
To create less lethal blunt trauma, many emergency service providers wear body armour made of KevlarTM or use:
ceramic inserts
Handgun ammunition is more resistant to travel through human tissue, and releases kinetic energy:
more quickly
If a bullet fragments, the projectile will give up its energy:
more rapidly than if it was to stay intact.
The damage potential associated with automatic weapons is increased because of the:
likelihood of multiple impacts.
Domestic hunting ammunition is especially lethal because it is often designed to:
expand dramatically on impact
The assault rifle differs from the domestic hunting rifle in that it generally has:
a larger magazine capacity
The weapon that expels a single projectile with numerous pellets at a medium velocity is a(n):
shotgun
Knife and arrow wounds are often difficult to assess because:
the depth of the wound is difficult to estimate
The damage done as the projectile strikes tissue, contuses, and tears that tissue is the:
direct injury.
The space created behind the high-energy bullet as tissue moves rapidly away from the bullet’s path is the
temporary cavity
Most of the human organs are contained in the largest body cavity known as the
abdomen
