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Ch03 penetrating
- 1. Paramedic Care: Principles &Practice Volume 5 Trauma Emergencies
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- 3. Topics Introduction to PenetratingTrauma Kinetics of Penetrating Trauma Specific Tissue/Organ Injuries Special Concerns with Penetrating Trauma
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- 5. Introduction to Penetrating Trauma Thereare 30,000 deaths in the U.S. annually due to shootings. Other mechanisms of penetrating trauma include: Knives, arrows, nails, etc. Understanding the principles of energy exchange increases the index of suspicion associated with the MOI.
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- 7. Kinetics of PenetratingTrauma When a projectile strikes a target, it exchanges its kinetic energy with the object struck. An objectโs kinetic energy is equal to its mass times the square of its velocity, all divided by 2.
- 8. Kinetics of Penetrating Trauma Thegreater the mass of an object, the greater its energy. If you double the mass of an object, it will have twice the kinetic energy. The speed (or velocity) of an object has a squared relationship to its kinetic energy. If you double the speed of an object, its kinetic energy increases by fourfold.
- 9. Ballistics Study of thecharacteristics of projectiles in motion and effects upon objects impacted Factors affecting energy exchange between a projectile and body tissue: Velocity Profile Stability Expansion and fragmentation Secondary Impacts Shape
- 10. Ballistics Velocity Causes trajectory Faster =straighter trajectory Slower = more curved due to gravity
- 11. Ballistics Profile Portion of bulletyou see as it travels toward you Larger profile = greater energy exchange Caliber Diameter of a bullet (ID of gun) 0.22 caliber = 0.22 inches Bullets become unstable as they pass from one medium to another. Collection of Robert Porter
- 12. Ballistics Stability Bullet length increasesbullet tumbling Can reduce the accuracy of the shot Reduced by rifling in barrel (spinning) Yaw Gyroscopic effect on the center axis of the bullet that reduces tumbling Tumbling of bullet once it strikes object Increases rate of energy exchange Greater tissue damage
- 13. Ballistics Expansion and Fragmentation Results inincreased profile Mushrooming Initial impact forces may result in fragmenting Greater tissue damage Both: Collection of Robert Porter
- 14. Ballistics Secondary Impacts Bullet strikingother objects can cause yaw and tumble Body armor (Kevlar) Transmits energy throughout entire vest resulting in blunt trauma Myocardial contusion Pulmonary contusion Rib fractures
- 15. Ballistics Shape Handgun ammunition israther blunt More resistant to travel through human tissue Releases kinetic energy more quickly Rifle bullets are more pointed and cut through the tissue more efficiently May tumble or fragment
- 17. Specific Weapon Characteristics Handguns Often asmall-caliber, short-barreled, medium-velocity weapon Severity of injury is related to the organs directly damaged by the bulletโs passage Collection of Robert Porter
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- 19. Specific Weapon Characteristics Rifle Heavier projectile Longerbarrel Greater muzzle velocity Bullet travels much farther, with greater accuracy, and retains much more of its kinetic energy Collection of Robert Porter
- 20. Specific Weapon Characteristics Assault Rifle Generallyhas a larger magazine capacity Multiple wounds and casualties can be expected Will fire in both the semiautomatic and automatic mode
- 22. Specific Weapon Characteristics Shotgun May firea single projectile (a slug) or numerous spheres (pellets or shot) at medium velocity The larger the shot, the smaller the number of projectiles
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- 25. Specific Weapon Characteristics Knives andArrows Slow-moving, penetrating objects cause low-velocity, low-energy wounds Usually limited to physical injury caused by direct contact between the blade or object and the victimโs tissue Hunting tips designed for arrows can be especially damaging
- 26. Biomechanics of Penetrating Trauma DirectInjury Occurs as the projectile strikes tissue, contuses and tears that tissue, and displaces the tissue Limited to the profile of the bullet as it moves through the body Handgun bullet damage is usually limited to direct injury
- 27. Biomechanics of Penetrating Trauma PressureShock Wave When a high-velocity high- energy projectile strikes human tissue, it creates a pressure shock wave. The faster and more blunt the bullet, the greater the effect.
- 28. Biomechanics of Penetrating Trauma TemporaryCavity Space created behind the high-energy bullet as tissue moves rapidly away from the bulletโs path After the bulletโs passage, tissue elasticity causes the temporary cavity to close Cavitation
- 29. Biomechanics of Penetrating Trauma PermanentCavity Tissue may not return to its normal orientation, resulting in a permanent cavity Cavity fills with debris Zone of Injury Zone of injury extends beyond the permanent cavity May be slow to heal
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- 31. Low-Velocity Wounds Objects Knives, ice-picks,arrows Flying objects or debris Injury limited to tissue impacted Object pathway Object twisting or moved Oblique angle Attacker Characteristics Males: outward and crosswise Females: overhand and downward
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- 33. Specific Tissue/Organ Injuries Connective Tissue Absorbsenergy and limits tissue damage Organs Solid organs Dense and low resilience Hemorrhage associated with solid organ projectile damage is often severe Hollow organs Fluid filled: transmit energy = increased damage Air filled: absorb energy = less damage
- 34. Connective Tissue Including musclesand skin Dense, elastic, hold together well โAbsorb energy while limiting tissue damageโ Damage is limited to projectileโs pathway
- 35. Solid Organs Liver, spleen,kidneys, pancreas, brain Have density but not resiliency Hemorrhage is often severe Damage outside of the profile
- 36. Hollow Organs Bowel, stomach,heart, bladder Muscular and hold fluid If filled with fluid, organ may tear explosively If filled with air (not distended), injury tolerated Pericardial tamponade
- 37. Specific Tissue/Organ Injuries Lungs Air inlung absorbs energy Parenchyma is compressed and rebounds Pneumothorax or hemothorax can result Bone Resists displacement until it shatters Alters projectile path
- 38. General Body Regions Extremities Injurylimited to resiliency of tissue 60โ80% of injuries with <10% mortality Do not immediately threaten life Injuries above the elbow or knee are more likely to cause significant vascular injury Abdomen (includes pelvis) Highly susceptible to injury and hemorrhage Bowel perforation: 12โ24 hrs. peritoneal irritation
- 39. General Body Regions Thorax Ribimpact results in explosive energy. Heart and great vessels have extensive damage due to lack of fluid compression. Any large chest wound compromises breathing.
- 40. General Body Regions Neck Damagestrachea and blood vessels Neurological problems Sucking neck wound Head Cavitational energy trapped inside skull Serious bleeding, lethal
- 42. Wound Characteristics Entrance Wounds Sizeof bullet profile for non-deforming bullets Deforming projectiles may cause large wounds Close range Powder burns (tattooing of powder) Exit Wounds Appear to be โblownโ outward Pressure wave ยฉ Edward T. Dickinson, MD
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- 44. Special Concerns With PenetratingTrauma Scene Size-up Law enforcement DO NOT ENTER UNTIL SCENE IS SAFE! Weapons: victim or assailant Preserve crime scene when possible ยฉ Mikael Karlsson/On Scene Photography
- 45. Special Concerns With PenetratingTrauma Penetrating Wound Assessment Try to determine the pathway of the penetrating object Internal organ injury potential Entrance and exit wounds
- 46. Special Concerns With PenetratingTrauma Penetrating Wound Care Facial wounds Facial gunshot wounds destroy many airway landmarks Cricothyrotomy may provide temporary airway care Collection of Robert Porter
- 47. Special Concerns With PenetratingTrauma Penetrating Wound Care Chest wounds Requires a large wound to be present for air to move into the chest cavity Open pnuemothorax Tension pnuemothorax Consider the possibility of heart and great vessel damage Pericardial tamponade
- 48. Special Concerns With PenetratingTrauma Impaled Objects Low energy Dangerous to remove Do not remove unless: In cheek, neck, or trachea Interferes with CPR
- 56. Summary Introduction to PenetratingTrauma Kinetics of Penetrating Trauma Specific Tissue/Organ Injuries Special Concerns with Penetrating Trauma