We saw the infamous 26/11 at Mumbai, India. We lost some brave-hearts. Hence, we look into the forensics behind firearm injuries. We shall also discuss the JFK assassination case in brief. I would recommend downloading the presentation and view it in power point 2010 or above to see all the effects flawlessly.
We saw the infamous 26/11 at Mumbai, India. We lost some brave-hearts. Hence, we look into the forensics behind firearm injuries. We shall also discuss the JFK assassination case in brief. I would recommend downloading the presentation and view it in power point 2010 or above to see all the effects flawlessly.
Skull fractures (Regional injury part - 1)Suraj Dhara
THE REFERENCES ARE :
THE ESSENTIALS OF FORENSIC MEDICINE & TOXICOLOGY BY NARAYAN REDDY.
FORENSIC MEDICINE NOTHING BEYOND FOR PGMEE BY J MAGENDRAN.
REVIEW OF FORENSIC MEDICINE AND TOXICOLOGY BY GAUTAM BISWAS.
IMAGE SOURCE ....NETWORK
A POWER POINT PRESENTATION BY DR.SANGEETA CHOWDHRY & DR.SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Cutting and Stabbing Wounds - Criminal Documentation Darren Dake
This course is designed to introduce the student to the forensic importance of stabbing and cutting injuries.
This course will describe what these wounds are and how they are made. It will also explore each type of wound’s forensic importance to an investigation.
Skull fractures (Regional injury part - 1)Suraj Dhara
THE REFERENCES ARE :
THE ESSENTIALS OF FORENSIC MEDICINE & TOXICOLOGY BY NARAYAN REDDY.
FORENSIC MEDICINE NOTHING BEYOND FOR PGMEE BY J MAGENDRAN.
REVIEW OF FORENSIC MEDICINE AND TOXICOLOGY BY GAUTAM BISWAS.
IMAGE SOURCE ....NETWORK
A POWER POINT PRESENTATION BY DR.SANGEETA CHOWDHRY & DR.SUNIL SHARMA, DEPARTMENT OF FORENSIC MEDICINE & TOXICOLOGY, GOVT. MEDICAL COLLEGE, JAMMU (JAMMU AND KASHMIR)
Drowning is an inhalation of liquid in respiratory tract leading to suffocation and death. it can be wet or dry drowning depending upon the water entering in trachea. some times water touching the larynx leading to spasm and complete closure leading to dry drowning.
Cutting and Stabbing Wounds - Criminal Documentation Darren Dake
This course is designed to introduce the student to the forensic importance of stabbing and cutting injuries.
This course will describe what these wounds are and how they are made. It will also explore each type of wound’s forensic importance to an investigation.
This presentation illustrates different threat modes such as guns, ammunition and armours. The damage effect of bullets of different calibers are shown here. Development of armours and its types are discussed. This presentation gives a qualitative and quantifiable idea of threats and protect military had to deal with, while in operation
A lecture for 5th stage dental students.
any questions or notes please contact me on theses links :
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https://web.facebook.com/mohamedrahil.alhadithy
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https://twitter.com/DrMohamed_rahil
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. History
The gunpowder was first discovered by Chinese and
transmitted to Europe around the thirteenth century
It quickly followed by the development of projectile
weapons based on its explosive Properties
The first recorded use of a cannon was by
Edward III against the Scots in 1327
small arms carried by one or two soldiers
began appearing in the fourteenth century
3. GSWs are the second most source of injury and death , after motor
vehicle accidents .
The majority of civilian firearm injuries are sustained from handguns
(86%), followed by shotguns (8%) and rifles (5%).
40% involved the frontal bone and cranium, 9% involved
the orbits, 14% involved the maxilla , 13% involved the
mandible, and 24% involved multiple sites.
Shotgun injuries most commonly involved the mandible followed by
the maxilla and zygoma Then orbits and nasal bones .
36% 0f patients die following admission. All of the deaths were
secondary to injuries to the chest, abdomen,or brain. There is small
percentage of deaths associated with isolated facial injuries
Demographics
4. Ballistics
Ballistics is the science of projectile motion.
The potential problems of a wound caused by a
projectile can be better anticipated if one has some
knowledge of the weapon and projectile type that
cause the wound.
Ballistic science typically divided into three stages :
o Internal ballistics
o External ballistics
o Terminal ballistics
5. Internal (or interior) ballistics
describes the forces that apply to
a projectile from the time the
propellant is ignited to the time
the projectile leaves the barrel .
An important consideration is
barrel length , longer barrels
(rifles) allow the force of the
propellant to act on the projectile
longer and generate higher
velocities than do shorter-
barreled weapons. In addition, a
longer barrel serves to stabilize
the bullet over longer distances.
6. Most handguns and rifles have barrels
with internal grooves referred to as
rifling , This keeps the projectile stable in
flight over longer distances
7. External ballistics
refers to forces that act on
the bullet in flight.
The primary factors that
govern external ballistics
are the weight and shape of
the bullet .
8. Terminal ballistics
is the study of bullet
behavior once it impacts the
target .
The science of termal
ballistics is most important
to the surgeon and is the
most common source of
controversy when discussing
ballistic wounding .
9. Factors
which affect
the degree
of injury
Velocity of
the bullet
Mass of
the bullet
Size of
the bullet
Drag and
retardation
Composition
and shape
of the bullet
Extent of
the
cavitation
Extent of
deviation
(yaw) of
the bullet
10. Velocity and Mass of the bullet
kinetic energy has been used as the basis to explain wounds caused
by the gunshot
KE = mv2
where KE is kinetic energy , ( m ) is the mass of the projectile, and ( v )
is the velocity of the projectile .
Wounding power is typically related to the amount of kinetic energy
transferred to the target: P = m(V impact – V exit)2 where P is
power, m is mass of the projectile,and V is velocity
Based on these formulas, the velocity of a projectile considered
more important than its mass in wounding power .
Considering a typically sized projectile velocity of approximately 50
m/s is required to penetrate the skin, and a velocity of around 65
m/s will fracture the bone .
11. Composition and shape of the bullet
earliest projectile was a stone or
lead ball .
Over time the projectile evolved to
the conical-shape .
full-metal jacket with exposed lead
tips to expand on impact for
maximum tissue destruction
hollow points handgun bullets
evolved to compensate for their low
velocity which is difficult to expand
in tissue.
some bullets are designed to explode
when impact .
12.
13. Extent of deviation of the bullet
all projectiles become unstable in flight because
of the center of gravity lies behind the center of
resistance of the bullet (bullet tip )
yaw ; Oscillation of the bullet around there
long axis
tumble ; rotation of the bullet around there
center .
when the projectile encounter a denser
substance such as tissue, it will starts tumbling
lead to Increase in their profiles causes more
tissue wounding because it presents a larger
surface area , Increase in the rate of kinetic
energy dissipation and Increased probability of
fragmentation .
15. low velocity
• ( < 350 m/s )
Intermediate velocity
• (350–600 m/s)
high velocity
• (> 600 m/s)
Classification of gunshot according to
velocity
16. Components of projectile wounding:
Penetration : a bullet must
penetrate to a sufficient depth
to cause damage.
Permanent cavity : the space
that results from direct tissue
disruption and destruction.
Temporary cavity : results in
stretching Of elastic tissues .
Fragmentation : missile
fragment or secondary
fragments such as clothing or
bone.
18. Also called pistols and revolvers
Low or intermediate velocity
Characterised by short barrel
Handguns
19. Rifles intermediate to high velocity
Charectarised by long barrel so the bullet has
more time to accelerate
20. Features of high velocity missile:
1) Temporary cavity :
results from stretching Of elastic
tissues
most tissues has an elastic nature and
ability to recover from stretching except
some tissues such as brain ,liver,spleen
damage from temporary cavitation is
not so important In the face : air
cavities mitigate the effect of cavitation
21. 2) Stress wave :
Precedes the cavitation phenomena
Not like the shock wave it does not have
the characteristic or velocity of the shock
wave produced by an explosion
Transmitted through fluid filled
structures like blood vessels causing
endothelial damage and thrombosis
Fracture of bone away from the wound
tract is due to stress wave rather than
cavitation
For maxillofacial region : the stress wave
is more important than cavitation .
22.
23. Shotguns
low to intermediate velocity
The charge from shotgun consist of
several hundred lead pellets
Because of their unique ballistic
profile,shotgun injuries are often
classified based on the distance to
the target …..
24. • Type I < 5 m ;
• the pellets strike the target as a single mass,
• resulting in massive kinetic energy transfer and
tissue avulsion
• high mortality rate (85–90%)
• Type II injuries (5–12 m) ;
• usually result in much less tissue destruction.
• there is significant dispersal of the pellets and
loss of energy.
• Penetration may occur through deep fascia,
but fractures are rare. Ocular injuries can occur
as well as embolization of lead pellets,
• mortality rate (15–20%)
• Type III injuries > 12 m ;
• usually only the skin is penetrated
• mortality is rare (0–5%)
27. Bomb blast injuries :
•Burns from the flash of explosion .
•Blast wave ( shock wave ) of the explosion
•Direct injury
•Indirect violence
Blast wave of the explosion :
1)positive phase: very high pressure travelling
faster than the speed of air last for few milliseconds
2)negative phase : low pressure of longer duration
Also the blast wave ( shock wave ) has “ spalling “
effect when pass from one medium to another of
less density which cause the medium to spall
“fragments “
So the shock wave damage in three ways :
• Hydrostatic pressure of the shock
( positive phase )
• Dynamic pressure of the shock which follow
the hydrostatic pressure behind it ( negative
phase ).
• Spalling effect
28.
29.
30.
31. Type of missile wounds :
• Nonpenetrating : grazing
or blast wound
• Penetrating : low impact
velocity ,bullet does not exit
• Perforating : high velocity
, bullet in and out
• Avulsive : massive
wounds with avulsion and
loss of tissues .
32.
33. Management of gunshot wounds :
Late phase
soft tissue and bone reconstruction
Intermediate phase
Diet and feeding Oral hygiene Control of infection
Immediate management
primary survey
(A,B,C,D,E )
Secondary survey primary surgery
34.
35. airway
• Loss of the airway is the most likely cause of death in
an isolated GSW to the face
• Immediately clear the lumen of the airway
• Maintain airway patency by three methods :
1. Gravity
2. Endotaracheal intubation
3. Upper airway bypass
36. Gravity
• Patient placed prone with his
forehead suspended so that
the tongue and mandible may
forwords and any debris
,blood,vomit will fall out and
thus preventing inhalation
• If there is reduction in the level
of neurological response
,placing the patient in recovery
position may be adequate but
with repeated suction of the
lumen
• In nonconscious patient oral
airway can be used
37. Endotaracheal intubation
• cuff tube inserted either by
oral or nasal route
• It is difficult to be placed in
patient with missile head and
neck injury because patient
usually conscious ,highly
distressed and hypoxic and so
not tolerated it
38. Upper airway bypass
Used when other techniques
failed
Include two procedures ;
1. Cricothyroidotomy
2. tracheostomy
39. Hemorrhage Control
Initial control of hemorrhage in the emergency department center is
by direct pressure and packing.
Blind clamping should be avoided because of the attendant risk of
damage to other structures .
Standard methods for epistaxis control such as Foley catheters or
specially designed balloon catheters will control most midface
bleeding
In cases of mandible fractures,temporary reduction of the fracture
may be required.
Indications for angiography include expanding hematoma and
bleeding that persists despite local measures.
Lacerations of the internal jugular artery are best controlled with
ligation or repair
40. Primary surgery
A)Debridment of the wound :
wound should heavily irrigated with normal saline
and all foreign bodies removed as it is visible .
antiseptic solution such as 1% cetrimide can be used
for cleaning the wound .
Small completely detached pieces of bone better to
be removed
all pieces with any viable soft tissue attachment
should be conserved
B)Management of involved teeth :
o Teeth remote to fracture tend to fracture
transversely below the gingiva ( in contrast to
maxilla )
o all invovled and broken teeth should be removed
unless used for fixation and then should be
removed after fixation completed because it will be
source of infection
41. C)Reduction and Fixation :
Closed reduction
Open reduction
D)Closure of mucosa and skin
Primary suture within 24 hr. give best aesthetic result
Delayed wounds or contaminated, managed by packing and delayed
suturing
In high velocity injury Serial surgical debridement” second-look
procedures”, at 24-to 48 hours intervals which reopen the soft tissue to
define additional areas of soft tissue necrosis, drain hematoma or
developing fluid collections, and ensure bone integrity.
Closure Should be watertightl except in area selected for through –and
through drainage
Closure of palatal defect may be extremely difficult and in this situation
better to be packed .
42. E)Drainage :
All shotgun wounds of the mandible should be drained and it is
better to be placed in several places
Where ever possible , placed away from suture lines
In contaminated comminuted fracture the drain better be (through
–and through ) to facilitate irrigation
Removal of the drain depend on the amount of discharge on the
dressing which should be changed at least once daily
In general drain should be removed after progressive shortening
within the first 10 postoperative days .
43. management of Skin loss
o if skin loss (< 2 cm) it should be
reconstructed by undermining
o If more ( > 2 cm ) it managed by :
• Dressing to promot epithelialisation
• Covered by split skin graft
• Transposed flap
• Free flap
44. Contamination
The projectiles from firearms are not sterile , The heat generated by
the discharge of the propellant as well as the friction between the
bullet and barrel is not sufficient to sterilize the bullet.
Contamination can occur from the bullet and also from skin flora and
foreign bodies (clothing) carried into the wound ,and wounds in
which the bullet traverses the aerodigestive tract or paranasal
sinuses are at particular risk .
Prophylactic coverage with broad-spectrum antibiotics, typically a
second-generation cephalosporin, and tetanus prophylaxis,should be
initiated in all gunshot wounds.
Lead toxicity may occure but it is a rare complication
45. Management of foreign bodies within the tissues
Evaluation of the risk of removal
Small fragments may not be possible to removed all
Larger fragments should be removed if :
a. Pain
b. Tendernes
c. Deformity
d. Infection
e. brass- or copper-jacketed bullets that are in close
proximity to central or major peripheral nerves because
of potential neurotoxicity
46. Penetrating injury of the neck
Management strategies for penetrating
neck injuries are typically based on the
zone(s) Involved
Zone I ; from the clavicles to the cricoid
cartilage
Zone II ; from the cricoid cartilage to
the angle of the mandible .
Zone III ; from the skull base to the
angle of the mandible
48. Intermediate care :
• Diet and feeding
• Liquid diet
• Nasogastric tube can be used in extensive injury
• When there is loss of oral sphenicter saliva shield made of acrylic or silicon can be used
• gastrostomy if longterm bypass of the oral cavity is necessary
• Oral hygiene
• Mouth wash with antiseptic solution (chlorhexidine )
• Active irrigation with 4% sodium bicarbonate at least once daily
• Brashing by soft tooth brush
• 1% hydrocortisone ointment applied regularly to the lip
• Control of infection
• Prophylactic antibiotic to prevent infection especially meningitis and pulmonary infection
• Infection of fracture site : controled by intermediate surgery to remove teeth or sequestra
with drainage of pus if present and do culture and sensetivety test to advocate the
appropreiat antibiotic
• Early mobilisation and physiotherapy to prevent thrombophlebitis
49. Secondary or late reconstruction treatment :
It is difficult to restore function and appearance in the
secondary phase so every effort is made to minimise the
residual defect during the initial surgical management
delayed reconstruction in gunshot wounds that resulted from
suicide attempts
50. References ;
Rowe and williams maxillofacial injurries
PETERSON'S PRINCIPLES OF ORAL AND MAXILLOFACIAL
SURGERY
Second Edition
Articles from internet