外科急診創(chuàng)傷(英文)-貫通傷課件

1、Penetrating TraumaSections Introduction to Penetrating TraumaPhysics of Penetrating TraumaSpecific Tissue/Organ InjuriesSpecial Concerns with Penetrating Trauma38,000 Deaths in US annually due to shootings.Mechanisms of penetrating traumaKnives, Arrows, Nails, etcUnderstanding principles of energy e

2、xchange increase the Index of Suspicion associated with the MOIIntroduction to Penetrating TraumaRecall Kinetic Energy EquationGreater the mass the greater the energyDouble mass = double KEGreater the speed the greater the energyDouble speed = 4x increase KEPhysics of Penetrating Trauma(continued)Ph

3、ysics of Penetrating TraumaSmall & Fast bullet can cause greater damage than large and slow.Different bullets of different weights traveling at different speeds causeLow Energy/Low VelocityKnives and arrowsMedium Energy/Medium Velocity WeaponsHandguns, shotguns, low-powered rifles250-400 mpsHigh Ene

4、rgy/High VelocityAssault Rifles600-1,000 mps(continued)Physics of Penetrating TraumaBullet spins as it travels down barrelRifling in barrelAllows bullet to travel straight with slight yawBullet departs barrel, spinning with a slight wobble or yawWeapon forced backward and absorbs energyRecoil(contin

5、ued)Energy DissipationDrag: wind resistanceCavitation: formation of a partial vacuum and cavity within a semi-fluid mediumProfile: Size and shape of a projectile as it contacts a targetLarger the profile=greater energy exchangeExpansion and fragmentation results in damageStabilityAllows for straight

6、er trajectoryDecreases after striking object results in tumblingAspects of BallisticsStabilityBullet length increases bullet tumblingCan reduce the accuracy of the shotReduced by Rifling in barrel (spinning)YawGyroscopic effect on the center axis of the bullet that reduces tumblingTumbling of bullet

7、 once it strikes objectReduces kinetic energyGreater tissue damageBullet Gyroscopic EffectAspects of BallisticsExpansion & FragmentationResults in increased profileMushroomingInitial impact forces may result in fragmentingGreater tissue damageHandgunsSmall caliber, short barrel, medium-velocityEffec

8、tive at close rangeSeverity of injury based upon organs damagedRifleHigh-velocity, longer barrel, large caliberIncreased accuracy at far distancesAssault RiflesLarge magazine, semi- or full-automaticSimilar injury to hunting riflesMultiple woundsSpecific Weapon CharacteristicsShotgunSlug or pellets

9、at medium velocity00 (1/3”) to #9 (pin head sized)Larger the load, the smaller the number of projectilesDeadly at close rangeKnives & ArrowsLow-energy & low-velocityDamage related to depth and angle of attackMovement of the victim can increase damageSpecific Weapon CharacteristicsDamage PathwayProje

10、ctile Injury ProcessTip impacts tissueTissue pushed forward and to the sideTissue collides with adjacent tissueShock wave of pressure forward and lateralMoves perpendicular to bullet pathRapid compression, crushes and tears tissueCavity forms behind bullet pulling in debris with suction.Damage Pathw

11、ayDirect InjuryDamage done as the projectile strikes tissuePressure Shock WaveHuman tissue is semi-fluidSolid and dense organs are damaged greatlyTemporary CavityDue to cavitationPermanent CavityDue to seriously damaged tissueZone of InjuryArea that extends beyond the area of permanent injuryBallist

12、ics CavitationLow-Velocity WoundsObjectsKnives, Ice-picks, ArrowsFlying objects or debrisInjury limited to tissue impactedObject pathwayObject twisting or movedOblique angleAttacker CharacteristicsMales: outward and crosswiseFemales: overhand and downwardDensity of tissue affects the efficiency of e

13、nergy transmissionResiliencyStrength and elasticity of an objectConnective TissueAbsorbs energy and limits tissue damageOrgansSolid OrgansDense and low resilienceHollow OrgansFluid filled: transmit energy = increased damageAir filled: absorbs energy = less damageSpecific Tissue & Organ InjuriesLungs

14、Air in lung absorbs energyParenchyma is compressed and reboundsPneumothorax or hemothorax can resultBoneResists displacement until it shattersAlters projectile pathSpecific Tissue & Organ InjuriesGeneral Body RegionsExtremitiesInjury limited to resiliency of tissue60-80% of injuries with 10% mortali

15、tyAbdomen (Includes Pelvis)Highly susceptible to injury and hemorrhageBowel perforation: 12-24 hrs peritoneal irritationThoraxRib impact results in explosive energyHeart & great vessels have extensive damage due to lack of fluid compressionAny large chest wound compromises breathingGeneral Body Regi

16、onsNeckDamages Trachea and Blood VesselsNeurological problemsSucking neck woundHeadCavitational energy trapped inside skullSerious bleeding and lethalWound CharacteristicsEntrance WoundsSize of bullet profile for non-deforming bulletsDeforming projectiles may cause large woundsClose RangePowder Burn

17、s (Tattooing of powder)1-2 mm circle of discolorationLocalized subcutaneous emphysemaExit WoundsAppears to be “Blown” outwardPressure waveScene Size-UpLaw-EnforcementDO NOT ENTER UNTIL SCENE IS SAFE!Weapons: Victim or AssailantAssailantsIF A CRIME SCENEDOCUMENTDO NOT DISTURB EVIDENCERETAIN CLOTHING,

18、 ETCLIMIT PERSONNEL INVOLVEMENTSpecial Concerns with Penetrating TraumaPenetrating Wound AssessmentInternal Organ Injury PotentialEntrance & Exit WoundsSpecial Concerns with Penetrating TraumaPROVIDE RAPID TRANSPORT FOR ANY GSW TO HEAD, CHEST,OR ABDOMEN. TREAT AGGRESIVELY FOR SHOCK!Penetrating Wound CareFacial WoundsDifficult intubationsDepress chestPass ET through bubbling tissueConsider LMA and CombitubeConsider Cricothyreotomy & CricothyreostomyChest WoundsPneumothorax2/3” th