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PenetratingTrauma
PenetratingTrauma
Sections IntroductiontoPenetratingTraumaPhysicsofPenetratingTraumaSpecificTissue/OrganInjuriesSpecialConcernswithPenetratingTraumaSections IntroductiontoPene38,000DeathsinUSannuallyduetoshootings.MechanismsofpenetratingtraumaKnives,Arrows,Nails,etcUnderstandingprinciplesofenergyexchangeincreasetheIndexofSuspicionassociatedwiththeMOIIntroductionto
PenetratingTrauma38,000DeathsinUSannuallydRecallKineticEnergyEquationGreaterthemassthegreatertheenergyDoublemass=doubleKEGreaterthespeedthegreatertheenergyDoublespeed=4xincreaseKEPhysicsof
PenetratingTrauma(continued)RecallKineticEnergyEquation外科急診創(chuàng)傷(英文)貫通傷資料課件Physicsof
PenetratingTraumaSmall&Fastbulletcancausegreaterdamagethanlargeandslow.DifferentbulletsofdifferentweightstravelingatdifferentspeedscauseLowEnergy/LowVelocityKnivesandarrowsMediumEnergy/MediumVelocityWeaponsHandguns,shotguns,low-poweredrifles250-400mpsHighEnergy/HighVelocityAssaultRifles600-1,000mps(continued)Physicsof
PenetratingTraumaPhysicsof
PenetratingTraumaBulletspinsasittravelsdownbarrelRiflinginbarrelAllowsbullettotravelstraightwithslightyawBulletdepartsbarrel,spinningwithaslightwobbleoryawWeaponforcedbackwardandabsorbsenergyRecoil(continued)Physicsof
PenetratingTraumaPhysicsof
PenetratingTraumaRemainderofenergypropelsbulletforwardatahighrateofspeed.TrajectoryiscurvedduetogravityAsbulletstrikesobject,itslowsandenergyistransferredtoobject.LawofConservationofEnergyPhysicsof
PenetratingTraumaBallisticsStudyofthecharacteristicsofprojectilesinmotionandeffectsuponobjectsimpactedFactorsaffectingenergyexchangebetweenaprojectileandbodytissueVelocityProfileStabilityExpansion&FragmentationSecondaryImpactsShapeBallisticsStudyofthecharactEnergyDissipationDrag:
windresistanceCavitation:
formationofapartialvacuumandcavitywithinasemi-fluidmediumProfile:
SizeandshapeofaprojectileasitcontactsatargetLargertheprofile=greaterenergyexchangeExpansionandfragmentationresultsindamageStabilityAllowsforstraightertrajectoryDecreasesafterstrikingobjectresultsintumblingEnergyDissipationDrag:外科急診創(chuàng)傷(英文)貫通傷資料課件外科急診創(chuàng)傷(英文)貫通傷資料課件外科急診創(chuàng)傷(英文)貫通傷資料課件AspectsofBallisticsVelocityCausesTrajectoryFaster=straightertrajectorySlower=morecurvedduetogravityAspectsofBallisticsVelocityAspectsofBallisticsProfilePortionofbulletyouseeasittravelstowardsyouLargerprofile=greaterenergyexchangeCaliberDiameterofabullet(IDofgun)0.22caliber=0.22inchesBulletsbecomeunstableastheypassfromonemediumtoanother.AspectsofBallisticsProfileAspectsofBallisticsStabilityBulletlengthincreasesbullettumblingCanreducetheaccuracyoftheshotReducedbyRiflinginbarrel(spinning)YawGyroscopiceffectonthecenteraxisofthebulletthatreducestumblingTumblingofbulletonceitstrikesobjectReduceskineticenergyGreatertissuedamageAspectsofBallisticsStabilityBulletGyroscopicEffectBulletGyroscopicEffectAspectsofBallisticsExpansion&FragmentationResultsinincreasedprofileMushroomingInitialimpactforcesmayresultinfragmentingGreatertissuedamageAspectsofBallisticsExpansion外科急診創(chuàng)傷(英文)貫通傷資料課件AspectsofBallisticsSecondaryImpactsBulletstrikingotherobjectscancauseyawandtumbleBodyArmor(Kevlar)TransmitsenergythroughoutentirevestresultinginblunttraumaMyocardialContusionPulmonaryContusionRibFracturesShapeHandgunAmmunition=Blunt=TumbleRifleAmmunition=Pointed=PiercingAspectsofBallisticsSecondaryHandgunsSmallcaliber,shortbarrel,medium-velocityEffectiveatcloserangeSeverityofinjurybaseduponorgansdamagedRifleHigh-velocity,longerbarrel,largecaliberIncreasedaccuracyatfardistancesAssaultRiflesLargemagazine,semi-orfull-automaticSimilarinjurytohuntingriflesMultiplewoundsSpecificWeaponCharacteristicsHandgunsSpecificWeaponCharacShotgunSlugorpelletsatmediumvelocity00(1/3”)to#9(pinheadsized)Largertheload,thesmallerthenumberofprojectilesDeadlyatcloserangeKnives&ArrowsLow-energy&low-velocityDamagerelatedtodepthandangleofattackMovementofthevictimcanincreasedamageSpecificWeaponCharacteristicsShotgunSpecificWeaponCharactDamagePathwayProjectileInjuryProcessTipimpactstissueTissuepushedforwardandtothesideTissuecollideswithadjacenttissueShockwaveofpressureforwardandlateralMovesperpendiculartobulletpathRapidcompression,crushesandtearstissueCavityformsbehindbulletpullingindebriswithsuction.DamagePathwayProjectileInjur外科急診創(chuàng)傷(英文)貫通傷資料課件DamagePathwayDirectInjuryDamagedoneastheprojectilestrikestissuePressureShockWaveHumantissueissemi-fluidSolidanddenseorgansaredamagedgreatlyTemporaryCavityDuetocavitationPermanentCavityDuetoseriouslydamagedtissueZoneofInjuryAreathatextendsbeyondtheareaofpermanentinjuryDamagePathwayDirectInjuryBallisticsCavitationBallisticsCavitationLow-VelocityWoundsObjectsKnives,Ice-picks,ArrowsFlyingobjectsordebrisInjurylimitedtotissueimpactedObjectpathwayObjecttwistingormovedObliqueangleAttackerCharacteristicsMales:outwardandcrosswiseFemales:overhandanddownwardLow-VelocityWoundsObjectsDensityoftissueaffectstheefficiencyofenergytransmissionResiliencyStrengthandelasticityofanobjectConnectiveTissueAbsorbsenergyandlimitstissuedamageOrgansSolidOrgansDenseandlowresilienceHollowOrgansFluidfilled:transmitenergy=increaseddamageAirfilled:absorbsenergy=lessdamageSpecificTissue&
OrganInjuriesDensityoftissueaffectstheLungsAirinlungabsorbsenergyParenchymaiscompressedandreboundsPneumothoraxorhemothoraxcanresultBoneResistsdisplacementuntilitshattersAltersprojectilepathSpecificTissue&
OrganInjuriesLungsSpecificTissue&
OrganGeneralBodyRegionsExtremitiesInjurylimitedtoresiliencyoftissue60-80%ofinjurieswith<10%mortalityAbdomen(IncludesPelvis)HighlysusceptibletoinjuryandhemorrhageBowelperforation:12-24hrsperitonealirritationThoraxRibimpactresultsinexplosiveenergyHeart&greatvesselshaveextensivedamageduetolackoffluidcompressionAnylargechestwoundcompromisesbreathingGeneralBodyRegionsExtremitieGeneralBodyRegionsNeckDamagesTracheaandBloodVesselsNeurologicalproblemsSuckingneckwoundHeadCavitationalenergytrappedinsideskullSeriousbleedingandlethalGeneralBodyRegionsNeckWoundCharacteristicsEntranceWoundsSizeofbulletprofilefornon-deformingbulletsDeformingprojectilesmaycauselargewoundsCloseRangePowderBurns(Tattooingofpowder)1-2mmcircleofdiscolorationLocalizedsubcutaneousemphysemaExitWoundsAppearstobe“Blown”outwardPressurewaveWoundCharacteristicsEntrance外科急診創(chuàng)傷(英文)貫通傷資料課件SceneSize-UpLaw-EnforcementDONOTENTERUNTILSCENEISSAFE!Weapons:VictimorAssailantAssailantsIFACRIMESCENEDOCUMENTDONOTDISTURBEVIDENCERETAINCLOTHING,ETCLIMITPERSONNELINVOLVEMENTSpecialConcernswithPenetratingTraumaSceneSize-UpSpecialConcernsPenetratingWoundAssessmentInternalOrganInjuryPotentialEntrance&ExitWounds
SpecialConcernswithPenetratingTraumaPROVIDERAPIDTRANSPORTFORANYGSWTOHEAD,CHEST, ORABDOMEN.TREATAGGRESIVELYFORSHOCK!!PenetratingWoundAssessmentSp外科急診創(chuàng)傷(英文)貫通傷資料課件PenetratingWoundCareFacialWoundsDifficultintubationsDepresschestPassETthroughbubblingtissueConsiderLMAandCombitubeConsiderCricothyreotomy&CricothyreostomyChestWoundsPneumothorax2/3”thediameterofthetracheaorlargertoentrainair3-sidedocclusivedressingNeedleDecompressPericardialTamponadeSpecialConcernswithPenetratingTraumaPenetratingWoundCareSpecial外科急診創(chuàng)傷(英文)貫通傷資料課件ImpaledObjectsLow-energyDangeroustoremoveDONOTREMOVEUNLESSInCheekInterfereswithCPR:ASSESS!!!SpecialConcernswithPenetratingTraumaImpaledObjectsSpecialConcern謝謝你的閱讀知識(shí)就是財(cái)富豐富你的人生謝謝你的閱讀知識(shí)就是財(cái)富40
PenetratingTrauma
PenetratingTrauma
Sections IntroductiontoPenetratingTraumaPhysicsofPenetratingTraumaSpecificTissue/OrganInjuriesSpecialConcernswithPenetratingTraumaSections IntroductiontoPene38,000DeathsinUSannuallyduetoshootings.MechanismsofpenetratingtraumaKnives,Arrows,Nails,etcUnderstandingprinciplesofenergyexchangeincreasetheIndexofSuspicionassociatedwiththeMOIIntroductionto
PenetratingTrauma38,000DeathsinUSannuallydRecallKineticEnergyEquationGreaterthemassthegreatertheenergyDoublemass=doubleKEGreaterthespeedthegreatertheenergyDoublespeed=4xincreaseKEPhysicsof
PenetratingTrauma(continued)RecallKineticEnergyEquation外科急診創(chuàng)傷(英文)貫通傷資料課件Physicsof
PenetratingTraumaSmall&Fastbulletcancausegreaterdamagethanlargeandslow.DifferentbulletsofdifferentweightstravelingatdifferentspeedscauseLowEnergy/LowVelocityKnivesandarrowsMediumEnergy/MediumVelocityWeaponsHandguns,shotguns,low-poweredrifles250-400mpsHighEnergy/HighVelocityAssaultRifles600-1,000mps(continued)Physicsof
PenetratingTraumaPhysicsof
PenetratingTraumaBulletspinsasittravelsdownbarrelRiflinginbarrelAllowsbullettotravelstraightwithslightyawBulletdepartsbarrel,spinningwithaslightwobbleoryawWeaponforcedbackwardandabsorbsenergyRecoil(continued)Physicsof
PenetratingTraumaPhysicsof
PenetratingTraumaRemainderofenergypropelsbulletforwardatahighrateofspeed.TrajectoryiscurvedduetogravityAsbulletstrikesobject,itslowsandenergyistransferredtoobject.LawofConservationofEnergyPhysicsof
PenetratingTraumaBallisticsStudyofthecharacteristicsofprojectilesinmotionandeffectsuponobjectsimpactedFactorsaffectingenergyexchangebetweenaprojectileandbodytissueVelocityProfileStabilityExpansion&FragmentationSecondaryImpactsShapeBallisticsStudyofthecharactEnergyDissipationDrag:
windresistanceCavitation:
formationofapartialvacuumandcavitywithinasemi-fluidmediumProfile:
SizeandshapeofaprojectileasitcontactsatargetLargertheprofile=greaterenergyexchangeExpansionandfragmentationresultsindamageStabilityAllowsforstraightertrajectoryDecreasesafterstrikingobjectresultsintumblingEnergyDissipationDrag:外科急診創(chuàng)傷(英文)貫通傷資料課件外科急診創(chuàng)傷(英文)貫通傷資料課件外科急診創(chuàng)傷(英文)貫通傷資料課件AspectsofBallisticsVelocityCausesTrajectoryFaster=straightertrajectorySlower=morecurvedduetogravityAspectsofBallisticsVelocityAspectsofBallisticsProfilePortionofbulletyouseeasittravelstowardsyouLargerprofile=greaterenergyexchangeCaliberDiameterofabullet(IDofgun)0.22caliber=0.22inchesBulletsbecomeunstableastheypassfromonemediumtoanother.AspectsofBallisticsProfileAspectsofBallisticsStabilityBulletlengthincreasesbullettumblingCanreducetheaccuracyoftheshotReducedbyRiflinginbarrel(spinning)YawGyroscopiceffectonthecenteraxisofthebulletthatreducestumblingTumblingofbulletonceitstrikesobjectReduceskineticenergyGreatertissuedamageAspectsofBallisticsStabilityBulletGyroscopicEffectBulletGyroscopicEffectAspectsofBallisticsExpansion&FragmentationResultsinincreasedprofileMushroomingInitialimpactforcesmayresultinfragmentingGreatertissuedamageAspectsofBallisticsExpansion外科急診創(chuàng)傷(英文)貫通傷資料課件AspectsofBallisticsSecondaryImpactsBulletstrikingotherobjectscancauseyawandtumbleBodyArmor(Kevlar)TransmitsenergythroughoutentirevestresultinginblunttraumaMyocardialContusionPulmonaryContusionRibFracturesShapeHandgunAmmunition=Blunt=TumbleRifleAmmunition=Pointed=PiercingAspectsofBallisticsSecondaryHandgunsSmallcaliber,shortbarrel,medium-velocityEffectiveatcloserangeSeverityofinjurybaseduponorgansdamagedRifleHigh-velocity,longerbarrel,largecaliberIncreasedaccuracyatfardistancesAssaultRiflesLargemagazine,semi-orfull-automaticSimilarinjurytohuntingriflesMultiplewoundsSpecificWeaponCharacteristicsHandgunsSpecificWeaponCharacShotgunSlugorpelletsatmediumvelocity00(1/3”)to#9(pinheadsized)Largertheload,thesmallerthenumberofprojectilesDeadlyatcloserangeKnives&ArrowsLow-energy&low-velocityDamagerelatedtodepthandangleofattackMovementofthevictimcanincreasedamageSpecificWeaponCharacteristicsShotgunSpecificWeaponCharactDamagePathwayProjectileInjuryProcessTipimpactstissueTissuepushedforwardandtothesideTissuecollideswithadjacenttissueShockwaveofpressureforwardandlateralMovesperpendiculartobulletpathRapidcompression,crushesandtearstissueCavityformsbehindbulletpullingindebriswithsuction.DamagePathwayProjectileInjur外科急診創(chuàng)傷(英文)貫通傷資料課件DamagePathwayDirectInjuryDamagedoneastheprojectilestrikestissuePressureShockWaveHumantissueissemi-fluidSolidanddenseorgansaredamagedgreatlyTemporaryCavityDuetocavitationPermanentCavityDuetoseriouslydamagedtissueZoneofInjuryAreathatextendsbeyondtheareaofpermanentinjuryDamagePathwayDirectInjuryBallisticsCavitationBallisticsCavitationLow-VelocityWoundsObjectsKnives,Ice-picks,ArrowsFlyingobjectsordebrisInjurylimitedtotissueimpactedObjectpathwayObjecttwistingormovedObliqueangleAttackerCharacteristicsMales:outwardandcrosswiseFemales:overhandanddownwardLow-VelocityWoundsObjectsDensityoftissueaffectstheefficiencyofenergytransmissionResiliencyStrengthandelasticityofanobjectConnectiveTissueAbsorbsenergyandlimitstissuedamageOrgansSolidOrgansDenseandlowresilienceHollowOrgansFluidfilled:transmitenergy=increaseddamageAirfilled:absorbsenergy=lessdamageSpecificTissue&
OrganInjuriesDensityoftissueaffectstheLungsAirinlungabsorbsenergyParenchymaiscompressedandreboundsPneumothoraxorhemothoraxcanresultBoneResistsdisplacementuntilitshattersAltersprojectilepathSpecificTissue&
OrganInjuriesLungsSpecificTissue&
OrganGeneralBodyRegionsExtremitiesInjurylimitedtoresiliencyoftissue60-80%ofinjurieswith<10%mortalityAbdomen(IncludesPelvis)HighlysusceptibletoinjuryandhemorrhageBowelperforation:12-24hrsperitonealirritationThoraxRibimpactresultsinexplosiveenergyHeart&greatvesselshaveextensivedamageduetolackoffluidcompressionAnylargechestwoundcompromisesbreathingGeneralBodyRegionsExtremitieGeneralBodyRegionsNeckDamagesTracheaandBloodVessels
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