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PenetratingTrauma
PenetratingTrauma
Sections IntroductiontoPenetratingTraumaPhysicsofPenetratingTraumaSpecificTissue/OrganInjuriesSpecialConcernswithPenetratingTraumaSections IntroductiontoPene38,000DeathsinUSannuallyduetoshootings.MechanismsofpenetratingtraumaKnives,Arrows,Nails,etcUnderstandingprinciplesofenergyexchangeincreasetheIndexofSuspicionassociatedwiththeMOIIntroductionto
PenetratingTrauma38,000DeathsinUSannuallydRecallKineticEnergyEquationGreaterthemassthegreatertheenergyDoublemass=doubleKEGreaterthespeedthegreatertheenergyDoublespeed=4xincreaseKEPhysicsof
PenetratingTrauma(continued)RecallKineticEnergyEquation外科急诊创伤(英文)贯通伤资料课件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:外科急诊创伤(英文)贯通伤资料课件外科急诊创伤(英文)贯通伤资料课件外科急诊创伤(英文)贯通伤资料课件AspectsofBallisticsVelocityCausesTrajectoryFaster=straightertrajectorySlower=morecurvedduetogravityAspectsofBallisticsVelocityAspectsofBallisticsProfilePortionofbulletyouseeasittravelstowardsyouLargerprofile=greaterenergyexchangeCaliberDiameterofabullet(IDofgun)0.22caliber=0.22inchesBulletsbecomeunstableastheypassfromonemediumtoanother.AspectsofBallisticsProfileAspectsofBallisticsStabilityBulletlengthincreasesbullettumblingCanreducetheaccuracyoftheshotReducedbyRiflinginbarrel(spinning)YawGyroscopiceffectonthecenteraxisofthebulletthatreducestumblingTumblingofbulletonceitstrikesobjectReduceskineticenergyGreatertissuedamageAspectsofBallisticsStabilityBulletGyroscopicEffectBulletGyroscopicEffectAspectsofBallisticsExpansion&FragmentationResultsinincreasedprofileMushroomingInitialimpactforcesmayresultinfragmentingGreatertissuedamageAspectsofBallisticsExpansion外科急诊创伤(英文)贯通伤资料课件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外科急诊创伤(英文)贯通伤资料课件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外科急诊创伤(英文)贯通伤资料课件SceneSize-UpLaw-EnforcementDONOTENTERUNTILSCENEISSAFE!Weapons:VictimorAssailantAssailantsIFACRIMESCENEDOCUMENTDONOTDISTURBEVIDENCERETAINCLOTHING,ETCLIMITPERSONNELINVOLVEMENTSpecialConcernswithPenetratingTraumaSceneSize-UpSpecialConcernsPenetratingWoundAssessmentInternalOrganInjuryPotentialEntrance&ExitWounds
SpecialConcernswithPenetratingTraumaPROVIDERAPIDTRANSPORTFORANYGSWTOHEAD,CHEST, ORABDOMEN.TREATAGGRESIVELYFORSHOCK!!PenetratingWoundAssessmentSp外科急诊创伤(英文)贯通伤资料课件PenetratingWoundCareFacialWoundsDifficultintubationsDepresschestPassETthroughbubblingtissueConsiderLMAandCombitubeConsiderCricothyreotomy&CricothyreostomyChestWoundsPneumothorax2/3”thediameterofthetracheaorlargertoentrainair3-sidedocclusivedressingNeedleDecompressPericardialTamponadeSpecialConcernswithPenetratingTraumaPenetratingWoundCareSpecial外科急诊创伤(英文)贯通伤资料课件ImpaledObjectsLow-energyDangeroustoremoveDONOTREMOVEUNLESSInCheekInterfereswithCPR:ASSESS!!!SpecialConcernswithPenetratingTraumaImpaledObjectsSpecialConcern谢谢你的阅读知识就是财富丰富你的人生谢谢你的阅读知识就是财富40
PenetratingTrauma
PenetratingTrauma
Sections IntroductiontoPenetratingTraumaPhysicsofPenetratingTraumaSpecificTissue/OrganInjuriesSpecialConcernswithPenetratingTraumaSections IntroductiontoPene38,000DeathsinUSannuallyduetoshootings.MechanismsofpenetratingtraumaKnives,Arrows,Nails,etcUnderstandingprinciplesofenergyexchangeincreasetheIndexofSuspicionassociatedwiththeMOIIntroductionto
PenetratingTrauma38,000DeathsinUSannuallydRecallKineticEnergyEquationGreaterthemassthegreatertheenergyDoublemass=doubleKEGreaterthespeedthegreatertheenergyDoublespeed=4xincreaseKEPhysicsof
PenetratingTrauma(continued)RecallKineticEnergyEquation外科急诊创伤(英文)贯通伤资料课件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:外科急诊创伤(英文)贯通伤资料课件外科急诊创伤(英文)贯通伤资料课件外科急诊创伤(英文)贯通伤资料课件AspectsofBallisticsVelocityCausesTrajectoryFaster=straightertrajectorySlower=morecurvedduetogravityAspectsofBallisticsVelocityAspectsofBallisticsProfilePortionofbulletyouseeasittravelstowardsyouLargerprofile=greaterenergyexchangeCaliberDiameterofabullet(IDofgun)0.22caliber=0.22inchesBulletsbecomeunstableastheypassfromonemediumtoanother.AspectsofBallisticsProfileAspectsofBallisticsStabilityBulletlengthincreasesbullettumblingCanreducetheaccuracyoftheshotReducedbyRiflinginbarrel(spinning)YawGyroscopiceffectonthecenteraxisofthebulletthatreducestumblingTumblingofbulletonceitstrikesobjectReduceskineticenergyGreatertissuedamageAspectsofBallisticsStabilityBulletGyroscopicEffectBulletGyroscopicEffectAspectsofBallisticsExpansion&FragmentationResultsinincreasedprofileMushroomingInitialimpactforcesmayresultinfragmentingGreatertissuedamageAspectsofBallisticsExpansion外科急诊创伤(英文)贯通伤资料课件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外科急诊创伤(英文)贯通伤资料课件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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