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1、Sections,Introduction to Penetrating TraumaPhysics of Penetrating TraumaSpecific Tissue/Organ InjuriesSpecial Concerns with Penetrating Trauma,38,000 Deaths in US annually due to shootings.Mechanisms of penetrating traumaKnives,Arrows,Nails,etcUnderstanding principles of energy exchange increase the
2、 Index of Suspicion associated with the MOI,Introduction to Penetrating Trauma,Recall Kinetic Energy EquationGreater the mass the greater the energyDouble mass=double KEGreater the speed the greater the energyDouble speed=4x increase KE,Physics of Penetrating Trauma,(continued),Physics of Penetratin
3、g Trauma,Small&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 Energy/High VelocityAssau
4、lt Rifles600-1,000 mps,(continued),Physics of Penetrating Trauma,Bullet 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,(continued),Physics of Pen
5、etrating Trauma,Remainder of energy propels bullet forward at a high rate of speed.Trajectory is curved due to gravityAs bullet strikes object,it slows and energy is transferred to object.Law of Conservation of Energy,Ballistics,Study of the characteristics of projectiles in motion and effects upon
6、objects impactedFactors affecting energy exchange between a projectile and body tissueVelocityProfileStabilityExpansion&FragmentationSecondary ImpactsShape,Energy Dissipation,Drag:wind resistanceCavitation:formation of a partial vacuum and cavity within a semi-fluid mediumProfile:Size and shape of a
7、 projectile as it contacts a targetLarger the profile=greater energy exchangeExpansion and fragmentation results in damageStabilityAllows for straighter trajectoryDecreases after striking object results in tumbling,Aspects of Ballistics,VelocityCauses TrajectoryFaster=straighter trajectorySlower=mor
8、e curved due to gravity,Aspects of Ballistics,ProfilePortion of bullet you see as it travels towards youLarger profile=greater energy exchangeCaliberDiameter of a bullet(ID of gun)0.22 caliber=0.22 inchesBullets become unstable as they pass from one medium to another.,Aspects of Ballistics,Stability
9、Bullet 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 once it strikes objectReduces kinetic energyGreater tissue damage,Bullet Gyroscopic Effect,Asp
10、ects of Ballistics,Expansion&FragmentationResults in increased profileMushroomingInitial impact forces may result in fragmentingGreater tissue damage,Aspects of Ballistics,Secondary ImpactsBullet striking other objects can cause yaw and tumbleBody Armor(Kevlar)Transmits energy throughout entire vest
11、 resulting in blunt traumaMyocardial ContusionPulmonary ContusionRib FracturesShapeHandgun Ammunition=Blunt=TumbleRifle Ammunition=Pointed=Piercing,HandgunsSmall caliber,short barrel,medium-velocityEffective at close rangeSeverity of injury based upon organs damagedRifleHigh-velocity,longer barrel,l
12、arge caliberIncreased accuracy at far distancesAssault RiflesLarge magazine,semi-or full-automaticSimilar injury to hunting riflesMultiple wounds,Specific Weapon Characteristics,ShotgunSlug or pellets at medium velocity00(1/3”)to#9(pin head sized)Larger the load,the smaller the number of projectiles
13、Deadly at close rangeKnives&ArrowsLow-energy&low-velocityDamage related to depth and angle of attackMovement of the victim can increase damage,Specific Weapon Characteristics,Damage Pathway,Projectile Injury ProcessTip impacts tissueTissue pushed forward and to the sideTissue collides with adjacent
14、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 Pathway,Direct InjuryDamage done as the projectile strikes tissuePressure Shock WaveHuman tissue is semi-fluid
15、Solid and dense organs are damaged greatlyTemporary CavityDue to cavitationPermanent CavityDue to seriously damaged tissueZone of InjuryArea that extends beyond the area of permanent injury,Ballistics Cavitation,Low-Velocity Wounds,ObjectsKnives,Ice-picks,ArrowsFlying objects or debrisInjury limited
16、 to tissue impactedObject pathwayObject twisting or movedOblique angleAttacker CharacteristicsMales:outward and crosswiseFemales:overhand and downward,Density of tissue affects the efficiency of energy transmissionResiliencyStrength and elasticity of an objectConnective TissueAbsorbs energy and limi
17、ts tissue damageOrgansSolid OrgansDense and low resilienceHollow OrgansFluid filled:transmit energy=increased damageAir filled:absorbs energy=less damage,Specific Tissue&Organ Injuries,LungsAir in lung absorbs energyParenchyma is compressed and reboundsPneumothorax or hemothorax can resultBoneResist
18、s displacement until it shattersAlters projectile path,Specific Tissue&Organ Injuries,General Body Regions,ExtremitiesInjury limited to resiliency of tissue60-80%of injuries with 10%mortalityAbdomen(Includes Pelvis)Highly susceptible to injury and hemorrhageBowel perforation:12-24 hrs peritoneal irr
19、itationThoraxRib impact results in explosive energyHeart&great vessels have extensive damage due to lack of fluid compressionAny large chest wound compromises breathing,General Body Regions,NeckDamages Trachea and Blood VesselsNeurological problemsSucking neck woundHeadCavitational energy trapped in
20、side skullSerious bleeding and lethal,Wound Characteristics,Entrance WoundsSize of bullet profile for non-deforming bulletsDeforming projectiles may cause large woundsClose RangePowder Burns(Tattooing of powder)1-2 mm circle of discolorationLocalized subcutaneous emphysemaExit WoundsAppears to be“Bl
21、own”outwardPressure wave,Scene Size-UpLaw-EnforcementDO NOT ENTER UNTIL SCENE IS SAFE!Weapons:Victim or AssailantAssailantsIF A CRIME SCENEDOCUMENTDO NOT DISTURB EVIDENCERETAIN CLOTHING,ETCLIMIT PERSONNEL INVOLVEMENT,Special Concerns with Penetrating Trauma,Penetrating Wound AssessmentInternal Organ
22、 Injury PotentialEntrance&Exit Wounds,Special Concerns with Penetrating Trauma,PROVIDE 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 CombitubeConsi
23、der Cricothyreotomy&CricothyreostomyChest WoundsPneumothorax2/3”the diameter of the trachea or larger to entrain air3-sided occlusive dressingNeedle DecompressPericardial Tamponade,Special Concerns with Penetrating Trauma,Impaled ObjectsLow-energyDangerous to removeDO NOT REMOVEUNLESSIn CheekInterferes with CPR:ASSESS!,Special Concerns with Penetrating Trauma,
