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Paramedic Care: Principles & Practice Volume 4 Trauma Emergencies

Paramedic Care:Principles & Practice

Volume 5Trauma Emergencies

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJChapter 3 Penetrating Trauma

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJTopicsIntroduction to Penetrating TraumaKinetics of Penetrating TraumaSpecific Tissue/Organ InjuriesSpecial Concerns with Penetrating Trauma

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJIntroduction to Penetrating Trauma

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJIntroduction to Penetrating TraumaThere are 30,000 deaths in the U.S. annually due to shootings.Other mechanisms of penetrating trauma include:Knives, arrows, nails, etc.Understanding the principles of energy exchange increases the index of suspicion associated with the MOI.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJKinetics of Penetrating Trauma

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJKinetics of Penetrating TraumaWhen a projectile strikes a target, it exchanges its kinetic energy with the object struck. An objects kinetic energy is equal to its mass times the square of its velocity, all divided by 2.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJKinetics of Penetrating TraumaThe greater the mass of an object, the greater its energy. If you double the mass of an object, it will have twice the kinetic energy. The speed (or velocity) of an object has a squared relationship to its kinetic energy. If you double the speed of an object, its kinetic energy increases by fourfold.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBallisticsStudy of the characteristics of projectiles in motion and effects upon objects impactedFactors affecting energy exchange between a projectile and body tissue:VelocityProfileStabilityExpansion and fragmentationSecondary ImpactsShape

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBallisticsVelocityCauses trajectoryFaster = straighter trajectorySlower = more curved due to gravity

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBallisticsProfilePortion of bullet you see as it travels toward 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.

Collection of Robert Porter

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBallisticsStabilityBullet 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 objectIncreases rate of energy exchangeGreater tissue damage

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBallisticsExpansion and FragmentationResults in increased profileMushroomingInitial impact forces may result in fragmentingGreater tissue damage

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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBallisticsSecondary ImpactsBullet striking other objects can cause yaw and tumbleBody armor (Kevlar)Transmits energy throughout entire vest resulting in blunt traumaMyocardial contusionPulmonary contusionRib fractures

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBallisticsShapeHandgun ammunition is rather blunt More resistant to travel through human tissueReleases kinetic energy more quickly Rifle bullets are more pointed and cut through the tissue more efficiently May tumble or fragment

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJSpecific Weapon CharacteristicsHandgunsOften a small-caliber, short-barreled, medium-velocity weapon Severity of injury is related to the organs directly damaged by the bullets passage

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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJRifles

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJSpecific Weapon CharacteristicsRifleHeavier projectile Longer barrel Greater muzzle velocityBullet travels much farther, with greater accuracy, and retains much more of its kinetic energy

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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJSpecific Weapon CharacteristicsAssault RifleGenerally has a larger magazine capacityMultiple wounds and casualties can be expected Will fire in both the semiautomatic and automatic mode

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJSpecific Weapon CharacteristicsShotgunMay fire a single projectile (a slug) or numerous spheres (pellets or shot) at medium velocity The larger the shot, the smaller the number of projectiles

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJ

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Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJSpecific Weapon CharacteristicsKnives and ArrowsSlow-moving, penetrating objects cause low-velocity, low-energy wounds Usually limited to physical injury caused by direct contact between the blade or object and the victims tissue Hunting tips designed for arrows can be especially damaging

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBiomechanics of Penetrating Trauma Direct InjuryOccurs as the projectile strikes tissue, contuses and tears that tissue, and displaces the tissue Limited to the profile of the bullet as it moves through the body Handgun bullet damage is usually limited to direct injury

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBiomechanics of Penetrating TraumaPressure Shock WaveWhen a high-velocity high-energy projectile strikes human tissue, it creates a pressure shock wave. The faster and more blunt the bullet, the greater the effect.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBiomechanics of Penetrating TraumaTemporary CavitySpace created behind the high-energy bullet as tissue moves rapidly away from the bullets path After the bullets passage, tissue elasticity causes the temporary cavity to close Cavitation

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJBiomechanics of Penetrating TraumaPermanent CavityTissue may not return to its normal orientation, resulting in a permanent cavity Cavity fills with debrisZone of InjuryZone of injury extends beyond the permanent cavity May be slow to heal

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJLow Velocity Wounds

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 4: Trauma Emergencies, 3rd. Ed. 2009 by Pearson Education, Inc. Upper Saddle River, NJLow-Velocity WoundsObjectsKnives, ice-picks, arrowsFlying objects or debrisInjury limited to tissue impactedObject pathwayObject twisting or movedOblique angleAttacker CharacteristicsMales: outward and crosswiseFemales: overhand and downward

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