Mechanism Of Injury
DEPT. OF SURGERY
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INTRODUCTION
Trauma or injury: damage to the body caused by an exchange with
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environmental energy that is beyond the body's resilienceInjury and trauma represent a major health problem worldwide.
Everyday around the world almost 16,000 people die from various injuries.
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12% of the global burden of diseaseRoad traffic injuries are a major cause of mortality
22.8% in the overall burden of death related to injuries
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Injury is the third most important cause of mortality and the main cause of death among 1 to 40-
year-olds.
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Road traffic injuries represent only a fraction of the trauma spectrumWARFARE INJURIES
War has plagued humanity since the dawn of time
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Celsus a addressed the management of battlefield casualties in the first century AD.
Introduction of gunpowder in the 14th century dramatically changed the nature of
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battlefield injuries.Advances in surgical management of war wounds followed advances in weapon technology
Musculoskeletal injuries represent approximately 70% of all war
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Ratio lower limb/upper limb is approximately 3/2, more than 50% of extremity fractures are open.Injuries to the head, chest, and/or abdomen have a higher mortality rate
Bullets: main cause of penetrating injury to the limbs
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Recently replaced by fragmenting weapons such as bombs, shells, grenades, and landmines
Blast injuries are in general dirtier than gunshot wounds and carry a higher potential for infection
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Years of Potential Life LostMECHANISMS OF INJURY:
BLUNT TRAUMA
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Pedestrian vs VehicleFalls
Mechanisms of Injury:
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Special Situations
? Explosions
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? Blunt + penetrating + burns? Burns
? Crush injuries
? Drowning
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? Hypothermia/ exposureCOMPRESSION INJURY
Frontal brain contusion
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PneumothoraxRupture of Left hemidiaphragm
Small bowel rupture
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Chance fracture
DECELERATION INJURY
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Aortic tearFixed descending aorta
Mobile arch
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Acute subdural brain
hematoma
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Kidney avulsionSplenic pedicle
GUN SHOT WOUNDS: MECHANISM
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Surface area distributedEnergy transfer
Tumble and yaw
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Shape/size of bullet
Fragmentation
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Distance to targetAnatomy
Velocity (most important)
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Viscoelasticity
Kinetic energy = (Mass ? Velocity2
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Muscle)/2
organs
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STAB WOUNDS
Mechanism
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Blunt: Crush injurySharp:Tissue disruption
Extent of Injury
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Weapon size, length, sharpness, penetration
Severe injury
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Chest and abdomen4+ wounds
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WEAPONSSome wound characteristics of different weapons
The power of a missile depends on how much kinetic
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energy is given up when it strikes tissue.
The energy :
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formula E = mv2m= mass and v= velocity.
BULLETS
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Small entrance wound and a large exit wound.Fragmentation of the bullet will cause severe
wounds
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FRAGMENTSCaused by explosive devices, such as;
Bombs, mortars, shells, rockets and grenades.
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The distance between the wounded person and the explosion determines the
outcome.
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The blast wave from an explosion might cause rupture of the ear drums and of gas-containing viscera, such as the stomach or bowels
hemorrhage in the lungs, without any penetrating wound.
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MINES
Exploding devices
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Traumatic amputation of foot or leg,Combined with multiple severe wounds.
The wounds are all severely contaminated by mud, grass, pieces of shoes
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and clothes
PRINCIPLES OF MANAGEMENT OF WAR WOUNDS:
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? Complete wound excision
? Delayed primary closure
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? No internal bone fixation? Antibiotics
? Antitetanus
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MULTIPLE WOUNDS
those on the posterior aspect of the body and limbs should
be dealt with before those on the anterior aspect.
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EARLY AND THOROUGH WOUND EXCISION
Reduces chances of death from gas gangrene or
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generalized infection;
Reduces the number of operations
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Allows delayed primary closure to be successful.Shortens the stay in hospital.
Wounds should not have dressings changed until delayed primary closure
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(DPC)
The exception to this will be when:
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1. persisting contamination2. infection develop
TREATMENT OF A SOFT TISSUE WOUND
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1.Excision of the wound
2.
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Delayed primary closure
Wounds should be left wide open, without any suture of skin or deep
structures.
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All dead muscle must be excised.
Dead muscle is the ideal medium for clostridial infection leading to gas
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gangrene.The track of the missile may be surrounded by dead muscle.
Must be excised until: healthy, contractile, bleeding muscle is found.
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DELAYED PRIMARY CLOSUREWithin seven days of injury.
By simple approximation of the deep structures and skin, without tension.
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WMDs
CBRNE
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HAZMATsPPE