Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 59 Trauma PPT-Powerpoint Presentations and lecture notes
Trauma:
Epidemiology
Warfare Injuries
Mechanism Of Injury
DEPT. OF SURGERY
INTRODUCTION
Trauma or injury: damage to the body caused by an exchange with
environmental energy that is beyond the body's resilience
Injury and trauma represent a major health problem worldwide.
Everyday around the world almost 16,000 people die from various injuries.
12% of the global burden of disease
Road traffic injuries are a major cause of mortality
22.8% in the overall burden of death related to injuries
Injury is the third most important cause of mortality and the main cause of death among 1 to 40-
year-olds.
Road traffic injuries represent only a fraction of the trauma spectrum
WARFARE INJURIES
War has plagued humanity since the dawn of time
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
battlefield injuries.
Advances in surgical management of war wounds followed advances in weapon technology
Musculoskeletal injuries represent approximately 70% of all war
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
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
Years of Potential Life Lost
MECHANISMS OF INJURY:
BLUNT TRAUMA
Pedestrian vs Vehicle
Falls
Mechanisms of Injury:
Special Situations
? Explosions
? Blunt + penetrating + burns
? Burns
? Crush injuries
? Drowning
? Hypothermia/ exposure
COMPRESSION INJURY
Frontal brain contusion
Pneumothorax
Rupture of Left hemidiaphragm
Small bowel rupture
Chance fracture
DECELERATION INJURY
Aortic tear
Fixed descending aorta
Mobile arch
Acute subdural brain
hematoma
Kidney avulsion
Splenic pedicle
GUN SHOT WOUNDS: MECHANISM
Surface area distributed
Energy transfer
Tumble and yaw
Shape/size of bullet
Fragmentation
Distance to target
Anatomy
Velocity (most important)
Viscoelasticity
Kinetic energy = (Mass ? Velocity2
Muscle
)/2
organs
STAB WOUNDS
Mechanism
Blunt: Crush injury
Sharp:Tissue disruption
Extent of Injury
Weapon size, length, sharpness, penetration
Severe injury
Chest and abdomen
4+ wounds
WEAPONS
Some wound characteristics of different weapons
The power of a missile depends on how much kinetic
energy is given up when it strikes tissue.
The energy :
formula E = mv2
m= mass and v= velocity.
BULLETS
Small entrance wound and a large exit wound.
Fragmentation of the bullet will cause severe
wounds
FRAGMENTS
Caused by explosive devices, such as;
Bombs, mortars, shells, rockets and grenades.
The distance between the wounded person and the explosion determines the
outcome.
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.
MINES
Exploding devices
Traumatic amputation of foot or leg,
Combined with multiple severe wounds.
The wounds are all severely contaminated by mud, grass, pieces of shoes
and clothes
PRINCIPLES OF MANAGEMENT OF WAR WOUNDS:
? Complete wound excision
? Delayed primary closure
? No internal bone fixation
? Antibiotics
? Antitetanus
MULTIPLE WOUNDS
those on the posterior aspect of the body and limbs should
be dealt with before those on the anterior aspect.
EARLY AND THOROUGH WOUND EXCISION
Reduces chances of death from gas gangrene or
generalized infection;
Reduces the number of operations
Allows delayed primary closure to be successful.
Shortens the stay in hospital.
Wounds should not have dressings changed until delayed primary closure
(DPC)
The exception to this will be when:
1. persisting contamination
2. infection develop
TREATMENT OF A SOFT TISSUE WOUND
1.
Excision of the wound
2.
Delayed primary closure
Wounds should be left wide open, without any suture of skin or deep
structures.
All dead muscle must be excised.
Dead muscle is the ideal medium for clostridial infection leading to gas
gangrene.
The track of the missile may be surrounded by dead muscle.
Must be excised until: healthy, contractile, bleeding muscle is found.
DELAYED PRIMARY CLOSURE
Within seven days of injury.
By simple approximation of the deep structures and skin, without tension.
WMDs
CBRNE
HAZMATs
PPE
This post was last modified on 08 April 2022