Download MBBS Surgery Presentations 59 Trauma Lecture Notes

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