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1、外科急诊创伤外科急诊创伤(英文英文)-)-贯通贯通伤伤Sections IntroductiontoPenetratingTraumaPhysicsofPenetratingTraumaSpecificTissue/OrganInjuriesSpecialConcernswithPenetratingTraumaBallisticsStudyofthecharacteristicsofprojectilesinmotionandeffectsuponobjectsimpactedFactorsaffectingenergyexchangebetweenaprojectileandbodytis
2、sueVelocityProfileStabilityExpansion&FragmentationSecondaryImpactsShapeEnergy DissipationDrag:windresistanceCavitation:formationofapartialvacuumandcavitywithinasemi-fluidmediumProfile:SizeandshapeofaprojectileasitcontactsatargetLargertheprofile=greaterenergyexchangeExpansionandfragmentationresultsin
3、damageStabilityAllowsforstraightertrajectoryDecreasesafterstrikingobjectresultsintumblingAspects of BallisticsVelocityCausesTrajectoryFaster=straightertrajectorySlower=morecurvedduetogravityAspects of BallisticsProfilePortionofbulletyouseeasittravelstowardsyouLargerprofile=greaterenergyexchangeCalib
4、erDiameterofabullet(IDofgun)0.22 caliber=0.22 inchesBulletsbecomeunstableastheypassfromonemediumtoanother.Aspects of BallisticsStabilityBulletlengthincreasesbullettumblingCanreducetheaccuracyoftheshotReducedbyRiflinginbarrel(spinning)YawGyroscopiceffectonthecenteraxisofthebulletthatreducestumblingTu
5、mblingofbulletonceitstrikesobjectReduceskineticenergyGreatertissuedamageBullet Gyroscopic EffectAspects of BallisticsExpansion&FragmentationResultsinincreasedprofileMushroomingInitialimpactforcesmayresultinfragmentingGreatertissuedamageAspects of BallisticsSecondaryImpactsBulletstrikingotherobjectsc
6、ancauseyawandtumbleBodyArmor(Kevlar)TransmitsenergythroughoutentirevestresultinginblunttraumaMyocardial ContusionPulmonary ContusionRib FracturesShapeHandgunAmmunition=Blunt=TumbleRifleAmmunition=Pointed=PiercingHandgunsSmallcaliber,shortbarrel,medium-velocityEffectiveatcloserangeSeverityofinjurybas
7、eduponorgansdamagedRifleHigh-velocity,longerbarrel,largecaliberIncreasedaccuracyatfardistancesAssaultRiflesLargemagazine,semi-orfull-automaticSimilarinjurytohuntingriflesMultiplewoundsSpecific Weapon CharacteristicsShotgunSlugorpelletsatmediumvelocity00(1/3”)to#9(pinheadsized)Largertheload,thesmalle
8、rthenumberofprojectilesDeadlyatcloserangeKnives&ArrowsLow-energy&low-velocityDamagerelatedtodepthandangleofattackMovementofthevictimcanincreasedamageSpecific Weapon CharacteristicsDamage PathwayProjectileInjuryProcessTipimpactstissueTissuepushedforwardandtothesideTissuecollideswithadjacenttissueShoc
9、kwaveofpressureforwardandlateralMoves perpendicular to bullet pathRapidcompression,crushesandtearstissueCavityformsbehindbulletpullingindebriswithsuction.Damage PathwayDirectInjuryDamagedoneastheprojectilestrikestissuePressureShockWaveHumantissueissemi-fluidSolidanddenseorgansaredamagedgreatlyTempor
10、aryCavityDuetocavitationPermanentCavityDuetoseriouslydamagedtissueZoneofInjuryAreathatextendsbeyondtheareaofpermanentinjuryBallistics CavitationLow-Velocity WoundsObjectsKnives,Ice-picks,ArrowsFlyingobjectsordebrisInjurylimitedtotissueimpactedObjectpathwayObjecttwistingormovedObliqueangleAttackerCha
11、racteristicsMales:outwardandcrosswiseFemales:overhandanddownwardDensityoftissueaffectstheefficiencyofenergytransmissionResiliencyStrengthandelasticityofanobjectConnectiveTissueAbsorbsenergyandlimitstissuedamageOrgansSolidOrgansDenseandlowresilienceHollowOrgansFluidfilled:transmitenergy=increaseddama
12、geAirfilled:absorbsenergy=lessdamageSpecific Tissue&Organ InjuriesLungsAirinlungabsorbsenergyParenchymaiscompressedandreboundsPneumothoraxorhemothoraxcanresultBoneResistsdisplacementuntilitshattersAltersprojectilepathSpecific Tissue&Organ InjuriesGeneral Body RegionsExtremitiesInjurylimitedtoresilie
13、ncyoftissue60-80%ofinjurieswith10%mortalityAbdomen(IncludesPelvis)HighlysusceptibletoinjuryandhemorrhageBowelperforation:12-24hrsperitonealirritationThoraxRibimpactresultsinexplosiveenergyHeart&greatvesselshaveextensivedamageduetolackoffluidcompressionAnylargechestwoundcompromisesbreathingGeneral Bo
14、dy RegionsNeckDamagesTracheaandBloodVesselsNeurologicalproblemsSuckingneckwoundHeadCavitationalenergytrappedinsideskullSeriousbleedingandlethalWound CharacteristicsEntranceWoundsSizeofbulletprofilefornon-deformingbulletsDeformingprojectilesmaycauselargewoundsCloseRangePowderBurns(Tattooingofpowder)1
15、-2mmcircleofdiscolorationLocalizedsubcutaneousemphysemaExitWoundsAppearstobe“Blown”outwardPressurewaveSceneSize-UpLaw-EnforcementDONOTENTERUNTILSCENEISSAFE!Weapons:VictimorAssailantAssailantsIFACRIMESCENEDOCUMENTDONOTDISTURBEVIDENCERETAINCLOTHING,ETCLIMITPERSONNELINVOLVEMENTSpecial Concerns with Pen
16、etrating TraumaPenetratingWoundAssessmentInternalOrganInjuryPotentialEntrance&ExitWoundsSpecial Concerns with Penetrating TraumaPROVIDE RAPID TRANSPORT FOR ANY GSW TO HEAD,CHEST,OR ABDOMEN.TREAT AGGRESIVELY FOR SHOCK!PenetratingWoundCareFacialWoundsDifficultintubationsDepress chestPass ET through bu
17、bbling tissueConsider LMA and CombitubeConsider Cricothyreotomy&CricothyreostomyChestWoundsPneumothorax2/3”thediameterofthetracheaorlargertoentrainair3-sidedocclusivedressingNeedleDecompressPericardialTamponadeSpecial Concerns with Penetrating TraumaImpaledObjectsLow-energyDangeroustoremoveDONOTREMOVEUNLESSIn CheekInterferes with CPR:ASSESS!Special Concerns with Penetrating Trauma结束语结束语谢谢大家聆听！谢谢大家聆听！40