2018 Trauma University: Penetrating Trauma-Penetrating Trauma

Penetrating Trauma - handout
Pdf Summary
This document is a presentation on penetrating trauma given by Dr. A. Britton Christmas, Vice Chief of Trauma and Associate Medical Director at the F.H. "Sammy" Ross, Jr. Trauma Center in Charlotte, NC. The objectives of the presentation are to understand the difference between high energy and low energy penetrating trauma, understand the ballistics of firearm injuries, and outline resuscitation and diagnostic strategies for penetrating traumatic injuries.<br /><br />The presentation begins with a discussion of low energy penetrating trauma, which includes injuries caused by knives, ice picks, and impalements. The depth of penetration, number and location of wounds, and external injuries are important considerations in these cases. Treatment options include compression, tourniquet, suturing, wound exploration, imaging, and observation.<br /><br />Next, the presentation covers diagnostic strategies for stab wounds in different regions of the abdomen, such as the anterior thoracoabdominal, anterior abdomen, and back/flank. Diagnostic methods include CXR, diagnostic laparoscopy, local wound exploration, CT scan, and observation.<br /><br />The presentation then moves on to high energy penetrating trauma, which involves bullets or other ballistic weapons. Factors affecting appearance of gunshot wounds (GSWs) are discussed, including type of bullet, integrity of bullet on impact/exit, dynamics of the bullet, and distance of gun from victim. The presentation also explains the concept of cavitation and the energy transferred to the body by different calibers of bullets.<br /><br />Assessment and resuscitation strategies for penetrating trauma are outlined. The importance of a complete exposure, proper marking of wounds, and the use of IV fluids and blood products are emphasized. Indications for emergent laparotomy and decompression for thoracic injuries are discussed, as well as the assessment and treatment of open pneumothorax, tension pneumothorax, massive hemothorax, and cardiac tamponade. The presentation concludes with a discussion of resuscitative thoracotomy and when it should be considered.<br /><br />Overall, the presentation covers various aspects of penetrating trauma, including its classification, assessment, resuscitation, and treatment strategies.
Keywords
penetrating trauma
high energy
low energy
ballistics
firearm injuries
resuscitation
diagnostic strategies
stab wounds
gunshot wounds
cavitation