DOCSLIB.ORG

Trauma Series Polytrauma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Trauma Series Polytrauma Trauma Series: POLYTRAUMA Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT The field of medicine is rapidly advancing, which means that we can save many people who once would have been lost to serious injury. However, these advances have created an influx of polytraumatic patients — patients with two or more acutely serious injuries, at least one of which is life threatening. Medical staff needs to be prepared to meet the unique needs of these patients, from the field to the emergency room and in both acute and post-acute care situations. Additionally, it is absolutely vital that medical professionals understand the psychological needs of polytrauma patients so they can help them achieve healing of both body and mind. 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Continuing Nursing Education Course Planners William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster, Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3.5 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need Initial stabilization of the polytrauma patient requires well-prepared teams to ensure life is saved. Patients with polytrauma show a high prevalence of post trauma biopsychosocial symptoms. Nurses are essential members of the trauma and critical care health teams. Educating nurses to provide competent early trauma and follow-up care is an essential requirement that significantly reduces morbidity/mortality, and improves quality of life, for polytrauma victims. 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Course Purpose This course will provide advanced learning for nurses interested in the management of the individual with polytrauma. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Activity Review Information Reviewed by Susan DePasquale, MSN, FPMHNP-BC Release Date: 3/1/2016 Termination Date: 8/10/2016 Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1. Which of the following statements is/are true of polytrauma: a. Polytrauma is the leading cause of death globally. b. The death rate is highest in individuals under the age of 44. c. Trauma is the leading cause of death in individuals under the age of 35. d. All of the above. 2. The most common cause of military polytrauma is: a. from gunshot wounds. b. caused by chemical weapons. c. caused by explosive devices or blasts. d. vehicular accidents. 3. True or False: Polytrauma in a patient differs from general, multiple injuries in a patient, in that with polytrauma injuries at least one of the injuries is life threatening. a. True. b. False. 4. During the initial stage of contact with a person suspected of having a traumatic brain injury, medical personnel should: a. ensure that the patient has a proper supply of oxygen to the brain and the rest of the body. b. maintain an adequate blood flow while controlling blood pressure. c. assess the patient and determine the extent of the injury. d. Answers a., and b. 5. When burns occur on the face or neck: a. the patient will require surgical procedures. b. the patient will require breathing assistance. c. the patient will require cutting the eschar in several places. d. the patient will require skin grafts. 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Introduction Due to advances in the field of medicine, many individuals who would have once been lost to serious injury can now be saved. As a result, the number of polytrauma patients – those with two or more acutely serious injuries, one of which is life threatening – has increased. Polytrauma is complex and requires medical personnel with advanced knowledge of emergency treatment and management.1 Medical personnel must be prepared to meet the unique needs of these patients, from the field to the emergency room and in both acute and post-acute care situations. Additionally, it is absolutely vital that medical professionals understand the psychological needs of polytraumatic patients so they can help them achieve healing of both body and mind. Polytrauma occurs as the result of accidents or during military combat. In either instance, the treatment must be tailored to meet the specific needs of the patient. In combat situations, polytrauma is caused primarily by blast related trauma, while civilian trauma can be caused by a number of incidents including motor vehicle accidents, bicycle accidents, firearms, industrial accidents and any other accidents that have the potential to cause severe injuries. Polytrauma is complex and requires a diverse range of services to best meet the needs of the individual patient. Polytrauma care providers must be able to provide initial care that is focused on patient stabilization, while also working to address any secondary issues that are caused by the trauma.2 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Definition And Incidence Polytrauma involves multiple injuries, which are typically complex. At least one of the injuries is life-threatening and requires immediate care. Polytrauma often has long lasting effects on the patient and can result in physical, cognitive, psychological or psychosocial impairments and disability. Polytrauma differs from general multiple injuries in a patient, as these are often not severe or life threatening; and, is also different from a single, severe, life threatening injury.3 Ultimately, what distinguishes polytrauma from other injuries is that it is specifically defined as multiple, complex injuries of which at least one is life threatening. Polytrauma is primarily caused by critical accidents and is especially prominent in the military population as a result of combat. The following is a list of the common causes of polytrauma: Type of Accident: Road traffic accidents Industrial accidents Sport accidents Accidents in leisure time Accidents in the home Violent crimes Burials Suicide attempts Catastrophes Effects of war Accidents caused by internal conditions (i.e., heart attack) 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Mechanism of accident:4 Deceleration trauma Fall trauma Trauma resulting from being run over Crush trauma Avulsion trauma Penetrating injury Explosion injury Thermal injury Chemical injury Radiation injury Polytrauma is the leading cause of death globally. The death rate is highest in individuals under the age of 44, with trauma being the leading cause of death in individuals under the age of 35. In the United States, blunt trauma caused by motor vehicle accidents and falls is the primary cause of death in polytrauma victims. In combat situations, polytrauma is usually the result of explosive devices and contact with flying shrapnel or gunshots. Polytrauma is also the leading cause of disability in individuals between the ages of 15 – 24.5 According to the World Health Organization (WHO), the following incidents accounted for the majority of non-combat polytrauma:6 Road Traffic Accidents – 24.3 million Falls – 37.3 million Violence – 17.2 million Fires – 10.9 million In the civilian population, polytrauma is very complex and impacts patients differently depending on the
Load more

Recommended publications
  • Thoracic Gunshot Wound: a Tanmoy Ganguly1, 1 Report of 3 Cases and Review of Sandeep Kumar Kar , Chaitali Sen1, Management Chiranjib Bhattacharya2, Manasij Mitra3
    2015 iMedPub Journals Journal of Universal Surgery http://www.imedpub.com Vol. 3 No. 1:2 ISSN 2254-6758 Thoracic Gunshot Wound: A Tanmoy Ganguly1, 1 Report of 3 Cases and Review of Sandeep Kumar Kar , Chaitali Sen1, Management Chiranjib Bhattacharya2, Manasij Mitra3, 1 Department of Cardiac Anesthesiology, Abstract Institute of Postgraduate Medical Thoracic gunshot injury may have variable presentation and the treatment plan Education and Research, Kolkata, India differs. The risk of injury to heart, major blood vessels and the lungs should be 2 Department of Anesthesiology, Institute evaluated in every patient with rapid clinical examination and basic monitoring and of Postgraduate Medical Education and surgery should be considered as early as possible whenever indicated. The authors Research, Kolkata, India present three cases of thoracic gunshot injury with three different presentations, 3 Krisanganj Medical College, Institute of one with vascular injury, one with parenchymal injury and one case with fortunately Postgraduate Medical Education and no life threatening internal injury. The first case, a 52 year male patient presented Research, Kolkata, India with thoracic gunshot with hemothorax and the bullet trajectory passed very near to the vital structures without injuring them. The second case presented with 2 hours history of thoracic gunshot wound with severe hemodynamic instability. Corresponding author: Sandeep Kumar Surgical exploration revealed an arterial bleeding from within the left lung. The Kar, Assistant Professor third case presented with post gunshot open pneumothorax. All three cases managed successfully with resuscitation and thoracotomy. Preoperative on table fluoroscopy was used for localisation of bullet. [email protected] Keywords: Horacic trauma, Gunshot injury, Traumatic pneumothorax, Emergency thoracotomy, Fluoroscopy.
    [Show full text]
  • MASS CASUALTY TRAUMA TRIAGE PARADIGMS and PITFALLS July 2019
    1 Mass Casualty Trauma Triage - Paradigms and Pitfalls EXECUTIVE SUMMARY Emergency medical services (EMS) providers arrive on the scene of a mass casualty incident (MCI) and implement triage, moving green patients to a single area and grouping red and yellow patients using triage tape or tags. Patients are then transported to local hospitals according to their priority group. Tagged patients arrive at the hospital and are assessed and treated according to their priority. Though this triage process may not exactly describe your agency’s system, this traditional approach to MCIs is the model that has been used to train American EMS As a nation, we’ve got a lot providers for decades. Unfortunately—especially in of trailers with backboards mass violence incidents involving patients with time- and colored tape out there critical injuries and ongoing threats to responders and patients—this model may not be feasible and may result and that’s not what the focus in mis-triage and avoidable, outcome-altering delays of mass casualty response is in care. Further, many hospitals have not trained or about anymore. exercised triage or re-triage of exceedingly large numbers of patients, nor practiced a formalized secondary triage Dr. Edward Racht process that prioritizes patients for operative intervention American Medical Response or transfer to other facilities. The focus of this paper is to alert EMS medical directors and EMS systems planners and hospital emergency planners to key differences between “conventional” MCIs and mass violence events when: • the scene is dynamic, • the number of patients far exceeds usual resources; and • usual triage and treatment paradigms may fail.
    [Show full text]
  • Cranio-Cerebral Gunshot Wounds
    438 C. Majer, G. Iacob Cranio-cerebral gunshot wounds Cranio-cerebral gunshot wounds C. Majer1, G. Iacob2 1Neurospinal Hospital Dubai, EAU 2Neurosurgery Clinic, Universitary Hospital Bucharest, Romania Abstract were assessed on admission by the Glasgow Cranio-cerebral gunshots wounds Coma Scale (GCS). After investigations: X- (CCGW) are the most devastating injuries ray skull, brain CT, Angio-CT, cerebral to the central nervous system, especially MRI, SPECT; baseline investigations, made by high velocity bullets, the most neurological, haemodynamic and devastating, severe and usually fatal type of coagulability status all patients underwent missile injury to the head. surgical treatment following emergency Objective: To investigate and compare, intervention. The survival, mortality and using a retrospective study on five cases the functional outcome were evaluated by clinical outcomes of CCGW. Predictors of Glasgow Outcome Scale (GOS) score. poor outcome were: older age, delayed Results: Referring on five cases we mode of transportation, low admission evaluate on a retrospective study the clinical CGS score with haemodynamic instability, outcome, imagistics, microscopic studies on CT visualization of diffuse brain damage, neuronal and axonal damage generated by bihemispheric, multilobar injuries with temporary cavitation along the cerebral lateral and midline sagittal planes bullet’s track, therapeutics, as the review of trajectories made by penetrating high the literature. Two patients with an velocity bullets fired from a very close admission CGS 9 and 10 survived and three range, brain stem and ventricular injury patients with admission CGS score of 3, with intraventricular and/or subarachnoid with severe ventricular, brain stem injuries hemorrhage, mass effect and midline shift, and lateral plane of high velocity bullets evidence of herniation and/or hematomas, trajectories died despite treatment.
    [Show full text]
  • How to Manage Penetrating Wounds in the Field
    HOW TO MANAGE CRITICAL FIELD EMERGENCIES How to Manage Penetrating Wounds in the Field Shannon J. Murray, DVM, MS, Diplomate ACVS Author’s address: Rhinebeck Equine, LLP, 26 Losee Lane, Rhinebeck, NY 12572; e-mail: [email protected]. © 2012 AAEP. 1. Introduction pneumothorax can be classified as either closed (le- Penetrating injuries to a body cavity such as the sion in lung parenchyma) or open (lesion in the thorax or abdomen can result from a horse running thoracic wall). The horse will often exhibit in- into or attempting to jump over a fixed object in the creased respiratory effort, dyspnea, and flared field (fence post, tree, etc.). True penetrating nostrils. Additional findings may include subcuta- wounds into the thoracic cavity and abdominal cav- neous emphysema, hemothorax, and pneumomedi- ity are associated with a guarded prognosis due to astinum.4 If a pneumothorax is suspected, the pneumothorax and infection that develop.1,2 Gun- wound should be wrapped with a sterile airtight shot wounds penetrating only the skeletal muscle bandagea to minimize further influx of air into the tend to have a good prognosis.3 Initial evaluation thoracic cavity. Thorough auscultation must be of a patient with a penetrating injury should focus performed. In the case of a pneumothorax, auscul- on patient homeostasis.4 tation will reveal little to no air movement dorsally. Ultrasound (air echo that does not move with respi- 2. Penetrating Wounds to the Thoracic Cavity ration) and radiographs (dorsal edge of the lung Wounds must be carefully examined to ascertain the margin is apparent) can help confirm the 1,2,4,5 depth of penetration.
    [Show full text]
  • Successful Recovery in a Paediatric Patient with Polytrauma Following Multiple Gunshot Wounds: Case Report and Review of Literature
    eCommons@AKU Section of Paediatric Surgery Department of Surgery 2-1-2020 Successful recovery in a paediatric patient with polytrauma following multiple gunshot wounds: Case report and review of literature Areej Saleem Rida Ahmed Abeer Aziz Sohail Asghar Dogar Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_paediatr Part of the Pediatrics Commons, Surgery Commons, and the Trauma Commons S-122 5th AKU Annual Surgical Conference (Trauma) CASE REPORT Successful recovery in a paediatric patient with polytrauma following multiple gunshot wounds: Case report and review of literature Areej Salim, Rida Ahmed, Abeer Aziz, Sohail Asghar Dogar Abstract established in the paediatric population.5-11 In this report, we describe the successful management of a 2 year 6- Our case report evaluates a 2½ year old boy who month old boy who suffered polytrauma via multiple presented to emergency care, following multiple gunshot gunshot wounds with primary repair of gastrointestinal injuries and was managed emergently using a injuries. multidisciplinary surgical approach at our center. The patient was unresponsive, had poor perfusion, bilaterally Case Report decreased air entry, a distended abdomen, and multiple The following case report was written and submitted after entry and exit wounds. A multidisciplinary team including obtaining informed consent from the parents of the Paediatric Surgery, Cardiothoracic Surgery, Paediatric minor and head of department approval. A 2 year 6- anaesthesiology team and Orthopaedic surgery were month-old boy presented to the Aga Khan University taken on board. Following effective immediate Hospital, Karachi, in March 2018, after sustaining 3 management and stabilization, the patient was admitted gunshot wounds to the thorax, abdomen and lower to the ward under careful observation.
    [Show full text]
  • Chapter 10 RHABDOMYOLYSIS and COMPARTMENT SYNDROME in MILITARY TRAINEES
    Rhabdomyolysis and Compartment Syndrome in Military Trainees Chapter 10 RHABDOMYOLYSIS AND COMPARTMENT SYNDROME IN MILITARY TRAINEES † JOHN J. WALSH, MD*; AND STEVEN M. PAGE, MD INTRODUCTION RHABDOMYOLYSIS Pathophysiology Acute Exertional Rhabdomyolysis COMPARTMENT SYNDROME Diagnosis Measurement of Compartment Pressure RELATIONSHIP BETWEEN RHABDOMYOLYSIS AND COMPARTMENT SYNDROME SUMMARY * Assistant Professor, University of South Carolina, School of Medicine, Department of Orthopaedics, 2 Medical Park, Suite 404, Columbia, South Caro- lina, 29203; formerly, Major, Medical Corps, US Army, Staff Physician and Clinic Director, Department of Orthopaedics, Moncrief Army Community Hospital, Fort Jackson, South Carolina † Orthopaedic Surgeon, Brandon Orthopedic Associates, 721 W. Robertson St., Suite 102, Brandon, Florida 33511; formerly, Fellow, Sports Medicine, University of Miami, Coral Gables, Florida 165 Recruit Medicine INTRODUCTION Extremity trauma is a common occurrence during a dangerous point. military training. All basic trainees, to some degree, The purpose of this chapter is to highlight two experience muscle injury below the threshold of per- closely related problems that occur within the train- manent damage. However, the likelihood of a trainee ing environment: rhabdomyolysis and compartment developing a musculoskeletal injury that seriously syndrome. These conditions develop as a result of a threatens life or limb is quite low. Physicians who treat physiological cascade of metabolic abnormalities that personnel undergoing basic military training need to occurs when the body is no longer able to compensate be aware of factors that can push the level of injury to for the demands placed upon it. RHABDOMYOLYSIS Pathophysiology 600,000 U/L reported. (Normal values range from 50 to 200 U/L.3) Severe cases can develop into disseminated Rhabdomyolysis is the breakdown of skeletal intravascular coagulation and renal failure, and can muscle as a result of injury.
    [Show full text]
  • DCMC Emergency Department Radiology Case of the Month
    “DOCENDO DECIMUS” VOL 6 NO 2 February 2019 DCMC Emergency Department Radiology Case of the Month These cases have been removed of identifying information. These cases are intended for peer review and educational purposes only. Welcome to the DCMC Emergency Department Radiology Case of the Month! In conjunction with our Pediatric Radiology specialists from ARA, we hope you enjoy these monthly radiological highlights from the case files of the Emergency Department at DCMC. These cases are meant to highlight important chief complaints, cases, and radiology findings that we all encounter every day. PEM Fellowship Conference Schedule: February 2019 If you enjoy these reviews, we invite you to check out Pediatric Emergency Medicine Fellowship 6th - 9:00 First Year Fellow Presentations Radiology rounds, which are offered quarterly 13th - 8:00 Children w/ Special Healthcare Needs………….Dr Ruttan 9:00 Simulation: Neuro/Complex Medical Needs..Sim Faculty and are held with the outstanding support of the 20th - 9:00 Environmental Emergencies………Drs Remick & Munns Pediatric Radiology specialists at Austin Radiologic 10:00 Toxicology…………………………Drs Earp & Slubowski 11:00 Grand Rounds……………………………………….…..TBA Association. 12:00 ED Staff Meeting 27th - 9:00 M&M…………………………………..Drs Berg & Sivisankar If you have and questions or feedback regarding 10:00 Board Review: Trauma…………………………..Dr Singh 12:00 ECG Series…………………………………………….Dr Yee the Case of the Month, feel free to email Robert Vezzetti, MD at [email protected]. This Month: Let’s fall in love with learning from a very interesting patient. His story, though, is pretty amazing. Thanks to PEM Simulations are held at the Seton CEC.
    [Show full text]
  • Polytrauma Care: a Delicate Balance for the Military Nurse Case Manager
    CLINICAL CARE Polytrauma Care: A Delicate Balance for the Military Nurse Case Manager Anne M. Cobb, MSN, RNC, CMAC brokering communication between facilities, providers, Nancy Pridgen, MS, RN and families to foster optimization of the discharge out- come. Case management has a pivotal role in ensuring that care arranged prior to discharge is executed after dis- s with every military engagement, the Operation Iraqi charge to foster enhanced continuity of care. Maintaining AFreedom and Operation Enduring Freedom casual- a caseload of patients with polytrauma requires that the ties present unique combat-related healthcare issues. case manager implement a refined organizational and Because of better body armor protection and sophisticated clinical skill set. weaponry, casualties are surviving with complex injuries Since the extensive and complex injuries sustained by the and rehabilitation requirements never seen before. The casualties have not existed previously, it is crucial to antici- casualties no longer have a single injury but rather several pate and address the multiple specialty needs of the casu- injuries (polytrauma or multitrauma), such as traumatic alty.3 Arranging care and subsequent follow-up provisions brain injury (TBI) and blindness, TBI with amputation and pose a variety of challenges, particularly when obtaining prosthetic requirements, or TBI with vision injuries.1 and consolidating required authorizations for care (planned Trauma to multiple organ and sensory systems requires and emergent) and clinical reports from a multitude of complex coordination rehabilitation and a multidiscipli- providers. The need for an average of 7 specialists to treat nary team functioning in tandem. Involvement by the case each casualty exemplifies the intricacy of care.
    [Show full text]
  • Evaluation and Management of Abdominal Gunshot Wounds: a Western Trauma Association Critical Decisions Algorithm
    2019 WTA PODIUM PAPER Evaluation and management of abdominal gunshot wounds: A Western Trauma Association critical decisions algorithm 01/21/2020 on 8uk0Zth40dAfp4cavR312AYBCIK5pC5Bv36rXL17h+BhYlz5/ljyLewteYwWcBChS9Dexu/EpxsYEdogfkiC4LCdokbdCbopQj8r0xXe2wo3RqbAvIfZ5LTeX4asgT67qt0lbM2/iC8= by https://journals.lww.com/jtrauma from Downloaded Matthew J. Martin, MD, Carlos V. R. Brown, MD, David V. Shatz, MD, Hasan Alam, MD, Karen Brasel, MD, Downloaded Carl J. Hauser, MD, Marc de Moya, MD, Ernest E. Moore, MD, Gary Vercruysse, MD, and Kenji Inaba, MD, Portland, Oregon from https://journals.lww.com/jtrauma KEY WORDS: Gunshot wounds; abdominal trauma; penetrating; Western Trauma Association; algorithm. his is a recommended evaluation and management algorithm as a general framework in the approach to these patients, and to T from the Western Trauma Association (WTA) Algorithms customize and adapt the algorithm to better suit the specifics of by 8uk0Zth40dAfp4cavR312AYBCIK5pC5Bv36rXL17h+BhYlz5/ljyLewteYwWcBChS9Dexu/EpxsYEdogfkiC4LCdokbdCbopQj8r0xXe2wo3RqbAvIfZ5LTeX4asgT67qt0lbM2/iC8= Committee addressing the management of adult patients with ab- that program, personnel, or location. We also recognize that the dominal gunshot wounds (GSW). Because there is a paucity of majority of civilian experience and published literature comes published prospective randomized clinical trials that have gener- from injuries due to standard low-velocity weapons and projec- ated class I data, these recommendations are based primarily on tiles, and that there
    [Show full text]
  • Gunshot Wounds to the Chest
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by NORA - Norwegian Open Research Archives GUNSHOT WOUNDS TO THE CHEST Lillian Beate Holmen Prosjektoppgave ved det medisinske fakultet UNIVERSITETET I OSLO Oktober 2013 ABSTRACT Introduction: This is a review of gunshot wounds to the chest. Although uncommon in Norway, they represent a big health problem in other parts of the world and in war situations. Method: A systematic literature search using PubMed and McMaster+. Results: Gunshot wounds to the chest can be highly lethal. Depending on the injured organ, a large percentage of the patients die before reaching the hospital. There is a big difference between low-velocity and high-velocity weapons. Low velocity injuries are most common in the civilian sector, whereas high-velocity injuries are over- represented in war zones and cause much greater tissue damage. The initial evaluation at the hospital needs to be quick and well practiced in order to rush the most critical patients to treatment and surgery without delay. All organs in the thoracic cavity may potentially be harmed. Parenchymal lung injury is the most common and the usual form of presentation is hemo- or pneumohemothorax. The most common forms of presentation of cardiac injury are cardiac tamponade and excessive hemorrhage. However, most patients with gunshot wounds to the chest can be managed non-operatively, or with a simple chest drain. Conclusion: Gunshot wounds to the chest are dangerous injuries. In order to decrease mortality, good systems for transportation and experienced personnel are necessary. INTRODUCTION I was inspired to write about gunshot wounds by the events that took place in Oslo city center and at Utøya the 22nd of July, 2011.
    [Show full text]
  • A Review of the Diagnosis and Treatment of Gunshot Trauma in Birds
    A REVIEW OF THE DIAGNOSIS AND TREATMENT OF GUNSHOT TRAUMA IN BIRDS Brett Gartrell New Zealand Wildlife Health Centre Institute of Veterinary, Animal and Biomedical Sciences Palmerston North, New Zealand This paper reviews the diagnosis and treatment of gunshot trauma in birds. A primer on basic ballistic theory as it applies to the pathophysiology of gunshot wounds is included, and in particular the difference in wounds caused by high and low energy impacts. The currently recommended treatment for soft tissue, orthopaedics and antibiotic treatment of gunshot trauma in human medicine and surgery is outlined and discussed as to how this might apply to birds. The complications of gunshot injury in humans and birds and the issues around post mortem diagnosis and forensic investigation of these cases are discussed. INTRODUCTION Gunshot trauma is seen commonly in wild birds and rarely in aviary and companion birds. For example, in Canada, gunshot injury was detected in 6.4% of 4805 wild raptors admitted to rehabilitation networks in Quebec between 1986 and 2007, although the incidence decreased in later years (Desmarchelier et al. 2010). Many wild birds survive with embedded ammunition from previous injury. There is scant information in the avian medical literature on this subject, so extrapolations from the extensive literature on gunshot wounds in humans are necessary. Birds will differ in their response to gunshot trauma due to their size and anatomical differences. However, the basic principles of ballistics, and tissue response to gunshot wounds should be broadly similar between humans and birds. Much of human medical knowledge of gunshot injury was based on military grade weaponry and so was dominated by the effects of high calibre weapons which because of their widespread soft tissue damage and tendency of the ammunition to fragment necessitate aggressive surgical therapy (Farjo and Miclau, 1997).
    [Show full text]
  • Gunshot Wound Policy
    Gunshot Wound Policy You can’t always prevent injuries from happening, but you can have a financial safety net in place in case they do. A gunshot wound policy from Colonial Life & Accident Insurance Company can provide a benefit to help pay your medical expenses if you receive a non-fatal gunshot wound. This policy pays a lump-sum benefit for an injury regardless of any other insurance you may have. Gunshot wound benefit ................................................... $ ____________________ Guaranteed issue You can get this coverage without answering any health questions. Portability You can keep coverage even if you change jobs or leave your company. Guaranteed renewable For more information, You can keep your coverage as long as you pay your premiums when they are due. talk with your On/o1-job coverage benefits counselor. You may receive benefits regardless of whether the injury occurs on or o' the job. Direct payment Benefits are paid directly to you unless you specify otherwise. You can use these benefits however you choose. This policy covers a non-fatal gunshot wound from a conventional firearm that requires treatment by a doctor and overnight hospitalization within 24 hours of the injury. If you are shot more than once in a 24-hour period, we will pay benefits only for the first wound. THIS POLICY PROVIDES LIMITED BENEFITS. EXCLUSIONS AND LIMITATIONS We will not pay benefits for an injury which is caused by or occurs as the result of: war, illegal activities, or suicide or ColonialLife.com injuries which you intentionally do to yourself. For cost and complete details, see your Colonial Life benefits counselor.
    [Show full text]