Bullets and Blasts, Trauma Assessment (Unstable/stable)

Question 1

Remember, penetrating injuries or injuries that are caused by an object that can penetrate the surface of the body.

Answer 1

This may be a knife, a bullet, shrapnel from a blast, nails and so on. In this video, we will cover bullets and blasts.

Question 2

Penetrating injuries are classified as

Answer 2

Penetrating injuries are classified as low, medium and high velocity

Question 3

Low velocity injuries

Answer 3

Low velocity injuries would include stabbing or knife injury that is impaled into the body. They are limited to direct tissue damage that can occur only as far as the object can penetrate. Thus, knowing the length of the knife used in a stabbing can provide important information about how far injuries may have occurred. Medium and high-velocity penetrating injuries are often caused by bullets.

Question 4

Medium an high-velocity penetrating injuries are often caused by bullets.

Answer 4

A medium velocity bullet would be most shotguns and handguns, where high-velocity weapons would be rifles or potentially shrapnel from bomb blasts. The difference can clue you into how much damage you may be dealing with. So, it could be helpful to know what kind of gun was used in this sort of injury

Question 5

When a bullet strikes the patient and enters the body, it may change trajectory.

Answer 5

The trajectory is the path of a projectile and can essentially change course as it changes the medium through which it’s traveling. Thus the place that the bullet went into the body, may be very different from where it ends up. However, the higher the velocity of the bullet, the more reliable it is that it went on a straight trajectory.

Question 6

Another thing that can happen is that the bullet may break apart into smaller pieces as it enters the body.

Answer 6

This can cause a larger area of tissue damage. This is called fragmentation and oftentimes the internal damage is much larger than what you see externally.

Question 7

Another term that is important to understand when dealing with gunshot wounds is cavitation.

Answer 7

This is also called pathway expansion. Essentially, there is a pressure wave that is caused by the bullet as it enters the body and this wave can cause tissue damage beyond the physical pathway of the bullet. This only occurs in medium and high-velocity penetrating injuries and similar to fragmentation, can cause a much larger injury than may be externally apparent

Question 8

Much of the severity of the injury depends on the

Answer 8

Much of the severity of the injury depends on the location of the gunshot wound, its trajectory and whether it causes cavitation or fragmentation causing a large amount of internal damage.

Question 9

blast injury

Answer 9

These explosions could be from natural gas, fireworks, bombs or anything that causes a pressure wave that will lead to the scattering of shrapnel or other debris which can cause penetrating injury. There are three phases to a blast injury.

Question 10

The primary phrase of blast injury

Answer 10

he primary phrase injuries result from the pressure wave of the blast itself. Organs in the body that contain gas such as the stomach or intestines, are often affected because of rapid change of pressure. Other organs that can be damaged in the primary phase are the lungs, inner ears and sinuses. This phase alone can cause severe injury and even death, depending on the injuries that occur with the pressure wave from the explosion

Question 11

The secondary phase

Answer 11

The secondary phase of blast injuries are due to the flying debris that is propelled by the force of the blast. These are injuries that result from the debris striking the body and can cause anything from lacerations to amputations to low or high velocity penetrating injuries. Usually, these injuries are fairly obvious and externally visible unlike injuries that may have occurred in the primary phase.

Question 11

the tertiary phase i

Answer 11

Finally, the tertiary phase injuries occur when the patient is physically thrown from the explosion. The body then sustained injury from striking another surface or landing somewhere. This can cause blunt trauma depending on how far they are thrown, or even penetrating depending on where they land. As you can see, blast injuries can result in multi-system trauma because of the significant amount of damage that can occur over the three phases of injury.

Question 12

In trauma patients, we frequently refer to the Glasgow Coma Scale or GCS as a way to communicate with others about the level of responsiveness

Answer 12

A normal GCS is 15. We will not review all of the assessment of airway. You already learned that in course two.