Tag Archives: Penetrating Trauma

Straight, No Chaser: Penetrating Trauma (Gunshot and Stab Wounds)

Trauma, , , , , , ,

penetrating trauma gun

Penetrating trauma (PT) is of such magnitude in this country that it is nearly impossible to do it justice in short form. This is primarily a medical blog, and as such I’ll defer addressing the politics of it all. The fact remains that gunshot and stab wounds take an astounding toll on human life in the U.S, with over 16,000 homicides annually (approximately 45 deaths every day). The ramifications of these wounds encompass much more than medical considerations, but I’ll devote this space to discussing basics of penetrating trauma.

penetrating trauma weapons

What Happens
By design, intentional stab and gunshot wounds aim to kill. Any area of the body can be shot or stabbed. Unintentional injuries are also a source of common emergency room presentations. Major ERs and Trauma Centers are known within the industry as the “knife and gun clubs.”
Penetrating injuries to virtually all areas (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshot wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone).

  • PT that reaches blood vessels can cause fatal bleeding. In the abdomen, the liver is the most commonly injured organ because of its large size. It can bleed enough to cause shock and death.
  • PT that reaches the spinal cord can cause paralysis and death.
  • PT to the brain can cause all manners of dysfunction, including loss of speech, motion, sensation, bodily functions, paralysis and death.
  • PT to the chest can cause puncture, rupture and/or loss of lung and heart function, leading to a pretty rapid death.

Be reminded that although both gunshot wounds and stab wounds involve penetration and may puncture your internal organs, gunshots are more prone to deeper penetration with higher energy and may create exit wounds, causing damage throughout its course.
What You Can Do
Here are the things you must consider after becoming a victim of penetrating trauma.

  • Get to safety. Perpetrators of penetrating trauma mean to hurt you and often mean for you to be dead. They may be looking to finish the job. I’ve been involved in many scenarios where individuals came to the ER to do just that.
  • Once you’re safe,immediately call 911 regardless of how you feel. You may be in shock and your body will fight feverishly to normalize how you feel – right up until you crash. In other words, you can’t trust how you feel. Another vital consideration about getting medical attention rapidly is what we call “The Golden Hour.” The opportunity to address many of the truly life threatening considerations in penetrating trauma is best done within the first 60 minutes of the injury.
  • Once you’re safe, apply pressure (clean towels) to any bleeding sites. Cover yourself with blankets as needed to preserve heat.
  • Avoid movement. Gunshot wounds are associated with spinal cord injuries, so movement could be dangerous.

JHSH-ED

What You Should Expect
Treatment of penetrating trauma is very dramatic and necessarily regimented due to the early lack of knowledge of the depth and location of injuries. As such, assessment and treatment protocols generally are in place for the region of the body penetrated. The first consideration is always ensuring that the patient’s Airway is intact, Breathing is still ongoing, and Circulation (blood flow) is sufficient (The “ABCs” of Trauma management). After that, use of x-rays, CT scans and other radiologic modalities to identify the location and extent of injuries will be employed based on the stability of the patient. Sometimes immediate surgical intervention is needed.
This is another situation where prevention is the best course of action. Avoiding injuries when possible should go without saying but often does not. Gun safety for gun owners is crucial to avoid unintentional injuries. Attention to detail is very important when handling guns and knives. Unintentional injuries tend to occur when handlers of these weapons get too comfortable. Unfortunately, once penetrating trauma has occurred, it seems like a game of chance. For every person who is told, “If that bullet was one more inch to the right, you’d be paralyzed (or dead),” another family has to be told to make arrangements. Unfortunately, my father was the victim of a random fatal gunshot wound when I was six years old, so I know that story all too well.
If you remember anything from this blog post, remember time is of the essence. Get your loved one to us inside of ‘The Golden Hour” to give the best chance of a good outcome.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Penetrating Trauma (Gunshot and Stab Wounds)

Trauma, , , , , , ,

penetrating trauma gun

Penetrating trauma (PT) is of such magnitude in this country that it is nearly impossible to do it justice in short form. This is primarily a medical blog, and as such I’ll defer addressing the politics of it all. The fact remains that gunshot and stab wounds take an astounding toll on human life in the U.S, with over 16,000 homicides annually (approximately 45 deaths every day). The ramifications of these wounds encompass much more than medical considerations, but I’ll devote this space to discussing basics of penetrating trauma.
Penetrating trauma (PT) is of such magnitude in this country that it is nearly impossible to do it justice in short form. This is primarily a medical blog, and as such I’ll defer addressing the politics of it all. The fact remains that gunshot and stab wounds take an astounding toll on human life in the U.S, with over 16,000 homicides annually (approximately 45 deaths every day). The ramifications of these wounds encompass much more than medical considerations, but I’ll devote this space to discussing basics of penetrating trauma.

penetrating trauma weapons

What Happens
By design, intentional stab and gunshot wounds aim to kill. Any area of the body can be shot or stabbed. Unintentional injuries are also a source of common emergency room presentations. Major ERs and Trauma Centers are known within the industry as the “knife and gun clubs.”
Penetrating injuries to virtually all areas (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshot wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone).

  • PT that reaches blood vessels can cause fatal bleeding. In the abdomen, the liver is the most commonly injured organ because of its large size. It can bleed enough to cause shock and death.
  • PT that reaches the spinal cord can cause paralysis and death.
  • PT to the brain can cause all manners of dysfunction, including loss of speech, motion, sensation, bodily functions, paralysis and death.
  • PT to the chest can cause puncture, rupture and/or loss of lung and heart function, leading to a pretty rapid death.

Be reminded that although both gunshot wounds and stab wounds involve penetration and may puncture your internal organs, gunshots are more prone to deeper penetration with higher energy and may create exit wounds, causing damage throughout its course.
What You Can Do
Here are the things you must consider after becoming a victim of penetrating trauma.

  • Get to safety. Perpetrators of penetrating trauma mean to hurt you and often mean for you to be dead. They may be looking to finish the job. I’ve been involved in many scenarios where individuals came to the ER to do just that.
  • Once you’re safe,immediately call 911 regardless of how you feel. You may be in shock and your body will fight feverishly to normalize how you feel – right up until you crash. In other words, you can’t trust how you feel. Another vital consideration about getting medical attention rapidly is what we call “The Golden Hour.” The opportunity to address many of the truly life threatening considerations in penetrating trauma is best done within the first 60 minutes of the injury.
  • Once you’re safe, apply pressure (clean towels) to any bleeding sites. Cover yourself with blankets as needed to preserve heat.
  • Avoid movement. Gunshot wounds are associated with spinal cord injuries, so movement could be dangerous.

JHSH-ED

What You Should Expect
Treatment of penetrating trauma is very dramatic and necessarily regimented due to the early lack of knowledge of the depth and location of injuries. As such, assessment and treatment protocols generally are in place for the region of the body penetrated. The first consideration is always ensuring that the patient’s Airway is intact, Breathing is still ongoing, and Circulation (blood flow) is sufficient (The “ABCs” of Trauma management). After that, use of x-rays, CT scans and other radiologic modalities to identify the location and extent of injuries will be employed based on the stability of the patient. Sometimes immediate surgical intervention is needed.
This is another situation where prevention is the best course of action. Avoiding injuries when possible should go without saying but often does not. Gun safety for gun owners is crucial to avoid unintentional injuries. Attention to detail is very important when handling guns and knives. Unintentional injuries tend to occur when handlers of these weapons get too comfortable. Unfortunately, once penetrating trauma has occurred, it seems like a game of chance. For every person who is told, “If that bullet was one more inch to the right, you’d be paralyzed (or dead),” another family has to be told to make arrangements. Unfortunately, my father was the victim of a random fatal gunshot wound when I was six years old, so I know that story all too well.
If you remember anything from this blog post, remember time is of the essence. Get your loved one to us inside of ‘The Golden Hour” to give the best chance of a good outcome.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook atSterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: The Drama of Gunshot Wounds and a Nation at War with Itself

Trauma, Public Health, , , , , ,

gunviolence

Somewhere in the midst of reconciling the parts of me that are physician, public health professional and African-American male, I realized that I don’t have the luxury to simply review the medical aspects of gunshot wounds. As an African-American, I have lived my entire life learning and having it reinforced that I and others of my kind are a misunderstanding or inappropriate interaction away from becoming a statistic. As a physician I get to treat, and as a public health professional I get to report and fashion broad solutions to various challenges, but as an African-American, I get to live a certain reality that for me began when my father died from a gunshot wound when I was a small child.

GunshotWoundsBrain_300x

The trauma inflicted by a gunshot wound is not theoretical. It is a medical lie that such a thing as a warning shot exists, if indeed a bullet enters your body. Penetrating injuries to virtually all areas of the body (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshot wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone). When you shoot someone, you have factored in a possibility that the wound you inflict could be fatal. Police officers shooting individuals are aiming at areas correlating with defined statistic probabilities of death, none of which is zero. No one should ever be allowed to claim otherwise.

gun violence chicago

We live in a country that is without debate the most violent country on earth, both outside of and within all parts of our borders. From the individual’s rights to bear militia levels of arms to the police’s increasing position as military units, from the contradictions of allowing both “Open Carry” and “Stand Your Ground,” we are spiraling toward an inevitable conclusion.
You want to participate in a challenge? Stop being so deficient of attention about what’s happening before our eyes, and think and ask what the inevitable conclusion of all of this is going to be. Regardless of your political persuasion, there are issues to be addressed.

gun-violence

Consider the following facts from the Children’s Defense fund,

  • approximately 2900 children and teens died from guns in the US in both 2008 and 2009. (Does anyone think the numbers have declined since then?) That’s one child or teen every 3 hours. That’s eight children or teens every day. That’s 55 children or teens every week for two years. What is our country’s response to this? What are you specifically doing to contribute to a solution to this?
  • Young Blacks are being exterminated by gunshot wounds in this country. Black children and teens accounted for 45% of all child and teen deaths in those years, while only accounting for 15% of the total child population. Are you just going to read this statement passively without wondering about and contributing to a solution?
  • Black males 15-19 were eight times as likely as White males of the same age and two-and-a-half times as likely as their Hispanic peers to be killed in a gun homicide in 2009. In fact, gun homicide is the leading cause of death among Black teens ages 15-19 in 2008-2009.
  • The most recent analysis of data from industrialized nations shows that 87% of the children under age 15 killed by guns in these nations lived in the U.S. The homicide rate in the U.S. for teens and young adults ages 15-24 was 42.7 times higher than the combined rate for all other nations.
  • In spite of all this, in absolute numbers more White than Black children and teens have died from gun violence since data started being collected.

Using more recently available data, the Centers for Disease Control and Prevention lists the number of firearm-induced deaths in 2013 as 11,068. This accounted for over 68% of all murders in the U.S. last year.

GunViolenceend

What is it going to take to get the American public and leaders to stand up to protect the lives and safety of children over the lobbies of gun owners and sellers? America can walk and chew gum at the same time. We can fashion reasonable safety measures and restrictions that will save lives while working within the framework of current interpretations of the Constitution by the Supreme Court. This will not occur without pressure from the populace.
Martin Luther King, Jr had two famous and related quotes that are relevant and applicable here.

  • “Our lives begin to end the day we become silent about things that matter.”
  • “In the end, we will remember not the words of our enemies, but the silence of our friends.”

If you are not willing to take specific actions to eradicate the challenges facing us, that makes your condolences somewhat hollow after tragedies have occurred. It is past time to get involved in whatever way you can or choose. The life you save may be your own.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress.

Straight, No Chaser: Penetrating Trauma – Gunshot and Stab Wounds

Trauma, , , , , ,

school shootings

Penetrating trauma (PT) is of such magnitude in this country that it is nearly impossible to do it justice in short form. This is primarily a medical blog, and as such I’ll defer addressing the politics of it all. The fact remains that gunshot and stab wounds take an astounding toll on human life in the U.S, with over 16,000 homicides annually (approximately 45 deaths every day). The ramifications of these wounds encompass much more than medical considerations, but I’ll devote this space to discussing basics of penetrating trauma.

GunshotWoundsBrain_300x

What Happens
By design, intentional stab and gunshot wounds aim to kill. Any area of the body can be shot or stabbed. Unintentional injuries are also a source of common emergency room presentations. Major ERs and Trauma Centers are known within the industry as the “knife and gun clubs.”
Penetrating injuries to virtually all areas (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshot wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone).

  • PT that reaches blood vessels can cause fatal bleeding. In the abdomen, the liver is the most commonly injured organ because of its large size. It can bleed enough to cause shock and death.
  • PT that reaches the spinal cord can cause paralysis and death.
  • PT to the brain can cause all manners of dysfunction, including loss of speech, motion, sensation, bodily functions, paralysis and death.
  • PT to the chest can cause puncture, rupture and/or loss of lung and heart function, leading to a pretty rapid death.

Be reminded that although both gunshot wounds and stab wounds involve penetration and may puncture your internal organs, gunshots are more prone to deeper penetration with higher energy and may create exit wounds, causing damage throughout its course.
What You Can Do
Here are the things you must consider after becoming a victim of penetrating trauma.

  • Get to safety. Perpetrators of penetrating trauma mean to hurt you and often mean for you to be dead. They may be looking to finish the job. I’ve been involved in many scenarios where individuals came to the ER to do just that.
  • Once you’re safe, immediately call 911 regardless of how you feel. You may be in shock and your body will fight feverishly to normalize how you feel – right up until you crash. In other words, you can’t trust how you feel. Another vital consideration about getting medical attention rapidly is what we call “The Golden Hour.” The opportunity to address many of the truly life threatening considerations in penetrating trauma is best done within the first 60 minutes of the injury.
  • Once you’re safe, apply pressure (clean towels) to any bleeding sites. Cover yourself with blankets as needed to preserve heat.
  • Avoid movement. Gunshot wounds are associated with spinal cord injuries, so movement could be dangerous.

What You Should Expect
Treatment of penetrating trauma is very dramatic and necessarily regimented due to the early lack of knowledge of the depth and location of injuries. As such, assessment and treatment protocols generally are in place for the region of the body penetrated. The first consideration is always ensuring that the patient’s Airway is intact, Breathing is still ongoing, and Circulation (blood flow) is sufficient (The “ABCs” of Trauma management). After that, use of x-rays, CT scans and other radiologic modalities to identify the location and extent of injuries will be employed based on the stability of the patient. Sometimes immediate surgical intervention is needed.
This is another situation where prevention is the best course of action. Avoiding injuries when possible should go without saying but often does not. Gun safety for gun owners is crucial to avoid unintentional injuries. Attention to detail is very important when handling guns and knives. Unintentional injuries tend to occur when handlers of these weapons get too comfortable. Unfortunately, once penetrating trauma has occurred, it seems like a game of chance. For every person who is told, “If that bullet was one more inch to the right, you’d be paralyzed (or dead),” another family has to be told to make arrangements. Unfortunately, my father was the victim of a random fatal gunshot wound when I was six years old, so I know that story all too well.
If you remember anything from this blog post, remember time is of the essence. Get your loved one to us inside of ‘The Golden Hour” to give the best chance of a good outcome.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook atSterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Been Stabbed? Impaled?

General Health and Wellness, , , , ,

This post contains graphic pictures.

impaledkey

Accidents happen. So does penetrating trauma. Would you know what to do if you were stabbed or fell on an object that got stuck? I know what your instincts would be: Immediately evict any unwelcome tenants! Let’s discuss the correct steps to take in the presence of an impaled object.

 impaledpencil

Your first move is your best move. Get out of harm’s way. In those cases where an assailant wants you dead, your injuries/trauma represents an unfinished job. If you can safely remove yourself from the environment, do so.

impaled eyenail

Have someone immediately call 911 or your area’s emergency hotline.

impaled backknife

You’re waiting for this, so let’s address what’s likely to be your first question: In the overwhelming majority of cases, the correct thing to do is to leave the object in place. Do not attempt to remove it. There are possibly vital structures in place (e.g., nerves, arteries, veins), and the fact that you’re not yet dead means your body has successfully adjusted to the presence of the object (well, at least temporarily). Removing it could have the effect of uncorking a dam, meaning you could be releasing a massive flow of blood from a punctured blood vessel.

impaled bigknife

Keep yourself or the affected person as still as possible. You really don’t want to move someone unless there is an obvious and immediate life-threatening situation. If practical, the preferred positioning of the affected person is lying down with arms and legs elevated. This will reduce blood flow to the arms and legs and keep it in the core, where your brain and heart need it.
impaled neckknife
Prepare and be prepared for bleeding. This can occur from nicking a blood vessel or accidentally dislodging the object and producing bleeding. Obtain plenty of clean towels and create a big, bulky dressing around the object. If you have bandages, use them to secure this dressing; you want to keep everything in place as much as possible. It’s also a good idea to remove clothing from around the object as well because it’s likely dirty and will increase the risk of infection.

impaled treelimb

Keep yourself or the affected person as comfortable and calm as possible. Excitement increases your blood pressure, which will increase bleeding. You don’t want this. You only have so much blood, and you don’t want it squirting out of you. This is an example where you don’t want the person to go to sleep, as this could represent settling into shock. Keep the person awake, alert and engaged in calm conversation. Realize that your panic is likely to translate to the person you are trying to help.

impalediron

Your best bet is to wait for the ambulance to arrive. Resist the strong urge to “Don’t just stand there. Do something!” Your efforts at moving and maneuvering the person are likely to be harmful. You want professionals to take the next steps. That said, if you believe the person is deteriorating, or you can’t overcome your panic, attempt to transport someone without moving the object and while keeping the person calm and still as possible.

Of course, I would be remiss if I didn’t suggest the best measure is to avoid the situation in the first place. Whether at home or work, taking the time to assess your environment and be aware of potential risks goes a long way to avoiding these types of accidents.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Trauma Quick Tips and The Week In Review

Health Prevention, Medical Treatment, , , , , , , , , , , ,

cch trauma
This week in Straight, No Chaser, we reviewed multiple topics related to Trauma, the #1 cause of death between ages 1-44.  Here’s the Week In Review and featured Quick Tips.
1)   Over the weekend, we started with discussions of Amputations of Permanent Teeth and Fingers.

  1. Remember, you lose 1% viability per minute for a dislodged tooth.  Get help quick!  https://jeffreysterlingmd.com/2013/07/27/straight-no-chaser-saturday-quick-tips-the-tooth-of-the-matter-is/
  2. The transport of displaced fingers and teeth is vital to successful reimplantation.  Never place them directly on ice!  https://jeffreysterlingmd.com/2013/07/28/sunday-quick-tips-give-me-the-finger/

2)   On Monday, we talked about Motor Vehicle Crashes.
https://jeffreysterlingmd.com/2013/07/29/straight-no-chaser-human-shark-week-part-1-motor-vehicle-trauma/
https://jeffreysterlingmd.com/2013/07/29/trauma-quick-tips-how-to-survive-that-motor-vehicle-crash-mvc/

  1. Avoiding distracted driving is the most important factor in preventing crashes.
  2. Wearing your seat beat is the most important factor in surviving crashes.
  3. The middle back seat (while wearing a seat belt) is the safest place in the car.

3)   On Tuesday, we reviewed Traumatic Brain Injuries/Concussions.
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussions-part-i/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-heads-up-traumatic-brain-injuries-concussion-part-ii/
https://jeffreysterlingmd.com/2013/07/30/straight-no-chaser-concussions-post-script-a-neurologists-thoughts/

  1. Dr. Flippen, a neurologist from UCLA, reminded us that most patients will recover but never as fast as they wish.
  2. After a head injury, expect not to be released back to sporting activity for at least two weeks.

4)   On Wednesday, we reviewed Mass Disasters and talked about the importance of an Emergency Kit.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-when-disaster-strikes/

  1. Remember to have access to 1 gallon per day per person, half for drinking and half for cooking/hygiene.

5)   On Wednesday, we also discussed Dog, Cat and Shark Bites.
https://jeffreysterlingmd.com/2013/07/31/straight-no-chaser-who-let-the-dogs-out-animal-bites/

  1. Cat scratches are also a major infection risk and should be evaluated.
  2. Who’d have thought sharks were nibbling you out of curiosity instead of biting you out of hunger?

6)   On Thursday, we reviewed Penetrating Trauma (Gunshot and Stab Wounds).  https://jeffreysterlingmd.com/2013/08/01/straight-no-chaser-gunshot-and-stab-wounds/

  1. Remember the ‘Golden Hour’ of Trauma and get seen as soon as possible after being stabbed or shot, just as soon as you ensure your safety.
  2. It is very important to avoid worsening possible spinal injuries by excessive movement.

7)   On Friday, we reviewed Residential Fires and its associated trauma.

  1. In Part I, we emphasized the importance of installing smoke and carbon monoxide detectors, having an escape plan and not sticking around to fight the fire.   https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-the-roof-is-on-fire-the-trauma-of-residential-fires/
  2. In Part II, we discussed treatment of possible injuries that may occur.  https://jeffreysterlingmd.com/2013/08/02/straight-no-chaser-your-questions-on-treatment-of-fire-related-injuries/
  3. Remember if any head or neck injuries exist, try your best not to move.
  4. Remember that if you’re feeling like you have the flu after being exposed to a fire, it could be carbon monoxide poisoning!

8)   On Saturday, we reviewed Snakebites.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-stop-the-life-you-save-may-be-your-own-snake-bites/

  1. We debunked the myth about sucking venom out of snakebite wounds.  Don’t do it!

9)   Saturday, we also reviewed Elderly Falls.
https://jeffreysterlingmd.com/2013/08/03/straight-no-chaser-ive-fallen-and-cant-get-up-quick-tips-on-elderly-falls/

  1. We identified head injuries/bleeds, lacerations and hip fractures as injuries to guard against.
  2. We discussed the importance of home improvements, diet, exercise and checking for osteoporosis and vision checking for maintainance of health.

Straight, No Chaser: Your Questions About Gunshot and Stab Wounds

Health Prevention, Trauma, Skin/Dermatology, Medical Treatment, , , , , , , , , ,

 Your Top Five Questions:
 1. Why don’t the bullets always get taken out? 
Removal of bullet may cause more damage than leaving them in.  It’s sometimes not worth the effort.
2. What’s with the tubes that go in the chest?
Chest tubes are used to treat a pneumothorax (a collapsed lung).  The problem is there’s air in the space between the lung and the chest wall.  This can interfere with normal breathing and may be life threatening.  The tubes go through the chest wall to release the air from that space, thus allowing re-expansion of the lungs.
3. Why would doctors ever need to slit someone’s throat to save their lives?
That describes either a cricothyrotomy or a tracheostomy, and it’s not ‘slitting’ the throat as much as it’s creating an opening in the airway to permit airflow.  This is usually necessary because of some airway obstruction at the upper throat (foreign body in the throat, etc.) with an inability to clear it.  This procedure is only done to save a life.
4. Why would you die from a wound to the thigh?
Fractures of certain bones and laceration of certain blood vessels are potentially associated with enough blood loss that you could bleed to death.  Infection and blood clots are additional considerations that could be life-threatening.
5. What about gunshot or stab wounds to someone pregnant?
Penetrating trauma to the abdomen is typically less fatal to the mother than to a fetus because the fetus is literally acting as a shield.  In the event any wound has placed the mother’s life at risk or the mother has died from the wound, under certain extreme circumstances, an emergency C-section may be performed to save the baby.

Straight, No Chaser: Violent Crimes – Gunshot and Stab Wounds

Health Prevention, Trauma, Skin/Dermatology, Medical Treatment, , , , , , , , , ,

Penetrating trauma (PT) is of such magnitude in this country that it is nearly impossible to do it justice in short form. This is primarily a medical blog, and as such I’ll defer addressing the politics of it all. The fact remains that gunshot and stab wounds take an astounding toll on human life in the U.S, with over 16,000 homicides annually (approximately 45 deaths every day). The ramifications of these wounds encompass much more than medical considerations, but I’ll devote this space to discussing basics of penetrating trauma.
What Happens
By design, intentional stab and gunshot wound aim to kill. Just as I noted in discussing the blunt trauma seen in motor vehicle crashes, any area of the body can be shot or stabbed. Unintentional injuries are also a source of common emergency room presentations. Major ERs and Trauma Centers are known within the industry as the ‘knife and gun clubs’.
Penetrating injuries to virtually all areas (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshots wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone).

  • PT that reaches blood vessels can cause fatal bleeding. In the abdomen, the liver is the most commonly injured organ because of its large size and can bleed enough to cause shock and death.
  • PT that reaches the spinal cord can cause paralysis and death.
  • PT to the brain can cause all manners of dysfunction, including loss of speech, motion, sensation, bodily functions, paralysis and death.
  • PT to the chest can cause puncture, rupture and/or loss of lung and heart function, leading to a pretty rapid death.

Be reminded that although both gunshot wounds and stab wounds involve penetration and may puncture your internal organs, gunshots are more prone to deeper penetration with higher energy and may create exit wounds, causing damage throughout its course.
What You Can Do
Here are the things you must consider after becoming a victim of penetrating trauma.

  • Get to safety. Perpetrators of penetrating trauma meant to hurt you and often mean for you to be dead. They may be looking to finish the job. I’ve been involved in many scenarios where individuals came to the ER to do just that.
  • Once you’re safe, immediately call 911 regardless of how you feel. You may be in shock and your body will fight feverishly to normalize how you feel – right up until you crash. In other words, you can’t trust how you feel. Another vital consideration about getting medical attention rapidly is what we call ‘The Golden Hour’. The opportunity to address many of the truly life threatening considerations in penetrating trauma is best done within the first 60 minutes of the injury.
  • Once you’re safe, apply pressure (clean towels) to any bleeding sites. Cover yourself with blankets as needed to preserve heat.
  • Avoid movement. Gunshot wounds are associated with spinal cord injuries, so movement could be dangerous.

What You Should Expect
Treatment of penetrating trauma is very dramatic and necessarily regimented due to the early lack of knowledge of the depth and location of injuries. As such, assessment and treatment protocols generally are in place for the region of the body penetrated. The first consideration is always ensuring that the patient’s Airway is intact, Breathing is still ongoing, and Circulation (blood flow) is sufficient (The ‘ABCs’ of Trauma management). After that, use of x-rays, CT scans and other radiologic modalities to identify the location and extent of injuries will be employed based on the stability of the patient. Sometimes immediate surgical intervention is needed.
This is another situation where prevention is the best course of action. Avoiding injuries when possible should go without saying but often does not. Gun safety for gun owners is crucial to avoid unintentional injuries. Attention to detail is very important when handling guns and knives. Unintentional injuries tend to occur when handlers of these weapons get too comfortable. Unfortunately, once penetrating trauma has occurred, it seems like a game of chance. For every person who is told “If that bullet was one more inch to the right, you’d be paralyzed (or dead)”, another family has to be told to make arrangements. Unfortunately, my father was the victim of a random fatal gunshot wound when I was six years old, so I know that story all too well.
If you remember anything from this blog post, remember time is of the essence. Get your loved one to us inside of ‘The Golden Hour’ to give the best chance of a good outcome.