26 Questions
What is the primary factor that determines the amount of destruction in a gunshot wound?
All of the above
What is the term for the study of projectile penetration of tissues?
Wound ballistics
What is the primary indicator of determining the extent of injuries in a gunshot wound?
All of the above
What is the term for the energy carried by the bullet and transferred into the tissues?
Kinetic energy
What is the classification of hemorrhage with a blood loss of 1500-2000 ml?
Class III
What is the primary goal of treatment in shock management?
To stabilize the victim
What is the term for the maximal point of energy transfer in a gunshot wound?
V1
What is the term for the feeling of impending doom in a patient with shock?
Subjective feeling of impending doom
What is the term for the study of the motion of projectiles?
Ballistics
What is the term for the velocity of the bullet as it exits the body?
V2
What is a closed wound?
An injury to the soft tissue without a break in the skin
What is a contusion?
Bleeding beneath the skin into the soft tissue
What is the primary concern when dealing with a patient who has a soft tissue injury?
Managing shock
What is the first step in managing an open wound?
Covering the injury with sterile dressings and applying firm direct pressure
What is the purpose of elevating the injured area?
To help control bleeding
What is a laceration?
A tear in the skin
What should you do if the dressing becomes saturated while applying direct pressure?
Reinforce the dressing with additional gauze
Why is it important to ensure the patient has a distal pulse to the dressing?
To ensure the dressing is not too tight
What is the primary goal of elevating the injured area above the level of the heart?
To reduce bleeding
When should direct pressure not be applied to a bleeding site?
When a fracture is suspected
What is the purpose of pressure points in controlling bleeding?
To control bleeding when direct pressure is ineffective
Where are pressure points typically located?
Between the site of injury and the heart where a main artery passes over a bone or underlying muscle mass
How should the area surrounding a wound be prepared?
Shave only what is necessary and irrigate gently and copiously with isotonic sterile saline solution or sterile water
What is the purpose of anesthetizing the wound?
To alleviate patient discomfort during wound irrigation and cleaning
What should be removed during wound cleaning and irrigation?
Foreign matter and devitalized tissue
How much irrigant is typically used for wound irrigation?
50ml per inch of wound per hour of age of wound
Study Notes
Gunshot Wounds and Hemorrhage
- Gunshot wounds are the leading source of high-velocity penetrating trauma
- The amount of destruction caused by a gunshot wound is directly related to the caliber of the gun, type of bullet, and proximity of the muzzle to the victim
- Kinetic energy (KE) carried by the bullet and transferred to the tissues causes damage in a gunshot wound victim
- The greater the kinetic energy of a projectile, the greater the wounding potential
- If a projectile does not exit the body, all its kinetic energy has been transferred to the tissues; if it exits, only some of its kinetic energy has been transferred
Wound Ballistics
- Entrance wound is called V1 (inlet velocity) as the maximal point of energy
- Exit wound is called V2 (outlet velocity), if the bullet does not exit the body, outlet velocity is zero
- High V1 creates an inward path along which the bullet travels, and negative pressure also exists behind the bullet, which pulls debris and bacteria to the wound
Classification of Hemorrhage
- Class I: ≤750 ml blood loss, normal pulse and BP, mildly anxious
- Class III: 1500-2000 ml blood loss, >120 pulse, decreased BP, anxious and confused
- Class IV: >2000 ml blood loss, >140 pulse, decreased BP, confused and lethargic
Shock and Hemorrhage
- Signs/Symptoms of Shock: altered LOC, narrowing pulse pressure, hypotension, weak and thready pulse, UO of 25ml/hour, pale and cold skin, diaphoresis, feeling of impending doom
- Goals of Treatment: decrease blood loss and increase intravascular volume
Management of Soft Tissue Injuries
- Wound Preparation: shave area surrounding wound, irrigate with isotonic sterile saline solution or sterile water, remove devitalized tissue and foreign matter
- Closed Wound: an injury to the soft tissue without a break in the skin
- Open Wound: an injury to the soft tissue with a break in the skin
- Abrasion: superficial loss of skin resulting from rubbing or scraping the skin over a rough or uneven surface
- Laceration: tear in the skin; can be partial or full-thickness cut
- Puncture: occurs when the skin is penetrated by a pointed object
- Avulsion: involves a tearing off or loss of a flap of the skin
- Amputation: traumatic cutting or tearing off of a finger, toe, arm, or leg
What to Do!
- Direct Pressure: cover injury with sterile dressings and apply firm direct pressure to the site of injury
- Elevation: elevate the injured area while applying direct pressure to control bleeding
This quiz covers the relationship between gunshot wounds and acute hemorrhage, including the concepts of wound ballistics and the factors affecting the amount of destruction caused by a gunshot.
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