Gunshot Wounds and Hemorrhage
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Questions and Answers

What is the primary factor that determines the amount of destruction in a gunshot wound?

  • Type of bullet
  • Proximity of the muzzle to the victim
  • Caliber of the gun
  • All of the above (correct)

    • What is the term for the study of projectile penetration of tissues?

  • Trauma ballistics
  • Wound ballistics (correct)
  • Ballistics
  • Projectile physics

    • What is the primary indicator of determining the extent of injuries in a gunshot wound?

  • Gun's caliber
  • Presumed path and velocity
  • Distance from the weapon to the victim's entrance point
  • All of the above (correct)

    • What is the term for the energy carried by the bullet and transferred into the tissues?

    <p>Kinetic energy</p> Signup and view all the answers

    What is the classification of hemorrhage with a blood loss of 1500-2000 ml?

    <p>Class III</p> Signup and view all the answers

    What is the primary goal of treatment in shock management?

    <p>To stabilize the victim</p> Signup and view all the answers

    What is the term for the maximal point of energy transfer in a gunshot wound?

    <p>V1</p> Signup and view all the answers

    What is the term for the feeling of impending doom in a patient with shock?

    <p>Subjective feeling of impending doom</p> Signup and view all the answers

    What is the term for the study of the motion of projectiles?

    <p>Ballistics</p> Signup and view all the answers

    What is the term for the velocity of the bullet as it exits the body?

    <p>V2</p> Signup and view all the answers

    What is a closed wound?

    <p>An injury to the soft tissue without a break in the skin</p> Signup and view all the answers

    What is a contusion?

    <p>Bleeding beneath the skin into the soft tissue</p> Signup and view all the answers

    What is the primary concern when dealing with a patient who has a soft tissue injury?

    <p>Managing shock</p> Signup and view all the answers

    What is the first step in managing an open wound?

    <p>Covering the injury with sterile dressings and applying firm direct pressure</p> Signup and view all the answers

    What is the purpose of elevating the injured area?

    <p>To help control bleeding</p> Signup and view all the answers

    What is a laceration?

    <p>A tear in the skin</p> Signup and view all the answers

    What should you do if the dressing becomes saturated while applying direct pressure?

    <p>Reinforce the dressing with additional gauze</p> Signup and view all the answers

    Why is it important to ensure the patient has a distal pulse to the dressing?

    <p>To ensure the dressing is not too tight</p> Signup and view all the answers

    What is the primary goal of elevating the injured area above the level of the heart?

    <p>To reduce bleeding</p> Signup and view all the answers

    When should direct pressure not be applied to a bleeding site?

    <p>When a fracture is suspected</p> Signup and view all the answers

    What is the purpose of pressure points in controlling bleeding?

    <p>To control bleeding when direct pressure is ineffective</p> Signup and view all the answers

    Where are pressure points typically located?

    <p>Between the site of injury and the heart where a main artery passes over a bone or underlying muscle mass</p> Signup and view all the answers

    How should the area surrounding a wound be prepared?

    <p>Shave only what is necessary and irrigate gently and copiously with isotonic sterile saline solution or sterile water</p> Signup and view all the answers

    What is the purpose of anesthetizing the wound?

    <p>To alleviate patient discomfort during wound irrigation and cleaning</p> Signup and view all the answers

    What should be removed during wound cleaning and irrigation?

    <p>Foreign matter and devitalized tissue</p> Signup and view all the answers

    How much irrigant is typically used for wound irrigation?

    <p>50ml per inch of wound per hour of age of wound</p> Signup and view all the answers

    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

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    Description

    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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