![]() With the increase in violet confrontations in the United States, it is more and more likely that radiologists will be asked to interpret chest radiographs of patients who have had penetrating bullet injuries to the thorax. Bullet tracks may have a delayed appearance on chest radiographs, and thus may cause confusion in interpretation if a history of injury is not elicited. In other tissues, such as liver and brain, that have higher specific gravities and lower elastic content, bullet tracks are rarely, if ever, noted because widespread destruction usually occurs. ![]() A bullet track may occur in the lung because of this organ's low specific gravity and high elasticity. One finding that is unique to pulmonary parenchyma is the bullet track, which occurs along the course of a bullet as it traverses the lung. Penetrating missile or bullet wounds to the lung result in a number of abnormalities visible on chest radiographs. Physical examination should be completed by localization of all stabwounds, in- and outshot openings as well as recto-vaginal examination and inspection of the oropharynx. Neurovascular examination related to trauma of the spinal cord, peripheral nerves as well as vascular involvement should be carried out also in extremity injuries. In a work-up according to ATLS principles airway, breathing and circulation should be evaluated with great care. History and physical examination remain the corner stones of good medical praxis. Penetrating cranial injuries, as a neurosurgical emergency with poor prognosis, are not discussed. In this overview, penetrating injuries of neck, thorax, abdomen and extremities will be outlined. Finally in the 3rd phase, within 6-24 hours, definitive surgical care takes place. After temporary life-saving procedures, the 2nd phase is characterized by intensive care treatment, dealing with hypothermia, metabolic acidosis and clotting disturbances. In the Ist phase prompt interventions by emergency thoracotomy and laparotomy are carried out, with only two goals to achieve: surgical control of haemorrhage and contamination. This approach is somewhat different from "traditional" surgical treatment. In case of life-saving procedures, the principles of Damage Control Surgery (DCS) must be followed (4-5). Simple algorithms can be helpful, especially in case of limited experience (3). ![]() Although the basic principles of trauma care according to the guidelines of the Advanced Trauma Life Support (ATLS) (1-2) are the same for blunt and penetrating trauma with regard to priorities, diagnostics and primary therapy, there are some pitfalls in the strategy of management in penetrating trauma one should be aware of. The delay with scoop and run principles is very short for these cases, resulting in severely injured reaching the hospital alive in increasing frequency. All penetrating traumas are directly presented to our emergency department by a well organized ambulance service supported by a mobile medical team if necessary. In Rotterdam, the Erasmus Medical Centre is a level I trauma centre, situated directly in the town centre. Only few of us have experience with penetrating trauma, without exception far less than in the USA or South-Africa. In Western Europe the most frequent cause of multiple injuries is blunt trauma.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |