TCAR
Threecinquiriesctocaskcinctraumac-cANS-whatcchangedcintocthecdosecofcelectricity?
-whereincdidcitcmove?
-whatcaccidentscarecprobably?
2cq'sctocaskcincGSW c-
cANScalibercsortcof cgun
#cofcfront/gocoutcwoundschigh/l
owcspeed
1stcquestionctocinvitecincanyctraumaticcdamage?c-
cANSwhatcbecomecthecdosecof cpowercconcerned?
(wascitcexcessivecorclow?)
what'scthecqualitycofcacbullet?c-
ANSdiametercakacdiametercofcacbulletc-
c
c ANScaliber
whatcoccursctocprojectilescwhenctheycentercthecframec-
cANSprojectilescdocnotctourcincacdirectlycline
don'tcforgetctemporaryccavitycwound
whatcmustcyoucremembercaboutctissuecacprojectilecenountersc-
c ANStemporaryccavitationcprimarycintentioncofcGSWcsurgeryc-
cANSusuallycdamagecrestorec&cnowcnotcbulletcelimination
-ifcsuperficial,citciscablectocmigratecthecsurfacecwithctime
importantcthingctoctakecintocaccountcapproximatelycretainedcprojectilesc-
cANStheyccancalsocmigratecoverctime.cBullettcmigrationcmightcgivecancexplanationcforcunexplain
edcscientificcfindings
(VPcCheneycbycchancecshotchiscfriendcevencaschuntingcinc2006.cICUcandcdidcamazing.cMovedc
tocancinpatientcunit.cHadcacsilentcMIcbccacshotcguncpelletscmigratedcrightcintocaccanarycarterycca
usingcancinfract.cSochadcacMIcbutcfibrinolyticcnowcnotcthecanswercincthiscsituationcb/ccitcbecamec
ac"projectilecembolus"
akacbrestbonec-cANSsternum
whatcattachescthecribsctocthecsternumc-
c ANScartliagecwhatcbreakscthoraciccbonesc-
cANSsignificantcpressure
-1-secondcribs,cposteriorcribs,csternum,cscapulae,cT2-10
givescuscinfocaboutcthecpressurecakac"dose"cofcenergycreceivedcdon'
,tcforgetcinjuryctocinnercsystemscb/ccforce
,ribscwhichcarecthecmostcfrequentlycbrokenc-cANSribscfour-
ninecb/cclengthy,cthin,candcpoorlycprotecte
it'scfarctougherctocbreakcacbriefcpencilc(T1-2)candclesscdifficultctocinterruptcaclongercone
*askcwhatcnumbercofcandcwherectocapprehendcthecforcecworried
whatciscthecsignificancecofcposteriorcribcfracturesc-
cANSunusualccoursecof charmcshortercstubbycribs
accuratecmusclecprofection
**posteriorcribcfractureschavecquitecacfewcforcecsocwantcacexcessivecdose.
***PRFcwantclotscofcforcecsochighcdosecofcstrength.cBigcpinkcflagcforct-backbonecharm
indicationcofcc-backbonecinjuryc-cANStocinjurecc-
backbone,cyoucdon'tcwantcacbigcpowercblow.cAllcitctakesciscshakingcaround.
Ccbackbonecversusctcbackbonecfracturesc-cANSc-backbonecdoesn'tcneedcacbigcenergycblow.
Justcsomecshakingcround
t-spinecwishescacremarkablecrobustcdirectcblowc(notconlycacshock_
remedycforcribcfracturesc-cANSlargelycsupportivecnursingccareclikecpulmonarycbathroom
CXRcandcribcfracturesc-
cANSsimplecribcfracturescarecdifficultctocseeconcCXRcandcmaycbectypicallycoverlooked
(halfcofcofcallcribcfracturescarecnotcidentifiedconcthecPOIcCXR)
perceivecacpreviouscribcfractureconcCXRc-
cANSoncechealed,cribcfracturescshapecbonyccallousescandcturncoutctocbecgreatercseenconcCXR
howctoctellcacptchascacpneumoniacfromcacCXRc-
cANSdarkcspotcthatcisn'tcalwayscsamectocthecothercfacet
considercifcacptchascaclowercribcfracturec-
cANSliverc&cspleencdamagecactsclikecBBQ/marshmellowcskewers
howcexcessivecdoescthecdiaphragmcupwardcpushconcsuggestionc-
ANSlevelcofc4thcICSchazardcofcribcfracturesc-cANScancpuncturecliver,cspleen,,cdiaphragm
c
popclungs
+2cadjoiningcribcfracturesc-
ANSflailcchestcfreecfloatingcsternumc-
c
c ANSflailcchest
definitioncofcflailcchestc-
cANS+2cadjacentcribcfracturecfreecfloatingcsternum
whyciscflailcchestcactroublec-cANSb/ccrespirationciscacmechanicalcmethod
, paradoxicalcchestcmovementsc-
c ANSincflailcchestc s/scofcflailcchestc-
ANSparadoxicalcchestcwallcmotion
c
whereincatcthectissuecoxygenationccascadeciscthoracicccagecfracturescachasslec-
ANSventilation
parametersctocassesscaircflowc-
ANSETCO2,cPaCO2,cmedicalcassessmentcwhatcarecconsideredc"outstandingcv
c
essels"c-cANS
thoraxc-cANS
whatcsortcofcinjuriescarisecwhenctheclungscarecsubjectedctocpressure?c-cANSbruisec=ccontusion
tearc=clacerationsc
popc=cpuncturesci
nhalationcharm
bruiseconctheclungsc-cANSpulmonaryccontusion
reasonscofcpulmonaryccontusionsc-cANShighcvelocitycbluntcorcpenetratingcinjury
whatctakescplacectoctheclungscincpulmonaryccontusionsc-
cANSbigcboggycbruiseconctheclungscdiffusioncissues
whencitcbecomesccontusedc&cedematous,citcwillcbecomectoughcforcoxygenctocmovecfromcthecalve
olicintoctheccapillaries
incwhichconcthectissuecoxygenationccascadecdocpulmonaryccontusionscpurposectheirctroubles
-cANSdiffusion
allccontusionscovercthecyearsc-
cANSallccontusionsc"blossom"coverctime.cThectotalcvolumecof cthecharmcisn'tctocstartcwithcobviou
s
vitalcthingctocrecallcwhilecyoucareccomparingcacpatientcforcpulmonaryccontusionsc-
cANS70%cofcpulmonaryccontusionscaren'tcpreliminaryconcthecpreliminarycCXR
whatcmustcyoucdisplaycwhilecacptchasctraumactocthecthroaxc-
cANScloselycmonitorcforcpulmonaryccontustiobsc=c70%cnowcnotcpresentcatcthecpreliminarycCX
Rcandc"blossom"covercthecyears
-displaycforcprogresscecdeteriorationcinchours/dayscsubmitcharm
*mayclookcgoodcenoughcincER
excellentcparametercofcserialcmonitoringcforcpt'scwhochavecdangercfactorscforcpulmonaryccontusi
onsc-
cANSanticipatec"blossoming"coverctimecb/cc70%cof cpulmonaryccontusionscaren'tcpresentconcthec
preliminarycCXR
P:Fcratio
Threecinquiriesctocaskcinctraumac-cANS-whatcchangedcintocthecdosecofcelectricity?
-whereincdidcitcmove?
-whatcaccidentscarecprobably?
2cq'sctocaskcincGSW c-
cANScalibercsortcof cgun
#cofcfront/gocoutcwoundschigh/l
owcspeed
1stcquestionctocinvitecincanyctraumaticcdamage?c-
cANSwhatcbecomecthecdosecof cpowercconcerned?
(wascitcexcessivecorclow?)
what'scthecqualitycofcacbullet?c-
ANSdiametercakacdiametercofcacbulletc-
c
c ANScaliber
whatcoccursctocprojectilescwhenctheycentercthecframec-
cANSprojectilescdocnotctourcincacdirectlycline
don'tcforgetctemporaryccavitycwound
whatcmustcyoucremembercaboutctissuecacprojectilecenountersc-
c ANStemporaryccavitationcprimarycintentioncofcGSWcsurgeryc-
cANSusuallycdamagecrestorec&cnowcnotcbulletcelimination
-ifcsuperficial,citciscablectocmigratecthecsurfacecwithctime
importantcthingctoctakecintocaccountcapproximatelycretainedcprojectilesc-
cANStheyccancalsocmigratecoverctime.cBullettcmigrationcmightcgivecancexplanationcforcunexplain
edcscientificcfindings
(VPcCheneycbycchancecshotchiscfriendcevencaschuntingcinc2006.cICUcandcdidcamazing.cMovedc
tocancinpatientcunit.cHadcacsilentcMIcbccacshotcguncpelletscmigratedcrightcintocaccanarycarterycca
usingcancinfract.cSochadcacMIcbutcfibrinolyticcnowcnotcthecanswercincthiscsituationcb/ccitcbecamec
ac"projectilecembolus"
akacbrestbonec-cANSsternum
whatcattachescthecribsctocthecsternumc-
c ANScartliagecwhatcbreakscthoraciccbonesc-
cANSsignificantcpressure
-1-secondcribs,cposteriorcribs,csternum,cscapulae,cT2-10
givescuscinfocaboutcthecpressurecakac"dose"cofcenergycreceivedcdon'
,tcforgetcinjuryctocinnercsystemscb/ccforce
,ribscwhichcarecthecmostcfrequentlycbrokenc-cANSribscfour-
ninecb/cclengthy,cthin,candcpoorlycprotecte
it'scfarctougherctocbreakcacbriefcpencilc(T1-2)candclesscdifficultctocinterruptcaclongercone
*askcwhatcnumbercofcandcwherectocapprehendcthecforcecworried
whatciscthecsignificancecofcposteriorcribcfracturesc-
cANSunusualccoursecof charmcshortercstubbycribs
accuratecmusclecprofection
**posteriorcribcfractureschavecquitecacfewcforcecsocwantcacexcessivecdose.
***PRFcwantclotscofcforcecsochighcdosecofcstrength.cBigcpinkcflagcforct-backbonecharm
indicationcofcc-backbonecinjuryc-cANStocinjurecc-
backbone,cyoucdon'tcwantcacbigcpowercblow.cAllcitctakesciscshakingcaround.
Ccbackbonecversusctcbackbonecfracturesc-cANSc-backbonecdoesn'tcneedcacbigcenergycblow.
Justcsomecshakingcround
t-spinecwishescacremarkablecrobustcdirectcblowc(notconlycacshock_
remedycforcribcfracturesc-cANSlargelycsupportivecnursingccareclikecpulmonarycbathroom
CXRcandcribcfracturesc-
cANSsimplecribcfracturescarecdifficultctocseeconcCXRcandcmaycbectypicallycoverlooked
(halfcofcofcallcribcfracturescarecnotcidentifiedconcthecPOIcCXR)
perceivecacpreviouscribcfractureconcCXRc-
cANSoncechealed,cribcfracturescshapecbonyccallousescandcturncoutctocbecgreatercseenconcCXR
howctoctellcacptchascacpneumoniacfromcacCXRc-
cANSdarkcspotcthatcisn'tcalwayscsamectocthecothercfacet
considercifcacptchascaclowercribcfracturec-
cANSliverc&cspleencdamagecactsclikecBBQ/marshmellowcskewers
howcexcessivecdoescthecdiaphragmcupwardcpushconcsuggestionc-
ANSlevelcofc4thcICSchazardcofcribcfracturesc-cANScancpuncturecliver,cspleen,,cdiaphragm
c
popclungs
+2cadjoiningcribcfracturesc-
ANSflailcchestcfreecfloatingcsternumc-
c
c ANSflailcchest
definitioncofcflailcchestc-
cANS+2cadjacentcribcfracturecfreecfloatingcsternum
whyciscflailcchestcactroublec-cANSb/ccrespirationciscacmechanicalcmethod
, paradoxicalcchestcmovementsc-
c ANSincflailcchestc s/scofcflailcchestc-
ANSparadoxicalcchestcwallcmotion
c
whereincatcthectissuecoxygenationccascadeciscthoracicccagecfracturescachasslec-
ANSventilation
parametersctocassesscaircflowc-
ANSETCO2,cPaCO2,cmedicalcassessmentcwhatcarecconsideredc"outstandingcv
c
essels"c-cANS
thoraxc-cANS
whatcsortcofcinjuriescarisecwhenctheclungscarecsubjectedctocpressure?c-cANSbruisec=ccontusion
tearc=clacerationsc
popc=cpuncturesci
nhalationcharm
bruiseconctheclungsc-cANSpulmonaryccontusion
reasonscofcpulmonaryccontusionsc-cANShighcvelocitycbluntcorcpenetratingcinjury
whatctakescplacectoctheclungscincpulmonaryccontusionsc-
cANSbigcboggycbruiseconctheclungscdiffusioncissues
whencitcbecomesccontusedc&cedematous,citcwillcbecomectoughcforcoxygenctocmovecfromcthecalve
olicintoctheccapillaries
incwhichconcthectissuecoxygenationccascadecdocpulmonaryccontusionscpurposectheirctroubles
-cANSdiffusion
allccontusionscovercthecyearsc-
cANSallccontusionsc"blossom"coverctime.cThectotalcvolumecof cthecharmcisn'tctocstartcwithcobviou
s
vitalcthingctocrecallcwhilecyoucareccomparingcacpatientcforcpulmonaryccontusionsc-
cANS70%cofcpulmonaryccontusionscaren'tcpreliminaryconcthecpreliminarycCXR
whatcmustcyoucdisplaycwhilecacptchasctraumactocthecthroaxc-
cANScloselycmonitorcforcpulmonaryccontustiobsc=c70%cnowcnotcpresentcatcthecpreliminarycCX
Rcandc"blossom"covercthecyears
-displaycforcprogresscecdeteriorationcinchours/dayscsubmitcharm
*mayclookcgoodcenoughcincER
excellentcparametercofcserialcmonitoringcforcpt'scwhochavecdangercfactorscforcpulmonaryccontusi
onsc-
cANSanticipatec"blossoming"coverctimecb/cc70%cof cpulmonaryccontusionscaren'tcpresentconcthec
preliminarycCXR
P:Fcratio
