Penetrating trauma
Encyclopedia
Penetrating trauma is an injury
that occurs when an object pierces the skin and enters a tissue
of the body, creating an open wound
. In blunt, or non-penetrating trauma
, there may be an impact, but the skin is not necessarily broken. The penetrating object may remain in the tissues, come back out the way it entered, or pass through the tissues and exit from another area. An injury in which an object enters the body or a structure and passes all the way through is called a perforating injury, while penetrating trauma implies that the object does not pass through. Perforating trauma is associated with an entrance wound and an often larger exit wound.
Penetrating trauma can be caused by a foreign object or by fragments of a broken bone. Usually occurring in violent crime
or armed combat, penetrating injuries are commonly caused by gunshots
and stabbing
s.
Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection
. The severity of the injury varies widely depending on the body parts involved, the characteristics of the penetrating object, and the amount of energy
transmitted to the tissues. Assessment may involve X-ray
s or CT scan
s, and treatment may involve surgery, for example to repair damaged structures or to remove foreign objects.
As a missile passes through tissue, it decelerates
, dissipating and transferring kinetic energy
to the tissues; this is what causes the injury. The velocity
of the projectile is a more important factor than its mass in determining how much damage is done; kinetic energy increases with the square of the velocity. In addition to injury caused directly by the object that enters the body, penetrating injuries may be associated with secondary injuries, due for example to a blast injury
. High-velocity objects are usually projectile
s such as bullet
s from high-powered rifles, such as assault rifle
s or sniper rifle
s. Bullets classed as medium-velocity projectiles include those from handgun
s, shotgun
s, and submachine gun
s. Low-velocity items, such as knives, are usually propelled by a person's hand, and usually do damage only to the area that is directly contacted by the object. The space left by tissue that is destroyed by the penetrating object as it passes through forms a cavity; this is called permanent cavitation. In addition to causing damage to the tissues they contact, medium- and high-velocity projectiles cause a secondary cavitation injury: as the object enters the body, it creates a pressure wave
which forces tissue out of the way, creating a "temporary cavity" that can be much larger than the object itself. The tissues soon move back into place, eliminating the cavity, but the cavitation frequently does considerable damage first. Temporary cavitation can be especially damaging when it affects delicate tissues such as the brain
, as occurs in penetrating head trauma.
The characteristics of the tissue injured also help determine the severity of the injury; for example, the denser the tissue, the greater the amount of energy transmitted to it. The path of a projectile can be estimated by imagining a line from the entrance wound to the exit wound, but the actual trajectory may vary due to ricochet
or differences in tissue density.
accounts for only a small percentage of all traumatic brain injuries
, it is associated with a high mortality rate
, and only a third of people with penetrating head trauma
survive long enough to arrive at a hospital. Injuries from firearms are the leading cause of TBI-related deaths. Penetrating head trauma can cause cerebral contusion
s and lacerations, intracranial hematoma
s, pseudoaneurysm
s, and arteriovenous fistula
s. The prognosis for penetrating head injuries varies widely.
Penetrating facial trauma
can pose a risk to the airway
and breathing
; airway obstruction can occur later due to swelling
or bleeding. Penetrating eye trauma
can cause the globe of the eye
to rupture or vitreous humor
to leak from it, and presents a serious threat to eyesight.
Most penetrating injuries are chest wounds and have a mortality rate (death rate) of under 10%. Penetrating chest trauma
can injure vital organs such as the heart and lungs and can interfere with breathing and circulation. Lung injuries that can be caused by penetrating trauma include pulmonary laceration
(a cut or tear) pulmonary contusion
(a bruise), hemothorax
(an accumulation of blood in the chest cavity outside of the lung), pneumothorax
(an accumulation of air in the chest cavity) and hemopneumothorax
(accumulation of both blood and air). Sucking chest wound
s and tension pneumothorax may result.
Penetrating trauma can also cause injuries to the heart and circulatory system. When the heart is punctured, it may bleed profusely into the chest cavity if the membrane around it {the pericardium
) is significantly torn, or it may cause pericardial tamponade
if the pericardium is not disrupted. In pericardial tamponade, blood escapes from the heart but is trapped within the pericardium, so pressure builds up between the pericardium and the heart, compressing the latter and interfering with its pumping. Fractures of the ribs
commonly produce penetrating chest trauma when sharp bone ends pierce tissues.
(PAT) can be life threatening because abdominal organs, especially those in the retroperitoneal space, can bleed profusely, and the space can hold a great deal of blood. If the pancreas is injured, it may be further injured by its own secretion
s, in a process called autodigestion. Injuries of the liver
, common because of the size and location of the organ, present a serious risk for shock because the liver tissue is delicate and has a large blood supply and capacity. The intestines, taking a large part of the lower abdomen, are also at risk of perforation.
People with penetrating abdominal trauma may have signs of hypovolemic shock
(insufficient blood in the circulatory system
) and peritonitis
(an inflammation of the peritoneum
, the membrane that lines the abdominal cavity
). Penetration may abolish or diminish bowel sounds due to bleeding, infection, and irritation, and injuries to arteries may cause bruit
s (a distinctive sound similar to heart murmur
s) to be audible. Percussion of the abdomen may reveal hyperresonance (indicating air in the abdominal cavity) or dullness (indicating a buildup of blood). The abdomen may be distended or tender, signs which indicate an urgent need for surgery.
ning may be used to identify the type and location of potentially lethal injuries. Sometimes before an X-ray is performed on a person with penetrating trauma from a projectile, a paper clip is taped over entry and exit wounds to show their location on the film. The patient is given intravenous
fluids to replace lost blood. Surgery may be required; impale
d objects are secured into place so that they do not move and cause further injury, and they are removed in an operating room. Foreign bodies such as bullets may be removed, but they may also be left in place if the surgery necessary to get them out would cause more damage than would leaving them. Wounds are debrided
to remove tissue that cannot survive and other material that presents risk for infection.
Before the 17th century, medical practitioners poured hot oil into wounds in order to cauterize
damaged blood vessels, but the French surgeon Ambroise Paré
challenged the use of this method in 1545. Paré was the first to propose controlling bleeding using ligature
.
During the American Civil War
, chloroform
was used during surgery to reduce pain and allow more time for operations. Due in part to the fact that sterile technique
was not used in hospitals, infection was the leading cause of death for wounded soldiers.
In World War I
, doctors began replacing patients' lost fluid with salt solutions. With World War II
came the idea of blood bank
ing, having quantities of donated blood
available to replace lost fluids. The use of antibiotic
s also came into practice in World War II.
Injury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...
that occurs when an object pierces the skin and enters a tissue
Tissue (biology)
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
of the body, creating an open wound
Wound
A wound is a type of injury in which skin is torn, cut or punctured , or where blunt force trauma causes a contusion . In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.-Open:...
. In blunt, or non-penetrating trauma
Blunt trauma
In medical terminology, blunt trauma, blunt injury, non-penetrating trauma or blunt force trauma refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack; the latter usually being referred to as blunt force trauma...
, there may be an impact, but the skin is not necessarily broken. The penetrating object may remain in the tissues, come back out the way it entered, or pass through the tissues and exit from another area. An injury in which an object enters the body or a structure and passes all the way through is called a perforating injury, while penetrating trauma implies that the object does not pass through. Perforating trauma is associated with an entrance wound and an often larger exit wound.
Penetrating trauma can be caused by a foreign object or by fragments of a broken bone. Usually occurring in violent crime
Violent crime
A violent crime or crime of violence is a crime in which the offender uses or threatens to use violent force upon the victim. This entails both crimes in which the violent act is the objective, such as murder, as well as crimes in which violence is the means to an end, such as robbery. Violent...
or armed combat, penetrating injuries are commonly caused by gunshots
Ballistic trauma
The term ballistic trauma refers to a form of physical trauma sustained from the discharge of arms or munitions. The most common forms of ballistic trauma stem from firearms used in armed conflicts, civilian sporting and recreational pursuits, and criminal activity.-Destructive effects:The degree...
and stabbing
Stabbing
A stabbing is penetration with a sharp or pointed object at close range. Stab connotes purposeful action, as by an assassin or murderer, but it is also possible to accidentally stab oneself or others.Stabbing differs from slashing or cutting in that the motion of the object used in a stabbing...
s.
Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
. The severity of the injury varies widely depending on the body parts involved, the characteristics of the penetrating object, and the amount of energy
Energy
In physics, energy is an indirectly observed quantity. It is often understood as the ability a physical system has to do work on other physical systems...
transmitted to the tissues. Assessment may involve X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s or CT scan
Computed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
s, and treatment may involve surgery, for example to repair damaged structures or to remove foreign objects.
Mechanism
Acceleration
In physics, acceleration is the rate of change of velocity with time. In one dimension, acceleration is the rate at which something speeds up or slows down. However, since velocity is a vector, acceleration describes the rate of change of both the magnitude and the direction of velocity. ...
, dissipating and transferring kinetic energy
Kinetic energy
The kinetic energy of an object is the energy which it possesses due to its motion.It is defined as the work needed to accelerate a body of a given mass from rest to its stated velocity. Having gained this energy during its acceleration, the body maintains this kinetic energy unless its speed changes...
to the tissues; this is what causes the injury. The velocity
Velocity
In physics, velocity is speed in a given direction. Speed describes only how fast an object is moving, whereas velocity gives both the speed and direction of the object's motion. To have a constant velocity, an object must have a constant speed and motion in a constant direction. Constant ...
of the projectile is a more important factor than its mass in determining how much damage is done; kinetic energy increases with the square of the velocity. In addition to injury caused directly by the object that enters the body, penetrating injuries may be associated with secondary injuries, due for example to a blast injury
Blast injury
A blast injury is a complex type of physical trauma resulting from direct or indirect exposure to an explosion. Blast injuries occur with the detonation of high-order explosives as well as the deflagration of low order explosives...
. High-velocity objects are usually projectile
Projectile
A projectile is any object projected into space by the exertion of a force. Although a thrown baseball is technically a projectile too, the term more commonly refers to a weapon....
s such as bullet
Bullet
A bullet is a projectile propelled by a firearm, sling, or air gun. Bullets do not normally contain explosives, but damage the intended target by impact and penetration...
s from high-powered rifles, such as assault rifle
Assault rifle
An assault rifle is a selective fire rifle that uses an intermediate cartridge and a detachable magazine. Assault rifles are the standard infantry weapons in most modern armies...
s or sniper rifle
Sniper rifle
In military and law enforcement terminology, a sniper rifle is a precision-rifle used to ensure more accurate placement of bullets at longer ranges than other small arms. A typical sniper rifle is built for optimal levels of accuracy, fitted with a telescopic sight and chambered for a military...
s. Bullets classed as medium-velocity projectiles include those from handgun
Handgun
A handgun is a firearm designed to be held and operated by one hand. This characteristic differentiates handguns as a general class of firearms from long guns such as rifles and shotguns ....
s, shotgun
Shotgun
A shotgun is a firearm that is usually designed to be fired from the shoulder, which uses the energy of a fixed shell to fire a number of small spherical pellets called shot, or a solid projectile called a slug...
s, and submachine gun
Submachine gun
A submachine gun is an automatic carbine, designed to fire pistol cartridges. It combines the automatic fire of a machine gun with the cartridge of a pistol. The submachine gun was invented during World War I , but the apex of its use was during World War II when millions of the weapon type were...
s. Low-velocity items, such as knives, are usually propelled by a person's hand, and usually do damage only to the area that is directly contacted by the object. The space left by tissue that is destroyed by the penetrating object as it passes through forms a cavity; this is called permanent cavitation. In addition to causing damage to the tissues they contact, medium- and high-velocity projectiles cause a secondary cavitation injury: as the object enters the body, it creates a pressure wave
P-wave
P-waves are a type of elastic wave, also called seismic waves, that can travel through gases , solids and liquids, including the Earth. P-waves are produced by earthquakes and recorded by seismographs...
which forces tissue out of the way, creating a "temporary cavity" that can be much larger than the object itself. The tissues soon move back into place, eliminating the cavity, but the cavitation frequently does considerable damage first. Temporary cavitation can be especially damaging when it affects delicate tissues such as the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
, as occurs in penetrating head trauma.
The characteristics of the tissue injured also help determine the severity of the injury; for example, the denser the tissue, the greater the amount of energy transmitted to it. The path of a projectile can be estimated by imagining a line from the entrance wound to the exit wound, but the actual trajectory may vary due to ricochet
Ricochet
A ricochet is a rebound, bounce or skip off a surface, particularly in the case of a projectile. The possibility of ricochet is one of the reasons for the common firearms safety rule "Never shoot at a flat, hard surface."-Variables:...
or differences in tissue density.
Head
While penetrating head traumaPenetrating head injury
A penetrating head injury, or open head injury, is a head injury in which the dura mater, the outer layer of the meninges, is breached. Penetrating injury can be caused by high-velocity projectiles or objects of lower velocity such as knives, or bone fragments from a skull fracture that are...
accounts for only a small percentage of all traumatic brain injuries
Traumatic brain injury
Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...
, it is associated with a high mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
, and only a third of people with penetrating head trauma
Head injury
Head injury refers to trauma of the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in medical literature....
survive long enough to arrive at a hospital. Injuries from firearms are the leading cause of TBI-related deaths. Penetrating head trauma can cause cerebral contusion
Cerebral contusion
Cerebral contusion, Latin contusio cerebri, a form of traumatic brain injury, is a bruise of the brain tissue. Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Contusion occurs in 20–30% of severe head...
s and lacerations, intracranial hematoma
Intracranial hemorrhage
An intracranial hemorrhage is a hemorrhage, or bleeding, within the skull.-Causes:Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma or nontraumatic causes such as a ruptured aneurysm...
s, pseudoaneurysm
Pseudoaneurysm
A pseudoaneurysm, also known as a false aneurysm, is a hematoma that forms as the result of a leaking hole in an artery. Note that the hematoma forms outside the arterial wall, so it is contained by the surrounding tissues. Also it must continue to communicate with the artery to be considered a...
s, and arteriovenous fistula
Arteriovenous fistula
An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm....
s. The prognosis for penetrating head injuries varies widely.
Penetrating facial trauma
Facial trauma
Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries...
can pose a risk to the airway
Airway
The pulmonary airway comprises those parts of the respiratory system through which air flows, conceptually beginning at the nose and mouth, and terminating in the alveoli...
and breathing
Breathing
Breathing is the process that moves air in and out of the lungs. Aerobic organisms require oxygen to release energy via respiration, in the form of the metabolism of energy-rich molecules such as glucose. Breathing is only one process that delivers oxygen to where it is needed in the body and...
; airway obstruction can occur later due to swelling
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
or bleeding. Penetrating eye trauma
Eye injury
Physical or chemical injuries of the eye can be a serious threat to vision if not treated appropriately and in a timely fashion. The most obvious presentation of ocular injuries is redness and pain of the affected eyes. This is not, however, universally true, as tiny metallic projectiles may cause...
can cause the globe of the eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
to rupture or vitreous humor
Vitreous humour
The vitreous humour or vitreous humor is the clear gel that fills the space between the lens and the retina of the eyeball of humans and other vertebrates...
to leak from it, and presents a serious threat to eyesight.
Chest
Chest trauma
Chest trauma is a serious injury of the chest. Thoracic trauma is a common cause of significant disability and mortality, the leading cause of death from physical trauma after head and spinal cord injury. Blunt thoracic injuries are the primary or a contributing cause of about a quarter of all...
can injure vital organs such as the heart and lungs and can interfere with breathing and circulation. Lung injuries that can be caused by penetrating trauma include pulmonary laceration
Pulmonary laceration
A pulmonary laceration is a chest injury in which lung tissue is torn or cut. An injury that is potentially more serious than pulmonary contusion, pulmonary laceration involves disruption of the architecture of the lung, while pulmonary contusion does not...
(a cut or tear) pulmonary contusion
Pulmonary contusion
A pulmonary contusion is a contusion of the lung, caused by chest trauma. As a result of damage to capillaries, blood and other fluids accumulate in the lung tissue. The excess fluid interferes with gas exchange, potentially leading to inadequate oxygen levels...
(a bruise), hemothorax
Hemothorax
A hemothorax is a condition that results from blood accumulating in the pleural cavity.-Cause and presentation:Its cause is usually traumatic, from a blunt or penetrating injury to the thorax, resulting in a rupture of the serous membrane either lining the thorax or covering the lungs...
(an accumulation of blood in the chest cavity outside of the lung), pneumothorax
Pneumothorax
Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...
(an accumulation of air in the chest cavity) and hemopneumothorax
Hemopneumothorax
Hemopneumothorax, or haemopneumothorax, is a medical term describing the combination of two conditions: pneumothorax, or air in the chest cavity, and hemothorax , or blood in the chest cavity....
(accumulation of both blood and air). Sucking chest wound
Pneumothorax
Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...
s and tension pneumothorax may result.
Penetrating trauma can also cause injuries to the heart and circulatory system. When the heart is punctured, it may bleed profusely into the chest cavity if the membrane around it {the pericardium
Pericardium
The pericardium is a double-walled sac that contains the heart and the roots of the great vessels.-Layers:...
) is significantly torn, or it may cause pericardial tamponade
Cardiac tamponade
Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium ....
if the pericardium is not disrupted. In pericardial tamponade, blood escapes from the heart but is trapped within the pericardium, so pressure builds up between the pericardium and the heart, compressing the latter and interfering with its pumping. Fractures of the ribs
Rib fracture
A rib fracture is a break or fracture in one or more of the bones making up the rib cage.The first rib is rarely fractured because of its protected position behind the clavicle . However, if it is broken serious damage can occur to the brachial plexus of nerves and the subclavian vessels...
commonly produce penetrating chest trauma when sharp bone ends pierce tissues.
Abdomen
Penetrating abdominal traumaAbdominal trauma
Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a risk of severe blood loss and infection...
(PAT) can be life threatening because abdominal organs, especially those in the retroperitoneal space, can bleed profusely, and the space can hold a great deal of blood. If the pancreas is injured, it may be further injured by its own secretion
Secretion
Secretion is the process of elaborating, releasing, and oozing chemicals, or a secreted chemical substance from a cell or gland. In contrast to excretion, the substance may have a certain function, rather than being a waste product...
s, in a process called autodigestion. Injuries of the liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
, common because of the size and location of the organ, present a serious risk for shock because the liver tissue is delicate and has a large blood supply and capacity. The intestines, taking a large part of the lower abdomen, are also at risk of perforation.
People with penetrating abdominal trauma may have signs of hypovolemic shock
Hypovolemia
In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma...
(insufficient blood in the circulatory system
Circulatory system
The circulatory system is an organ system that passes nutrients , gases, hormones, blood cells, etc...
) and peritonitis
Peritonitis
Peritonitis is an inflammation of the peritoneum, the serous membrane that lines part of the abdominal cavity and viscera. Peritonitis may be localised or generalised, and may result from infection or from a non-infectious process.-Abdominal pain and tenderness:The main manifestations of...
(an inflammation of the peritoneum
Peritoneum
The peritoneum is the serous membrane that forms the lining of the abdominal cavity or the coelom — it covers most of the intra-abdominal organs — in amniotes and some invertebrates...
, the membrane that lines the abdominal cavity
Abdominal cavity
The abdominal cavity is the body cavity of the human body that holds the bulk of the viscera. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is the thoracic diaphragm , and its oblique floor is the pelvic inlet...
). Penetration may abolish or diminish bowel sounds due to bleeding, infection, and irritation, and injuries to arteries may cause bruit
Bruit
Bruit is the term for the unusual sound that blood makes when it rushes past an obstruction in an artery when the sound is auscultated with the bell portion of a stethoscope.The term "bruit" simply refers to the sound...
s (a distinctive sound similar to heart murmur
Heart murmur
Murmurs are extra heart sounds that are produced as a result of turbulent blood flow that is sufficient to produce audible noise. Most murmurs can only be heard with the assistance of a stethoscope ....
s) to be audible. Percussion of the abdomen may reveal hyperresonance (indicating air in the abdominal cavity) or dullness (indicating a buildup of blood). The abdomen may be distended or tender, signs which indicate an urgent need for surgery.
Assessment and treatment
Assessment can be difficult because much of the damage is often internal and not visible. The patient is thoroughly examined. X-ray and CT scanComputed tomography
X-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
ning may be used to identify the type and location of potentially lethal injuries. Sometimes before an X-ray is performed on a person with penetrating trauma from a projectile, a paper clip is taped over entry and exit wounds to show their location on the film. The patient is given intravenous
Intravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
fluids to replace lost blood. Surgery may be required; impale
Impalement
Impalement is the traumatic penetration of an organism by an elongated foreign object such as a stake, pole, or spear, and this usually implies complete perforation of the central mass of the impaled body...
d objects are secured into place so that they do not move and cause further injury, and they are removed in an operating room. Foreign bodies such as bullets may be removed, but they may also be left in place if the surgery necessary to get them out would cause more damage than would leaving them. Wounds are debrided
Debridement
Debridement is the medical removal of a patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue...
to remove tissue that cannot survive and other material that presents risk for infection.
History
Cauterization
The medical practice or technique of cauterization is the burning of part of a body to remove or close off a part of it in a process called cautery, which destroys some tissue, in an attempt to mitigate damage, remove an undesired growth, or minimize other potential medical harmful possibilities...
damaged blood vessels, but the French surgeon Ambroise Paré
Ambroise Paré
Ambroise Paré was a French surgeon. He was the great official royal surgeon for kings Henry II, Francis II, Charles IX and Henry III and is considered as one of the fathers of surgery and modern forensic pathology. He was a leader in surgical techniques and battlefield medicine, especially the...
challenged the use of this method in 1545. Paré was the first to propose controlling bleeding using ligature
Ligature (medicine)
In surgery or medical procedure, a ligature consists of a piece of thread tied around an anatomical structure, usually a blood vessel or another hollow structure to shut it off. With a blood vessel the surgeon will clamp the vessel perpendicular to the axis of the artery or vein with a hemostat,...
.
During the American Civil War
American Civil War
The American Civil War was a civil war fought in the United States of America. In response to the election of Abraham Lincoln as President of the United States, 11 southern slave states declared their secession from the United States and formed the Confederate States of America ; the other 25...
, chloroform
Chloroform
Chloroform is an organic compound with formula CHCl3. It is one of the four chloromethanes. The colorless, sweet-smelling, dense liquid is a trihalomethane, and is considered somewhat hazardous...
was used during surgery to reduce pain and allow more time for operations. Due in part to the fact that sterile technique
Aseptic technique
Aseptic technique refers to a procedure that is performed under sterile conditions. This includes medical and laboratory techniques, such as with microbiological cultures. It includes techniques like flame sterilization...
was not used in hospitals, infection was the leading cause of death for wounded soldiers.
In World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
, doctors began replacing patients' lost fluid with salt solutions. With World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
came the idea of blood bank
Blood bank
A blood bank is a cache or bank of blood or blood components, gathered as a result of blood donation, stored and preserved for later use in blood transfusion. The term "blood bank" typically refers to a division of a hospital laboratory where the storage of blood product occurs and where proper...
ing, having quantities of donated blood
Blood donation
A blood donation occurs when a person voluntarily has blood drawn and used for transfusions or made into medications by a process called fractionation....
available to replace lost fluids. The use of antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s also came into practice in World War II.
See also
- Blunt splenic traumaBlunt splenic traumaBlunt splenic trauma occurs when a significant impact to the spleen from some outside source damages or ruptures the spleen. Treatment varies depending on severity, but often consists of embolism or splenectomy. -Cause:...
- Blunt trauma personal protective equipmentBlunt trauma personal protective equipmentBlunt Trauma Personal Protective Equipment protects the wearer against injuries caused by blunt impacts. For law enforcement, corrections, military, and other personnel involved in emergency response operations, the protection against blunt impact threats can be a matter of life or death...
- Geriatric traumaGeriatric traumaGeriatric trauma refers to a traumatic injury that occurs to an elderly person. The three prevailing causes of traumatic death in the elderly are falls , traffic collisions and burns....
- Pediatric traumaPediatric traumaPediatric trauma refers to a traumatic injury that happens to an infant, child or adolescent.-Anatomic and physiologic differences in children:There are significant anatomical and physiological differences between children and adults...
- Stab woundStab woundA stab wound is a specific form of penetrating trauma that results from a knife, or a similar pointed object that is "deeper than it is wide". Most stabbings occur because of intentional violence or through self infliction. Typically deaths caused by stabbings are due to organ failure or blood...