WILTIMS #33: Gun and Knife Club 101

I was looking forward to today all weekend because of the title of our first lecture, "Blunt and Penetrating Trauma - Anatomical Considerations." It was every bit as gruesome as I had hoped, and more educational than I had expected. In order to predict the extent of injury for a stabbing or shooting victim, you really need to know your anatomy. I'll describe some of what we saw below, but as I know some of my readers would be averse to a gory slideshow, instead of blood and guts, each will be accompanied by a picture of my sister's adorable beagle.

A guy is stabbed through the middle of the chest. The most important piece of info we could glean from the picture was that the guy was alive and breathing. With this and the entry point location, we could piece together the most likely scenario playing out inside his chest. The knife was most likely (miraculously) wedged between the heart and diaphragm. Had it hit the heart it would have pierced the right ventricle (which would have killed him instantly or caused cardiac tamponade (which would have still killed him pretty quickly)).

A woman suffers blunt force trauma to the abdomen following a car crash. The CT scan shows a hematoma around the spleen. Where do you put a catheter to stop the bleeding while you repair or excise the damaged tissue? You find the celiac trunk coming off the abdominal aorta and then inject die to locate and block the splenic artery. But to be thorough, you must remember that the spleen can also get blood from anastomoses with the left gastric and left gastro-omental arteries. Depending on the location of the bleed, these other blood supplies could be important to the outcome of the case.

A soldier is shot with .22 rifle through the chest. How much damage does it do? Gunshots cause two types of damage: they create a hole following the flight path of the bullet, and they create a shockwave through the surrounding tissue, which can be just as damaging. With a high enough velocity round and a path along the anterior-posterior access, the shockwave may not have time to develop before the bullet exits the body, so you may only have to worry about the permanent cavity. If instead the victim is shot in the side, you will have to assume that extensive fragmentation and trauma from the shockwave will have occurred concentrically around the bullet's path.

TIL: How to place basic sutures and tie basic surgical knots. It's amazing how quickly I went from "I have no clue what I'm doing," to "I could do this in my sleep."

Special thanks to my sister Samantha for the distracting pictures. Please check out her blog too!