Penetrating injuries

Cutaneous Cutaneous relates to or affects the skin. The term subcutaneous refers to being below the skin (as in a penetrating injury or injection). Use your MSDS to determine the required personal protective equipment (PPE) that you must use. Protecting the skin (with gloves, aprons, coveralls, face masks, etc.) is important. After all, the skin is the largest organ in the human body. 

Mahajna, A. et al. Blunt and penetrating injuries caused by rubber bullets during the IsraeU-Arab conflict in October 2000 A retrospective study. Lancet, 359, 1795-1800, 2002. 

Yergey JA, Heyes MR 1990. Brain eicosanoid formation following acute penetration injury as studied by in vivo microdialysis. J Cereb Blood FlowMetab 10(1) 143-146. 

Volpin G, Said R, Simri W, Grimberg B, Daniel M. [Nerve palsies in a soldier with penetrating injuries following prolonged use of limb tourniquets]. Harefuah 1999 136 352-5, 419. 

Head Examine scalp and head for injury and fractures. Assess vision and pupils. Hemorrhage, penetrating injury, lens dislocation, and ocular entrapment may occur. Contacts should be removed at this time. Facial and periorbital edema will progressively impair eye exams. Completion of an initial eye exam is essential. 

Discuss blunt and penetrating injuries in relation to the body systems. Which are life threatening Which require immediate management ... 

Figure 26-27 Full-thickness comeal scar secondary to a full thickness penetrating injury. (Courtesy of Pat Caroline.)...

Figure 26-28 If a patient is referred for consultation due to a suspected corneal penetrating injury, it is appropriate to tape a metal Fox shield over the eye to protect from further trauma during transportation. Tape is placed over the edge of the Fox shield to enhance patient comfort (here shown partially completed).

Whereas penetrating injuries are less common today, the number of blunt injuries has increased, frequently accompanied by liver rupture. A liver injury is involved in up to 40% of patients with blunt abdominal trauma. Conservative treatment is recommended as far as possible in order to avoid unnecessary laparotomy. (353) The overall mortality rates were 11.8% and 16.8%, respectively. (345, 347) In many cases, the urgency of the situation does not allow the requisite examinations (e.g. US, CT (350, 352), angiography, laparoscopy) to be made -an emergency operation has to be performed. Such an operation must even be done under shock if the patient does not respond directly to conservative methods. 

A 43-year-old man developed a false aneurysm of the popliteal artery after a penetrating injury from an acupuncture needle (118). The aneurysm ruptured spontaneously, but the patient was successfully managed by vascular surgery. 

There are two types of venom delivery systems used by Sea Urchin. Venom within the spines is released after the spine penetrates the skin. Penetration of the skin by the spines also results in the release of violet-colored fluid that stains the wound and is a good indicator of penetrating injury. In addition to the spines, there are also seizing organs on the surface of the sea urchin scatted among the spines called Pedicellariea. The Pedicellariea will continue to deliver venom into the skin, even if they are broken off of the body of the sea urchin. 

Mahajna, A., Aboud, N., Harbaji, I., Agbaria, A., Lankovsky, V., Michaelson, M., Fisher, D., and Krauz, M. M., Blunt and penetrating injuries caused by mbber bullets during the IsraeU-Arab war in October, 2000 a retrospective study. Lancet, 359, 1795-1800, 2002. 

These are very rare. Clearly all the complications relating to arterial catheterization at any site and for whatever reason can occur. Non-target embolization should not happen in the experienced hands of a well trained operator. It is said that fungal abscesses are commoner after hepatic arterial embolization [3] but there is no real evidence for this and most patients have had surgery or a penetrating injury prior to the embolization. Liver infarction as described above is uncommon but a rise in liver enzymes is often observed [3]. 

Bleeding or penetrating injuries to the head, face, neck, chest, pelvis, or abdomen. 

All penetrating injuries, even minor surfece injuries, need hospital evaluation. 

Muscle laceration occurs as a result of direct penetrating injury. The laceration fills with haematoma which appears of low echogenicity (Fornage 2000). There is a high risk of scar formation. 

Subcutaneous mycoses, or mycoses of implantation are sporadically occurring infections caused by fungi present in the natural environment, which are directly inoculated into the dermis or subcutaneous tissue through a penetrating injury. They are not common, even in endemic countries, and are mainly seen in the tropics (Hay and Moore 1998). We have summarised, in Table 1, some of the features of the most important subcutaneous mycoses, including occupational sources of infection. 

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