Trauma, penetrating

FIGURE 7.1 Thoracic penetration of bean bags and sock rounds. (From Charles, A. et al., J. Trauma, 53, 997, 2002. With permission.)... 

NF typically erupts after an initial trauma, which can range from a small abrasion to a deep penetrating wound. The infection begins in the fascia, where bacteria replicate and release toxins that facilitate their spread.21... 

Peritonitis may be classified as primary, secondary, or tertiary. Primary peritonitis, also called spontaneous bacterial peritonitis, is an infection of the peritoneal cavity without an evident source of bacteria from the abdomen.1,2 In secondary peritonitis, a focal disease process is evident within the abdomen. Secondary peritonitis may involve perforation of the gastrointestinal (GI) tract (possibly because of ulceration, ischemia, or obstruction), postoperative peritonitis, or posttraumatic peritonitis (e.g., blunt or penetrating trauma). Tertiary peritonitis occurs in critically ill patients and is infection that persists or recurs at least 48 hours after apparently adequate management of primary or secondary peritonitis. 

Hooker KD, DiPiro JT, Wynn JJ. Aminoglycoside combinations versus single [1-lac la ms for penetrating abdominal trauma A meta-analysis. J Trauma 1991 31 1155-1160. 

Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enteral Nutr 2003 27 355-373. Kudsk KA, Croce MA, Fabian TC, et al. Enteral versus parenteral feeding Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992 215 503-513. 

The entry of air into the pleural cavity is referred to as a pneumothorax. This may occur spontaneously when a "leak" develops on the surface of the lung, allowing air to escape from the airways into pleural space. It may also result from a physical trauma that causes penetration of the chest wall so that air enters pleural space from the atmosphere. In either case, the pleural cavity is no longer a closed space and the pressure within it equilibrates with the atmospheric pressure (0 cmH20). As a result, the transpulmonary pressure is also equal to 0 cmH20 and the lung collapses. 

Blunt abdominal trauma with rupture of intestine Penetrating abdominal trauma Iatrogenic intestinal perforation (endoscopy)... 

Bowel injuries caused by penetrating, blunt, or iatrogenic trauma that are repaired within 12 hours and intraoperative contamination of the operative field by enteric contents under other circumstances should be treated with antibiotics 24 hours. 

The capacity of the photoactive material to penetrate into normal skin by percutaneous absorption as well as into skin altered by trauma, such as maceration, irritation, and sunburn. 

An intact CNS is critical to the well-being of a person. Nature has gone to a good deal of trouble to protect the CNS from damage, both external and internal. The brain is protected from external trauma by the bony structure we call the skull. The spine is similarly protected by the bony spinal column. The CNS is also protected by the blood-brain barrier against penetration by molecules that might prove a problem. There are special facilitated transport mechanisms for specific molecules required by the CNS but which cannot penetrate the blood-brain barrier. 

Contaminated Acute nonpurulent inflammation major technique break or major spill from hollow organ penetrating trauma less than 4 hours old chronic open wounds to be grafted or covered expected infection rate about 20%. 

Dirty Purulence or abscess preoperative perforation of respiratory, gastrointestinal, biliary, or oropharyngeal tract penetrating trauma more than 4 hours old expected infection rate about 40%. 

Dimethyl sulfoxide is a relatively stable solvent of low toxiaty. However, DMSO can penetrate the skin and may carry with it certain chemicals with which it is combined under certain conditions. Dimethyl sulfoxide has received considerable attention as a useful agent m medicine. In veterinary medicine, DMSO is used for horses and dogs as a topical application to reduce swelling resulting from injury or trauma. 

Human CEC cultured on filter inserts can be used to measure brain penetration of drugs to make in vitro-in vivo correlations. They can further be used to study for example brain inflammation that has been implicated in the development of brain edema and secondary brain damage in ischemia and trauma. Zhang et al. (2000) studied leukocyte infiltration across the blood-brain barrier and showed the expression of adhesion molecules and leukocyte chemoattractants under ishemia in vitro conditions. 

Last, there may be catastrophic casualties. This classification is used for conditions that have either a very grave prognosis or would require an amount of resources that are so large they would divert care from others with a much better prognosis. Examples of catastrophic casualties would include cardiac arrest, penetrating trauma to the head with loss of consciousness, and major burns over more than 50% of the body. 

Penetrating and blunt injuries are commonly sustained following an explosion therefore, standard Advanced Trauma Life Supporf and Advanced Cardiac Life Support principles can be applied. Llowever, unique injuries occur due to the mechanism of blast waves. 

Many health care practitioners have the knowledge and skill sets required to care for blunt and penetrating trauma from motor vehicle accidents, falls, gunshot wounds, and the like however, few have cared for survivors of an explosion. Whether the result of an industrial accident or a terrorist attack, explosions produce casualties that will present with blunt and penetrating... 

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