Penetrating Trauma

Stab wounds are relatively straightforward. The wounding blade directly injures tissue as it passes through the body. Unfortunately, the penetrating object produces a hole no larger than the blade. External examination of the size of the wound may grossly underestimate the degree of internal damage. In addition, the trajectory of the blade is not apparent by external examination. Any stab wound located in the lower chest, pelvis, flank, or back must be presumed to have an abdominal injury until proven otherwise.

Gunshot wounds injure in several different ways. Bullets may directly injure organs. They also may do so secondarily from missiles such as bone or bullet fragments or from energy transmission from the bullet. Some bullets are designed to expand or break apart once they enter a victim. These tend to cause much more tissue destruction than a bullet that remains intact.

Entrance and exit wounds can approximate the missile trajectory. Plain radiographs help to localize the foreign body, allowing prediction of organs at risk. Unfortunately, bullets may not travel in a straight line. Thus all structures in any proximity to the presumed trajectory must be considered injured until proven otherwise (see Chap 256, "Wound Ballistics").

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