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Tue Jun 12 18:59:56 BST 2012

Sorry.  Auto text and such.

In short, I was trying to not sound like a smart a$$.  

LT 

Sent from my 4G DROID

-----Original message-----
From: Stephen Richey <stephen.richey at gmail.com>
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Sent: Tue, Jun 12, 2012 13:07:47 EDT
Subject: Re: Ballistics

I think he meant to say "facetious".

On Tue, Jun 12, 2012 at 1:03 PM, Bjorn, Pret <pbjorn at emh.org> wrote:

> I'm not even sure I know what factitous means, but I'll chance it:
>
> Dr. McSwain, I believe Dr. Fackler might be speaking directly to this way
> of thinking.  In no small detail, and with no small emphasis.
>
> Very Respectfully...
>
> Sent from my iPhone.
>
> On Jun 12, 2012, at 12:48 PM, "McSwain, Norman E" <nmcswai at tulane.edu>
> wrote:
>
> > The energy exchange and the amount of cavitation around the likely
> trajectory indicate 1) if I operate or observe, 2) how much injured tissue
> I debride, 3) if I think that the patient needs re-exploration in 24 hours
> >
> > No, there is not a lot of difference in a 9mm, .40  or a .357 , but
> there is a lot of difference in the amount of cavitation in a .22  vs .40
> vs .223
> >
> > Norman
> > Professor, Tulane  Univ, Surgery
> > Trauma Director, Spirit of Charity Trauma Center, ILH
> > New Orleans, 504-988-5111
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Larry Torrey
> > Sent: Tuesday, June 12, 2012 11:40 AM
> > To: trauma-list at trauma.org
> > Subject: RE: Ballistics
> >
> > So at the risk of sounding factitious - and it is truly not my intent to
> do so - please tell me how the caliber or round characteristics impact the
> management of the patient.
> >
> > If you receive a pt in the ER with, say, an abd GSW, how would you
> approach this patient is it were known that he was show with a 9mm vs a
> .357 vs a .223 rifle?
> >
> > Additionally, do you even get this information at pt presentation?  I've
> spent my career in ERs that get some penetrating trauma but not a lot, and
> I don't recall the last time I received accurate ballistics information in
> the ER absent a suicide.
> >
> > LT
> >
> > Sent from my 4G DROID
> >
> > -----Original message-----
> > From: "McSwain, Norman E" <nmcswai at tulane.edu>
> > To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
> > Sent: Tue, Jun 12, 2012 12:20:15 EDT
> > Subject: RE: Ballistics
> >
> > Pret
> >
> > Lance is correct.  It is very important to those of us who make critical
> decisions in trauma management. I use this kind of information every time I
> see a such a patient.
> >
> > I guess it depends on your need. If you don't see much penetrating
> trauma you will not have much need for it
> >
> > Norman
> > Professor, Tulane  Univ, Surgery
> > Trauma Director, Spirit of Charity Trauma Center, ILH New Orleans,
> 504-988-5111
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> > [mailto:trauma-list-bounces at trauma.org] On Behalf Of Stuke, Lance E.
> > Sent: Tuesday, June 12, 2012 10:41 AM
> > To: Trauma-List [TRAUMA.ORG]
> > Subject: Re: Ballistics
> >
> > Good question and I believe the answer is definitely yes, especially for
> surgeons in places with high volumes of penetrating trauma. In some
> situations understanding, or more importantly - respecting, the significant
> energy exchange which can happen in a GSW can guide care or certainly raise
> the index of suspicion for other injuries such as surrounding blast effect.
> This is particularly true with high energy weapons such as an AK-47. At a
> center such as ours here in New Orleans, where 60% of our trauma
> activations are for penetrating trauma, understanding ballistics is
> critical to the comprehensive care of the trauma patient. Besides, it's
> pretty cool stuff!
> >
> > Stuke
> >
> > Lance Stuke, MD, MPH
> > Associate Program Director
> > LSU Department of Surgery
> > Spirit of Charity Trauma Center
> > New Orleans, LA
> >
> >
> >
> > On Jun 12, 2012, at 10:00 AM, "Bjorn, Pret" <pbjorn at emh.org> wrote:
> >
> >> Been awhile: has somebody discovered some new way in which any of this
> > is important to healthcare providers, at any level?
> >>
> >> In previous debates on the List, I think the majority opinion has been
> > that ballistics is a science far more important to the killer than the
> healer.
> >>
> >> Skunk poked.
> >>
> >> Pret Bjorn, RN
> >> Bangor, ME USA
> >>
> >>
> >>
> >>
> >> -----Original Message-----
> >> From: trauma-list-bounces at trauma.org
> >> [mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
> >> Sent: Tuesday, June 12, 2012 10:41 AM
> >> To: Trauma-List [TRAUMA.ORG]
> >> Subject: RE: Ballistics
> >>
> >> Christos
> >>
> >> Energy exchange is affected by 1)the number of tissue particles hit by
> > the penetrating object, and by 2)the momentum of the projectile. The
> more energy exchange therefore the more damage to the patient.
> >>
> >> NUMBER OR PARTICLES HIT during  transit of the projectile *The more
> > dense the tissue, the more particles that will be hit and the more
> energy exchange that will result.  The  body can be divided into 3 tissue
> densities for convenience of discussion.
> >> -Air density such as the lung;
> >> -water density such as muscle and soft tissue; and  hard density such
> > as the bone.
> >>
> >> *the larger the frontal projection of the penetrating object the more
> >> tissue particles hit. Three things happen to the projectile that can
> >> increase the frontal projection
> >> - tumble: if the bullet rotates to 90 degrees then it has a much
> > greater frontal surface than if it simply goes though in a straight line.
> >> -deformation: if the projectile spreads out (mushrooming) such as
> >> hollow point bullets or other mechanism used to produce spread at the
> >> time of traversing tissue
> >> - Fragmentation: Fragmentation can occur as the projectile1) leaves
> >> the muzzle (shotgun) or 2) when inside the tissue (exploding rounds)
> >>
> >> [By a *hard nose round*, I mean a round that is solid and does not
> >> fragment or mushroom. This is usually a round(bullet) that has
> >> slightly oblong nose that is covered my solid metal. Many target
> >> rounds are so shaped]
> >>
> >> 2
> >> MOMENTUM is related to Kinematic energy. KE = mass/2 x V (Velocity
> >> squared)
> >> For discussion momentum can be divided into:
> >> *low energy - knives and cutting instruments *medium energy - hand
> >> guns with ~1000 f/s muzzle velocity *high energy - long guns with
> >> ~2000 f/s muzzle velocity
> >>
> >> This is very brief description. More detail is in the "Kinematics"
> >> chapter of the PHTLS text book
> >>
> >>
> >>
> >> Norman
> >> Professor, Tulane  Univ, Surgery
> >> Trauma Director, Spirit of Charity Trauma Center, ILH New Orleans,
> >> 504-988-5111
> >>
> >>
> >> -----Original Message-----
> >> From: trauma-list-bounces at trauma.org
> >> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Christos Giannou
> >> Sent: Tuesday, June 12, 2012 2:05 AM
> >> To: trauma-list at trauma.org
> >> Subject: Ballistics
> >>
> >> Dear Norman,
> >>
> >> What do you call a "hard nose round"?
> >>
> >> There are many (hundreds?) of handgun bullets that have been developed
> > by private industry, most are concerned with what is euphemistically
> called "stopping power".
> >>
> >> As you well know, tissue damage after ballistic injury is the result
> > of effective transfer of kinetic energy. Velocity of the bullet at point
> of impact, and whether it stays in the body or exits, is only one factor.
> >> That is why "high-velocity bullet" means very little in terms of wound
> > ballistics.
> >>
> >> A bullet that deforms or fragments transfers more kinetic energy than
> > one of similar mass and velocity that does not. That is the definition
> of a "dum-dum" bullet, that the British army invented to better fight the
> Afridi Afghans in 1897.
> >>
> >> If you mean a bullet with a steel or tungsten core, I believe that
> > this only increases the penetrating power of the bullet (therefore can
> be used against armour), but does not increase its kinetic energy.
> >>
> >> Just wondering about Louisiana ballistic practice.
> >>
> >> regards
> >> christos giannou
> >>
> >> --
> >> christos giannou
> >> Monemvasia Lakonia
> >> 23070 Greece
> >> tel & fax: (++30) 27320-61772
> >> --
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-- 
Stephen Richey
Founder and Chief Researcher/Designer
Kolibri Aviation Safety Research
5174-B Winterberry Circle
Indianapolis, IN 46254
317-985-4740

 "I think the best thing, and the only thing in our infinite inadequacy in
making up for the loss of life, is to say something we have been able to
say in a lot of other accidents to grieving families.  That is 'Those
deaths will not be in vain. We will not let them be in vain. Every one of
those lives will be made to count in terms of making sure that three, four,
five or ten other people do not die."- John J. Nance
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