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Tue Jun 12 22:44:44 BST 2012

OH, NOT SO!!!  

I mean, no offense, but most folks would insist that even I am 'from away.'  I had a brother who was BORN here, but real natives wouldn't count even THAT.

"If a cat has kittens in the oven, you still can't call 'em muffins."

Sent from my iPhone.

On Jun 12, 2012, at 4:42 PM, "Forrest Robleto" <farcpr at gmail.com> wrote:

> I lived in Maine for ten years. They explained when we moved in that
> Maine has no residency requirements.  So on day one, you are a Mainer.
> But if you decide to stay after a winter you are a Main-iac.
> 
> On 6/12/12, Stephen Richey <stephen.richey at gmail.com> wrote:
>> Darn Maine-iacs...always causing trouble.
>> 
>> On Tue, Jun 12, 2012 at 2:00 PM, Bjorn, Pret <pbjorn at emh.org> wrote:
>> 
>>> Hey, it wasn't me who was factitious.  Or facetious.  Factious, perhaps.
>>> But I'm REALLY best at fatuous.  Anyway, it wasn't me.  It was Torrey.
>>> 
>>> Still: we surely agree that the caliber and velocity may predict the
>>> wound.  But really, are you going to believe the bullet, or your lying
>>> eyes?  That is, when was the last time you rushed back to the ICU to
>>> change
>>> your orders or head to the OR after discovering that the weapon was
>>> falsely
>>> described?
>>> 
>>> Pret
>>> 
>>> 
>>> 
>>> 
>>> -----Original Message-----
>>> From: trauma-list-bounces at trauma.org [mailto:
>>> trauma-list-bounces at trauma.org] On Behalf Of Gross, Ronald
>>> Sent: Tuesday, June 12, 2012 1:54 PM
>>> To: 'Trauma-List [TRAUMA.ORG]'
>>> Subject: RE: Ballistics
>>> 
>>> You have no intention of being factitious - now you are poking just to
>>> poke!!  The fact is that the damage and zone of injury from a 22 cal is
>>> NO
>>> was close to that seen with an M16 or a 45 cal, nad management of high
>>> velocity large mass missiles is MUCH different than the smaller low
>>> velocity missile.
>>> 
>>> Pret, you know better then that!
>>> 
>>> Ron
>>> 
>>> -----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 12:40 PM
>>> 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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> 
> 
> -- 
> 
> V/R
> 
> Forrest Robleto, NCEE
> R House Health & Safety
> www.RHouseTraining.com
> FRobleto at RhouseTraining.com
> 609-792-9047
> 
> Cogito ergo es
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
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