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Wed Jun 13 00:49:05 BST 2012

Of course some of our neighbors felt that way but most were very
freindly and accepted us after just a few years.  Still I insist, you
have to be  a maniac to stay after a winter.  Whether or not you are
ever a Mainer.

On 6/12/12, Bjorn, Pret <pbjorn at emh.org> wrote:
> 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
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>> http://www.trauma.org/index.php?/community/
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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

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