By Thomas E. Bowen
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Extra resources for Emergency War Surgery
Metal to metal. ♦ Plain radiography is safe. It helps identify the type of ammunition. ο Anesthesia. ♦ Regional/spinal/local preferred. ♦ Keep oxygen out of OR. ♦ Have anesthesiologist leave after induction. ο Operation: The surgeon should be alone with the patient. ♦ Employ gentle technique. ♦ Avoid excessive manipulation. ♦ Consider amputation if other methods fail. ♦ Remove en-bloc if possible. The decision to remove a chemical/biological UXO is a command decision. Immediately after removal, hand to explosive ordnance disposal (EOD) personnel for disposal.
This may cause catastrophic wounds to soldiers who are hit, or it may ignite fuel, ammunition, or hydraulic fluid. ◊ There is a second type of debris, called spall, which is material knocked off from the inside face of the armored plate. This produces a spray of small, irregularly shaped fragments inside of the compartment (Fig. 1-7b). ο Kinetic energy round. ♦ The kinetic energy (KE) round contains an aerodynamically shaped piece of hard metal (such as depleted uranium or tungsten) shaped like a dart.
This is untrue and has no bearing on surgical care. Exit wounds are always greater than entrance wounds. Full metal-jacketed bullets do not fragment, except in unusual circumstances. All projectile tracts must be fully explored, due to the effects of the temporary cavity. The M-193 bullet of the M-16A1 rifle reliably fragments at the level of the cannulure after traversing about 12 cm of tissue in soft tissue only. Elastic soft tissue (skeletal muscle, blood vessels, and nerves) generally heals uneventfully and does not require excision, provided the blood supply remains intact.