:Complications of wounds and causes of death

.Neurogenic or primary shock -1 .(Traumatic shock (secondary shock -2 .Hemorrhage -3 Embolism -4 .Infection -5 .Crush syndrome -6 .Neurogenic or primary shock -1 It is a reflex neurovascular disturbance which follows immediately after an :injury .It results from A- Parasympathetic inhibition of the circulation (vagal inhibition).or .B- Sympathetico-adrinal stimulation of the circulation :(A- Parasympathetic inhibition of the circulation (vagal inhibition :It results from Severe emotions .Rise of pressure in carotid sinuses Stimulation of trigger areas (epigastrium, testis, larynx, cervix and urethra) :as in the following situations application of pressure on the neck .Unexpected blows to the larynx, chest, abdomen and genital organs .Foreign bodies in the air passages .cervical dilatation :C/P - Bradycardia Sudden hypotension Sweating -

Nausea vertigo Pallor Usually death doesn't occur because, ventricles escape the shock state as they don't have vagal stimulation, However, ventricular escape may not .occur resulting in rapid death from acute circulatory failure :B- Symathetico- adrenal stimulation :It results from . severe pain severe fright AnxietyTremor Abdominal discomfort Sweating Tachycardia Hypertension .Dilatation of pupilIf death occurs it results from ventricular fibrillation particularly if the .patient suffers from cardiac disease .(Traumatic shock (secondary shock -2 It develops gradually after injury due to reduction of total circulating blood * volume, with .a secondary decline in venous return, cardiac output and blood pressure :It occurs due to* release of histamine like substance from the severely lacerated tissues that causes increase in the capillary permeability and loss of capillary tone, therefore a large number of capillaries are opened and dilated to

accommodate most of the blood. (the patient bleeds inside his own .(vessels :C/P .Skin is pale cold and clammy with profuse perspiration Progressive prostration and weakness with apathy and progressive .depression .Pupils are dilated :(Hemorrhage: (oligaemic shock -3 . It is the most common cause of death in wounds :Factors affecting the gravity of hemorrhage :a- Amount of blood lost .The loss of 2 liters ( one third of the total blood volume) is dangerous to life :b- Rate of hemorrhage Rapid loss of blood is more serious.(sudden quick hemorrhage doesn't allow (for compensation leading to shock :c-site of hemorrhage Internal hemorrhage is more serious than external as it carries the risk of .inducing pressure over the organs e.g .liter of blood in the pleural or peritoneal cavities are fatal 1/2.liter of blood in the pericardial sac is fatal 1/4Small intracranial hemorrhage is fatal ( few cc of blood in the brain (.substance is fatal :d- General condition of the patient .Healthy adults can tolerate hemorrhage more than children and old people :c- sex .Females tolerate hemorrhage than males

:Types of hemorrhage :Primary hemorrhage -1 .It is directly due to the wound, it is either internal or external :Secondary hemorrhage -2 It is due to sepsis of the wound dissolve the blood clot by the lytic enzymes of the organisms patent blood vessels bleeding (It occurs after a time of wound infliction (days, weeks or months :Reactionary hemorrhage-3 In this type of hemorrhage there is minimal bleeding at the time of injury .due to associated shock state Then, after a time (about 10 hours) the person starts to bleed again due to rise of blood pressure after recovery from the shock stage that leads to .dislodgement of the blood clot that has been formed to close the cut vessel :C/P Rapid weak pulse Low blood pressure Subnormal temperature Shallow rapid respiration .Cold clammy skin Embolism -4 :Types that have special medico legal importance :Air embolism -1 a- venous air embolism :a- Venous air embolism : Causes (Cut throat( cut jugular vein -ve pressure .I.V. infusion b- arterial air embolism

.Tubal insufflations .Criminal abortion .Fatal amount : 100-200 cc Cause of death: Air fills the right side of the heart and pulmonary arteries obstruction of pulmonary circulation by frothy non-compressible blood . acute heart failure :b- arterial air embolism :Causes .During artificial pneumothorax, if the needle is passed in a pulmonary vein .Stab transfixing wound connecting a bronchus with a pulmonary vein Fatal amount: few cc are fatal Cause of death .Occlusion of coronary and cerebral arteries :Fat embolism -3 :Causes .Fracture of a long bone with torn vein Burns in a fatty area Trauma to a fatty area :Cause of death Acute heart failure due to obstruction of the right side of the heart and .pulmonary artery with fats :Thromboembolism :Causes Prolonged recumbence in bed Cause of death

Prolonged recumbence in bed deep vein thrombosis may be detached .pulmonary embolism after about 10 days of the injury or may be earlier .((2-3 days .Infection -5 Contused and lacerated wounds are the most liable to severe infection .particularly, tetanus and gangrene due to devitalized tissue of the wounds : Infection of the wound may be a) primary is caused by organisms which are carried into the wound at the time of the injury eg) from the skin,clothing or street dirt(tetanus) often cannot be avoided b) secondary is caused by organisms which invade the wound after the injury eg) air droblet infection,contaminated dressing. It can be prevented by . adequate aseptic surgical measures :Crush syndrome -6 Severe crushing of muscles liberation of myoglobin blocking of renal .tubules acute renal failure By:fouad nagy 740