1. Penetrating trauma from stab or gunshot wounds can cause significant damage depending on the velocity and mass of the projectile. High velocity weapons like rifles cause more tissue damage than low velocity knives or pellet guns. 2. Upon impact, the projectile transfers kinetic energy to the tissues, causing direct damage along its path. It also creates shock waves and temporary and permanent cavitation that damages a wider area beyond the direct path. 3. Evaluation and management of penetrating trauma depends on the location and severity of injuries. Unstable patients with signs of blood loss or organ injury usually require immediate surgical exploration while stable patients can undergo further diagnostic testing and observation.

1. Penetrating trauma in Netherlands Antilles? No difference! Jeannouel van Leeuwen MD Trauma in the Caribbean II November 6-8, 2009

2. Woundman, from Hans von Gersdorff, Feldtbuch der Wundartzney , 1517.

9. High-Energy Penetrating Injuries How do these weapons differ from handguns and shotguns? How do the wounds differ internally and externally?

10. Medium-Energy Penetrating Injuries

11. Low-Energy Penetrating Wounds How does the length of the weapon relate to the cone of damage?

21. Now go and treat soft tissue injuries…. Reason #1 why you’re supposed to wear a helmet!

22. Head Trauma Boy, it almost feels like I’ve been shot with an arrow.

23. Head Trauma Yup, that definitely feels like an arrow .

30. Pericardial Effusion

46. It is better to see the outside of the artery before you see the inside

48. Pulseless Penetrating Abdominal Trauma Surgical complications are more likely on public holidays

49. Penetrating Abdominal Trauma Frequent dilemma:take your wife for dinner or the patient back to the OR?

53. Take Home Message – Don’t get shot or stabbed!!!