Complications and Death

7/30/2019 Complications and Death

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Complications of wounds and causes of death:

1-Neurogenic or primary shock.

2-Traumatic shock (secondary shock.(

3-Hemorrhage.

4-Embolism

5-Infection.

6-Crush syndrome.

1-Neurogenic or primary shock.

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


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-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

-Anxiety

-Tremor

-Abdominal discomfort

-Sweating

-Tachycardia

-Hypertension

-Dilatation of pupil.

If death occurs it results from ventricular fibrillation particularly if the

patient suffers from cardiac disease.

2-Traumatic shock (secondary shock.(

*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


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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.

3-Hemorrhage: (oligaemic shock:(

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.

-1/2liter of blood in the pleural or peritoneal cavities are fatal.

-1/4liter of blood in the pericardial sac is fatal.

Small 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.


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Types of hemorrhage:

1-Primary hemorrhage:

It is directly due to the wound, it is either internal or external.

2-Secondary hemorrhage:

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(

3-Reactionary hemorrhage:

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.

4-Embolism

Types that have special medico legal importance:

1-Air embolism:

a- venous air embolism b- arterial air embolism

a- Venous air embolism:

Causes:

-Cut throat( cut jugular vein -ve pressure(

-I.V. infusion.


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-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.

3-Fat embolism:

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


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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.(

5-Infection.

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.

6-Crush syndrome:

Severe crushing of muscles liberation of myoglobin blocking of renal

tubules acute renal failure.

By:fouad nagy 740

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Complications and Death