Saturday, April 24, 2010


The terrorists are typically not smart.  However, they are, by and large, devious.  They make their own improvised explosive devices with with whatever they can find around the cave.  Nuts, screws, bolts, springs, knife blades, pens.  Sometimes, when they are feeling particularly sinister, they sautee their frickasee in cow dung or human feces and dirt in the hopes that wounds will become infected and the injury, thus, more severe.

This picture from a radiograph of one of our patients shows a bolt lodged adjacent his R maxilla (upper jaw/face).  I am sure if there were a little more force, it would have traveled through the maxilla, and likely into the brain.  This is a recent wound, and he was transported quickly to the US after stabilization, so it is tough to tell if this was a septic explosive device or

not - his infections, and he likely has them brewing, are yet to come. 

This reminds me: the surgical paradigms here are thus altered to account for this kind of nonsense.  Trauma patients from auto wrecks in the US, for example, have entirely different injury patterns and are not taken back to the OR for the large number of repeat washings as they need to be here.  This took me some getting used to.  Just imagine the ballistics.  With a projectile, meant to explode and inflict damage hits the ground, the wall, the roof of a structure, there are various perimeters, roughly circular, which define the injuries to be expected.  In a car wreck, the force is pretty well vectored one direction - thus, people looking at a car driving away from them into something are much less likely to become injured than people watching a car driving toward them into something.  Follows the laws of physics, but not something you typically think about in daily care of patients in a civil society.  I quickly assimilated into the habit of counting bullet holes and matching wounds.  When I take care of leukemia patients, I rarely think of these types of things.

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