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Penetrating trauma is an open wound injury that occurs when an object pierces the skin and enters a tissue of the body, creating a deep but relatively narrow entry wound.In contrast, a blunt or non-penetrating trauma may have some deep damage, but the overlying skin is not necessarily broken and the wound is still closed to the outside environment.
Timing is important to wound healing. Critically, the timing of wound re-epithelialization can decide the outcome of the healing. [11] If the epithelization of tissue over a denuded area is slow, a scar will form over many weeks, or months; [12] [13] If the epithelization of a wounded area is fast, the healing will result in regeneration.
Stab wounds occur four times more than gunshot wounds in the United Kingdom, but the mortality rate associated with stabbing has ranged from 0–4% as 85% of injuries sustained from stab wounds only affect subcutaneous tissue. [7] [9] [27] In Belgium, most assaults resulting in a stab wound occur to and by men and persons of ethnic minorities. [28]
Subcutaneous emphysema can result from puncture of parts of the respiratory or gastrointestinal systems. Particularly in the chest and neck, air may become trapped as a result of penetrating trauma (e.g., gunshot wounds or stab wounds) or blunt trauma. Infection (e.g., gas gangrene) can cause gas to be trapped in the subcutaneous tissues.
A wound is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. [1] [2] Wounds can either be the sudden result of direct trauma (mechanical, thermal, chemical), or can develop slowly over time due to underlying disease processes such as diabetes mellitus, venous/arterial insufficiency, or immunologic disease. [3]
Whatever caused the moral injury, Amidon said, “we are not going to brush it aside. It did happen and it wasn’t OK. The point is to help them feel OK sitting in the darkness with the evil they experienced.” Often, patients feel guilty or ashamed, convinced they are unforgiven, worthless and impure.
The great moral power of an army, as Shay puts it, makes its participants more vulnerable to violation, and to a sense of guilt or betrayal when things go wrong. It was his work with Vietnam combat vets, in fact, that led him to recognize that their trauma often came from a deep sense of betrayal.
The symptoms are similar to PTSD: depression and anxiety, difficulty paying attention, an unwillingness to trust anyone except fellow combat veterans. But the morally injured feel sorrow and regret, too. Theirs are impact wounds caused by the collision of the ethical beliefs they carried to war and the ugly realities of conflict.