Medical Guide (For Experts)

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CHAPTER ONE: Trauma and Injury
Detailed in this chapter are the various types of Ailments you will encounter on the job. More specific details of treatment will be found in the following chapter.

SECTION A: Ballistic Trauma
"The term ballistic trauma refers to a form of physical trauma sustained from the discharge of arms or munitions. The most common forms of ballistic trauma are those which stem from small arms fire, namely semi-automatic pistols, machine guns, submachine guns and assault rifles used in armed conflicts and criminal activity."

Ballistic Trauma is one of the most common injuries you will encounter on the field, given the nature of our occupation. It is critical that this type of injury be assessed and delt with in great haste, as it can cause permanent damage if left unattended. There are several variables affecting the severity of ballistic wounds, and I will list them here-
The nature of the weapon used. A high caliber rifle round will naturally cause more damage that your common 9mm pistol cartridge.
The variety of bullet used. Expanding bullets are more damaging than non expanding. Of the non expanding bullets, flat or very blunt nosed bullets are more damaging than more pointed bullets as the more pointed bullet may push some tissue aside.
The range at which the wound was inflicted. A point blank gunshot will invariably cause more damage than a shot from 100 meters, as bullets greatly reduce in velocity as they travel through the air.
The path and location of the wound. The bullet could simply pierce flesh, or it could lodge itself in an organ, depending upon where the victim is shot. Point of entry is a bad judge of this, as bullets can penetrate at a wide range of angles.
The number of wounds inflicted. In a gun battle, multiple wounds are typically generated. The amount of wounds can greatly affect the amount of blood loss and bodily damage.

Ballistic Trauma has a wide range of effects on the body, depending on the variables above. The immidiate effects are blood loss and shock, shortly followed by a strong onset of shock, as the blood rushes to the core. If an organ is hit, organ failure often follows shortly after, which can lead to death if not attended to immediately.

The method for treating soft tissue balistic trauma are as follows-
First, the victim should have any neccescary painkillers or anesthetics injected, to prevent excess movement during treatment.
Next, the are around the wound should be cleared of obstructions, and any excess blood should be removed.
Now you should make an incision across the bullet hole, to give yourself a larger aperature from which to extract the bullet.
With a pair of forceps, carefully extract the bullet, and dispose of it appropriately.
Remove any excess blood that may have begun to pool, and clean the area surrounding the wound with saline.
Carefully suture the wound closed, keeping your stitching evenly spaced.
Now, wrap a roll bandage around the now dressed wound, keeping it loose enough for blood flow to continue.
Primary Treatment is now complete, but keep the victim in the medbay for a short time for observation.

The same base treatment should be used if the bullet penetrates an organ, and organ repair should begin shortly after bullet extraction.

SECTION B: Incisions and Penetrations
"Incisions and Penetrations are wounds cause typically by a sharp object that pierces the skin. Incisions are injuries in which the skin is simply cut, and penetrations are when the object enters the body's muscle and fat tissue. The most typical types of Incisions and Penetrations are caused by bladed weapons such as bayonets or knives."

These types of wounds are another more common instance of injury in our line of work. Depending on severity, it can cause anything from simple bleeding, to full blown organ damage, depending on how far the object penetrates, and where the injury occurs upon the body.

Presented here is a basic guide on treating such wounds.
As per normal, any painkillers or anesthetics should be injected before treatment begins.
First, any object left behind in the body should be removed, create an incision to widen the aperature of the wound if at all necesccary.
Now, any excess blood and foreign materials should be cleaned away, to both give yourself a clear area to work, and to prevent infection.
Carefully suture the now cleaned wound.
Wrap a bandage around the now dressed wound, keeping it loose enough for fair blood flow.
Operation is now complete, but keep victim under close observation for an appropriate amount of time.

If organ damage is evident, assess and treat it appropriately.

SECTION C: Blunt Trauma
"Blunt Trauma refers to a type of physical trauma caused to a body part, either by impact, injury or physical attack; the latter usually being referred to as blunt force trauma. There are a number of causes, from falls, to assault."

Blunt Trauma is a very common type of injury, as several things can cause it. Blunt Trauma can also cause an extnesive list of complications, so it is of a high priority to determine the nature of the injury. Blunt Trauma can lead to anything from a simple bruise, to collapsed lungs.

There is no specific way to treat Blunt Trauma, as it is not something that requires direct intervention. However, it is urgent that you give a full examination of a victim of Blunt Trauma, to determine what injuries it has caused. Keep Blunt Trauma victims under extremely close observation in the medbay for at least 24 hours.

SECTION D : Bone Fractures
"A bone fracture is a medical condition in which there is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis and certain types of cancer."

Bone fractures, less formaly known as Broken Bones, are a variety of injiry where the bones in the body are cracked from some extreme external force. Bone Fractures are generally categorised by two categories-
Whether or not the skin is pierced. A closed fracture is where the bone has not pierced the skin, and an open fracture is the opposite.
How many breaks are present. A simple fracture involves one bone being cleanly broken across, where as comminuted fractures involve the bone being broken into multiple pieces.
Generally, a simple closed fracture is the easiest to treat, where as an open comminuted fracture is the most difficult. An open fracture normally requires surgery, where as a closed fracture can often be healed with appliances to keep the bone in position, and the body will heal by itself.

The symptoms of Bone Fractures include intense pain, and inability to utilize fractured limbs to their full potential.

Treatment of closed fractures begins with an X-Ray of the affected area, to determine the severity of the break. Once the X-Ray is taken, various methods to promote bone healing are used, including casts, splints and intramedular nails, a metal appliance attached to the bone to keep it straight. If neccescary, bone fragments will be moved into place prior to any of these treatments. Open fractures are treated mostly the same way, but before such treatment begins, any debris, including dead tissue, and bone fragments that are unhealable will be removed, in an open wound surgery.

SECTION E: Burns
"A burn is a type of injury that may be caused by heat, cold, electricity, chemicals, light, radiation, or friction. Burns can be highly variable in terms of the tissue affected, the severity, and resultant complications. Muscle, bone, blood vessel, and epidermal tissue can all be damaged with subsequent pain due to profound injury to nerves."

Burns are rather common injuries, that can be caused by a number of things, from friction to fire. Depending on the location affected and the degree of severity, a burn victim may experience a wide number of potentially fatal complications including shock, infection, and respiratory distress. Burns are usually categorised by depth. The burn depths are described as either superficial, superficial partial-thickness, deep partial-thickness, or full-thickness. The following are brief descriptions of these classes:
First-degree burns are usually limited to redness, a white plaque and minor pain at the site of injury. These burns only affect the upper layer, or the epidermis of skin. Most sunburns can be included as first-degree burns.
Second-degree burns manifest as redness with superficial blistering of the skin, and can involve more or less pain depending on the level of nerve involvement. They can affect the first (epidermis), second (superficial dermis), and third (reticular dermis) layers of skin.
Third-degree burns occur when the epidermis is lost with damage to the subcutaneous tissue (body fat found under the skin). Burn victims will exhibit charring and extreme damage of the epidermis. Third-degree burns result in scarring and victims will also exhibit the loss of hair shafts. These burns may require skin grafting.
Fourth-degree burns damage muscle, tendon, and ligament tissue, thus result in charring and catastrophic damage of the hypodermis. In some instances the hypodermis tissue may be partially or completely burned away as well as this may result in a condition called compartment syndrome, which threatens both the life and the limb of the patient. Grafting is required if the burn does not prove to be fatal.

Burns are treated using a number of chemicals to promote healing, and depending on the class of burn, skin grafts.