# Need an opinion on an MOI



## curt (Jun 1, 2009)

A friend showed me this picture, and though it seems silly on an EMS-related board- be warned, it's ugly. 

http://img.photobucket.com/albums/v296/The_blood_reaper/russiangsw.jpg

 For some background, this is a picture of a soldier who was involved in the South Ossetia conflict, posted on a russian forum. There was no mention of any sort of history as to what caused this wound, and both my friend and myself were quite baffled as to what could have caused an injury like this. Pay particular attention to the two wounds on his anterior neck, bilateral to the trachea, as well as the the fact that they line up rather well with the large wound on his chest, which doesn't appear to go straight back but travels along a more superficial axis. Also note the fact that his visible arm appears to have a tourniquet on it, indicating other injuries and that it's been enough time between the injury and the picture for someone to have secured a tourniquet on him. My best hypothesis was a high-powered rifle round, which might've had too little tissue to work with to create a cavitation wave when passing through the trachea, but dug in against the chest once it reached there.

 Thoughts?


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## Aidey (Jun 1, 2009)

I think I know what it is.   My guess is that he was grazed by either a bullet or a piece of shrapnel. Imagine he was standing with his chest/shoulders thrust forward, and his head tipped back, and the object was just in front of him. It would probably hit those spots.   The two smaller abrasions are right in line with the large wound, so I think they were all caused at the same time, by the same thing.


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## curt (Jun 1, 2009)

Aidey said:


> I think I know what it is.   My guess is that he was grazed by either a bullet or a piece of shrapnel. Imagine he was standing with his chest/shoulders thrust forward, and his head tipped back, and the object was just in front of him. It would probably hit those spots.   The two smaller abrasions are right in line with the large wound, so I think they were all caused at the same time, by the same thing.


I'll agree that it was probably a single-event MOI, but as the neck's cylindrical, not flat, and we're talking about a projectile here, I don't quite follow on how those are abrasions. On the other hand, if it WAS a high-powered round that went through his trachea, something makes me suspect that he'd be breathing through a second mouth in that picture.


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## Aidey (Jun 2, 2009)

I don't think the wounds over his trachea are a deeper than the dermis. I think they are surface wounds where the projectile grazed him. Abrasion is just the best term I could come up with, since they aren't exactaly lacerations.


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## MSDeltaFlt (Jun 2, 2009)

curt said:


> A friend showed me this picture, and though it seems silly on an EMS-related board- be warned, it's ugly.
> 
> http://img.photobucket.com/albums/v296/The_blood_reaper/russiangsw.jpg
> 
> ...


 
Those two neck wounds are not through the trachea.  They're to one side only and they are superficial.  He is not swelling with SQ-air.  He's pink and not pale.  He's also pretty much verticle.  What's on the right arm is a dressing, not a tourniquet.  It's kinda sagging a bit.

That's my take on it.


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## DrankTheKoolaid (Jun 2, 2009)

*re*

Yeah i agree with MS on this also.  If this was my patient, i would be telling him what i tell all my got so freakin lucky patints.  Go buy a lottery ticket.


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## curt (Jun 2, 2009)

Now that I consider his positioning in the photo, the abrasions only being on one side of his trachea makes a good deal more sense. Shrapnel from the secondary phase of a blast, then?


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## Afflixion (Jun 11, 2009)

my take would be a poorly place rifle round that while he was standing of to the side during an engagement he took a round to the neck which was carried along the chest as the second wound on his neck appears to be where the round passed over the clavicle and is definitely not an exit wound but the wound on his chest appears to be the exit wound. Just my take though when you said ugly I was envisioning a 50cal through him or something of that magnitude.


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## MGary (Jun 11, 2009)

odd how little bullet wounds and penetrations like that actually bleed, huh? 

I agree with the others. Looks like a high-powered rifle round grazing down from the pattern of the neck wounds and into the shoulder area. Perhaps he flinched forward as he felt it graze his neck?


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## EMTrainer (Jun 25, 2009)

*One bullet*

I'm thinking that you are looking at a bullet entry wound with two exits. The first wound on the neck is the entry. The small wound next in line is probably where a small fragment of the bullet, it's jacket, or some other material broke through the skin as the major portion of the bullet traveled a rather superficial path to the elongated exit wound. It's my guess that you could take a flex guide and feed it into the first small wound and follow the path straight through the large wound.


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