ONE DEGREE

#11) High-Velocity Wounding

"Phu Bai "Fred administered twenty-eight units of blood during Richard's procedure. An initial thought could be that Declan was a sloppy surgeon, losing an excessive amount of Private Burrows' blood. Military missiles, bullets and fragments from exploding ordinance, travel at 2,600 feet per second or more. As they speed along, air molecules cannot get out of the way, becoming compressed into a ballistic shock wave. Just like a jet, "going through the sound barrier." This energized wave scrambles molecular structure as it passes through tissue. Immediately following, the kinetic energy associated with the speeding missile striking the body imparts an extraordinary amount of power, creating a hydrostatic shock wave that destroys tissue and, passing nearby, fractures bones. It is called hydrostatic for the body's density is essentially that of water, its major component. Skin and fatty tissue are somewhat resistant to damage. The surgeon must debride all dead (devitalized) muscle, for it becomes gangrenous and infected, threatening the patient's life. Often referred to as "meatball surgery," meticulous dissection is required to define and enter the viable muscle, thus releasing excessive blood loss that requires replacement. Coagulation issues occur due to decreased platelets, fibrinogen, and clotting factors (molecules that create the clot). The surgeon must order these components restored. Fresh warm "walking donor" unprocessed blood solves that problem.