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TEMS Hollywood Movie Injuries: Part 1 - Three Kings Lung Injuries


HOLLYWOOD MOVIE INJURIES: PART 1 - THREE KINGS LUNG INJURIES


HOT TOPIC BUT RARE IN THE FIELD BY ANDREW HAMILTON


www.itoa.org I


have spent a good part of my career teaching. From informal questions on the fl at range and sitting around various training sites after hours with a cold beverage to weeks spent in a jungle medical camp or days in a classroom. Two injuries always come up at some point. One is the infamous ‘Three Kings’ chest injury, as well as ‘sucking chest wound,’ which is different. The other is the ‘Black Hawk Down’ femoral artery injury. For this issue, let’s cover the lung injury. Here is some very basic anatomy. T e chest wall (think about what ribs look like pre-bbq) is made of ribs (structure) and a pleural lining (that shiny skin on the inner rib meat), plus muscles to move the whole thing like a bellows. Inside are your lungs, which more or less are gooey meat balloons.


Yes, there is some magic that happens inside, but that is gas ex- change and this is mechanics of breathing. T e lungs, when infl ated, are held to the inside of the lung lining by a slimy mucous (surfac- tant) that is both a bit sticky but also slippery enough to let the lungs move within the chest cavity. When you inhale, a mix of diff ering muscle groups and nerve plexus work together to expand the bony birdcage you call your


18 Tactical Response Winter 2015


chest. Since your lungs are stuck to that lining, they go for a ride, and in the process create a vacuum. Ambient air pressure wants to equalize, so your mouth and nose have an inrush of air. When you exhale, the springy bird cage collapses inward, creating positive pres- sure. Your lungs trade good air for bad and repeat. As long as this system isn’t compromised (sickness, bullets, knives, etc.), everything is puppies and rainbows. When the lungs are punc- tured, it’s not always a bad day. About a quarter of the folks shot through the lungs or stabbed get little treatment and are released within about eight hours. If the holes are small, don’t line up or leak air, there’s no issue. It’s when air gets in between the lining of the ribs and the lungs that we get some problems. T is injury is called a ‘Tension Pneumothorax’ meaning air in the thoracic (chest) cavity is in a place it shouldn’t be. T ere is a big diff erence between a Tension Pneumothorax, which is the T ree Kings injury and the sucking chest wound. T e Tension Pneumo- thorax isn’t a routine injury, but it can be lethal. Air leaks from inside the lung into the chest cavity, creating pressure that crushes lungs


“ If the holes are small, don’t line up or leak air, there’s no issue. It’s when air gets in between the lining of the ribs and the lungs that we get some problems.”


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