Gun shot wounds
Contents
Background
- Bullets
- Lead alloy
- Tip variation (pointed, flat, hollow)
- High Velocity Bullets (M-16 or 30/06 Springfield)
- Very high kinetic energy
- Little deformity when fired
- Cavitation is principle mechanism of destruction, the dissipation of energy radially away from the bullet as it travels through tissue
- Large zone of tissue injury even away from tract
- Low Velocity Bullets (.22 long rifle or .45 pistol)
- Relatively low kinetic energy
- Deform from friction
- Crash injury is priniciple mechanism of damage given projectile tumbling and fragmentation
- Shotgun
- Very high kinetic energy at close range
- Shells contain several to several hundred hundred pellets
- Spread of pellets and rapid energy transfer makes these weapons dangerous
Clinical Features
- Assess for entrance and exit wound
- Exit wound may not follow logical trajectory
- May be absent, especially with low velocity GSWs
- Missiles refer to fragments of bone or other tissue, secondary to the bullet
- Refer to specific systems for additional information
Region Specific Information
Head Trauma (Main) Neck Trauma Cardiac Trauma Pericardial Effusion Diaphragm Injury Abdominal Trauma Open Fracture Spinal Trauma (Main)
Workup
- ATLS/FAST/Trauma Labs
- CT Scan as needed depending on location
- X-ray if bony injury suspected
- CTA if vascular injury suspected
Management
- Trauma consult depending on location and extent of wound
- Ortho consult for bony injuries
- Neuro/OMF/ENT as needed
Disposition
- OR if significant injuries
- Admission/Obs for less concerning injuries
- Minor injuries may be discharged
- GSW Protocol allows lower extremity wounds to be discharged from ED after 9 hours without invasive imaging if they have normal ABIs[1]
Sources
- ↑ Sandjadi, Javid. Expedited treatment of lower extremity gunshot wounds.