Gun shot wounds
Revision as of 05:46, 24 February 2015 by Rossdonaldson1 (talk | contribs) (→Prophylactic Antibiotics)
Background
- Bullets
- Lead alloy
- Tip variation (pointed, flat, hollow)
Types
High Velocity Bullets
- Examples: 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
- Examples: .22 long rifle or .45 pistol
- Relatively low kinetic energy
- Deform from friction
- Crash injury is principle 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 at close range
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)
- Penetrating neck trauma
- Cardiac Trauma
- 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
Prophylactic Antibiotics
- Infection after gunshot injury is a rare complication
- No prophylactic antibiotics for:[1]
- Soft tissue gun shot wounds
- Non-operative fractures caused by gun shot wounds
- Give prophylactic for:[2]
- Intra-articular fracture (any type of gun shot wound)
- Fractures caused by high-velocity weapons or shotguns
Disposition
- To 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[3]
Sources
- ↑ Hot bullet, Dirty Wound? http://wueverydayebm.blogspot.com/2015/02/hot-bullet-dirty-wound.html
- ↑ Simpson, B. M., Wilson, R. H., & Grant, R. E. (2003). Antibiotic therapy in gunshot wound injuries. Clinical orthopaedics and related research, 408, 82-85.
- ↑ Sandjadi, Javid. Expedited treatment of lower extremity gunshot wounds.