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Gunshot Wounds

By: Nathan Mitchell

Injury Overview

  • The most important factors in causing injury or death are their placement of the wound and projectile path.
  • The head and torso are the most vulnerable areas
  • The extent of tissue and organ trauma will depend on terminal ballistics

First Aid

XSTAT

Injury Overview

  • The bullet crushes structures along its track once the target is reached
  • Initially, there is the temporary cavitation followed by permanent cavitation

  • First responders must follow a specific routine before performing first aid on a victim
  • Assess scene safety before approaching
  • Ask for consent. If the victim is unconscious or incapacitated, there is an implied consent
  • Employ standard trauma life support protocols for the initial assessment

Statistics

References

  • Gunshot injuries. (2014, May 28). Retrieved October 29, 2015, from Patient website: http://patient.info/doctor/gunshot-injuries
  • Heller, J. L. (2014, June 1). Gunshot wounds - aftercare. Retrieved December 13, 2015, from Medline Plus website: https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000737.htm
  • Hubbard, J. (n.d.). How to treat 4 types of gunshot wounds (From one shot?). Retrieved December 13, 2015, from The Survival Doctor website: http://www.thesurvivaldoctor.com/2012/07/26/gunshot-wounds/
  • Introduction to gun violence statistics. (2015, April 17). Retrieved October 29, 2015, from Smart Gun Laws website: http://smartgunlaws.org/category/gun-studies-statistics/gun-violence-statistics/
  • Statistics on gun crimes. (2012, January 1). Retrieved October 29, 2015, from Smart Gun Laws website: http://smartgunlaws.org/category/gun-studies-statistics/gun-violence-statistics/
  • Statistics on gun deaths & Injuries. (2012, November 16). Retrieved October 29, 2015, from Smart Gun Laws website: http://smartgunlaws.org/category/gun-studies-statistics/gun-violence-statistics/
  • Statistics on the dangers of gun use for self-defense. (2015, May 11). Retrieved October 29, 2015, from Smart Gun Laws website: http://smartgunlaws.org/category/gun-studies-statistics/gun-violence-statistics/
  • Sundra, J. R. (2010, November 2). Ballistics for dummies. Retrieved December 13, 2015, from Rifle Shooter website: http://www.rifleshootermag.com/shooting-tips/shooting_tips_ballistics_0303/

Arm & Leg

Head

  • Apply direct pressure
  • Elevate the limb
  • Pressure dress and bandage
  • If bleeding persists- second dressing, pressure on artery, or tourniquet
  • Splint if necessary
  • Perform a short survey
  • Remove any clothing surrounding the gunshot(s)
  • The FDA has recently approved XSTAT for civilian use
  • Essentially a modified syringe with tablet-sized sponges
  • Control the bleeding with direct pressure
  • No tourniquets
  • Approximately 100,000 people in the United States are shot per year in the United States and approximately 30,000 of these incidents are fatal
  • Approximately ⅔ of gun related deaths are suicides and the other ⅓ is homicide
  • 70% of all murders and 50% of all suicides are committed with firearms

  • Properly position the victim
  • Apply occlusive dressing to carotid artery if necessary
  • Easy to use
  • Space saver

Abdomen

Chest

Advanced Care

  • "Sucking chest wound"
  • Apply occlusive dressing with a “flapper valve”
  • Try to avoid movement
  • Find a moist, sterile dressing to place on top of the wound
  • Do not let the victim take anything orally until pain subsides
  • Try not to move
  • If the intestines are ripped open, the victim needs immediate medical care

- Depending on the severity of the injury, the patient may need surgery to:

  • Find and extract bullet fragments
  • Find and remove broken/shattered bone
  • Clean the wound
  • Stop bleeding
  • Repair organs

Ballistics

Prevention

Flat-Point

Case Studies

Advanced Care

  • Flat points
  • Disrupts tissue flow
  • Very destructive
  • Increased drag

1.) Body armour

2.) Suicide prevention

3.) Gun safety

Expanding

- All patients with non-trivial gunshot wounds will need...

  • Cross-matching of six units of blood
  • At least one (preferably two) large-bore IVs
  • Investigation
  • Monitoring
  • High-dependency/intensive care.

Ballistics Summary

  • Hydraulic pressure
  • Connected pieces
  • Wide cavity
  • Don't remove the bullet
  • Three types of ballistics: Internal, External, and Terminal

Andrea Michalkova Scott

  • Thin
  • Bullet breaks apart on impact
  • "Blows apart" region hit

Case Studies

Stephanie Ayula

Fragmenting

  • Two broad categories of bullets: Maximum Penetration and Controlled Penetration

Frangible

  • Thin
  • Metal pellets in the tip
  • Small pellets
  • Wide, shredded cavity
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