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Male skull showing bullet exit wound on parietal bone, 1950s.
Ballistic trauma or gunshot wound (GSW) is a form of physical trauma sustained from the discharge of arms or munitions.[1] The most common forms of trauma stem from firearms used in armed conflicts, civilian sporting, recreational pursuits and criminal activity.[2] Ballistic trauma is sometimes fatal for the recipient, or causes long term consequences.
Contents
- 1 Destructive effects
- 2 Origins of medical treatment
- 3 See also
- 4 References
- 5 Bibliography
- 6 External links
Destructive effects
Acute penetrating trauma from a close-range shotgun blast injury to knee. Birdshot pellets are visible in the wound, within the shattered patella. The powder wad from the shotgun shell has been extracted from the wound, and is visible at the upper right of the image.
Repaired laparotomy incision to abdomen
The degree of tissue disruption caused by a projectile is related to the size of the temporary versus permanent cavity it creates as it passes through tissue.[3] The extent of cavitation, in turn, is related to the following characteristics of the projectile:
- Kinetic energy: KE = mv2/2 (where m is mass and v is velocity). This helps to explain why wounds produced by missiles of higher mass and/or higher velocity produce greater tissue disruption than missiles of lower mass and velocity.
- Yaw
- Deformation
- Fragmentation
The immediate damaging effect of a gunshot wound is typically severe bleeding, and with it the potential for hypovolemic shock, a condition characterized by inadequate delivery of oxygen to vital organs. In the case of traumatic hypovolemic shock, this failure of adequate oxygen delivery is due to blood loss, as blood is the means of delivering oxygen to the body's constituent parts. Devastating effects can result when a bullet strikes a vital organ such as the heart or lungs, or damages a component of the central nervous system such as the spine or brain. Common causes of death following gunshot injury include exsanguination, hypoxia caused by pneumothorax, catastrophic injury to the heart and larger blood vessels, and damage to the brain or central nervous system. Additionally, gunshot wounds typically involve a large degree of nearby tissue disruption and destruction due to the physical effects of the projectile. Non-fatal gunshot wounds can result in serious disability.
Gunshot injuries can vary widely from case to case since the location of the injury can be in any part of the body, with wide variations in entry point. Also, the path and possible fragmentation of the bullet within the body is unpredictable. The study of the dynamics of bullets in gunshot injuries is called terminal ballistics.
Non-fatal gunshot wounds frequently have severe and long-lasting effects, even after the victim has made a successful recovery.[4] Typically, the consequences involve some form of major disfigurement and/or permanent disability. As a rule, all gunshot wounds are considered medical emergencies that require immediate hospital treatment. Hospitals are generally required to report all gunshot wounds to police.[5]
Origins of medical treatment
Until the 1880s, the standard practice for treating a gunshot wound called for physicians to insert their unsterilized fingers into the wound to probe and locate the path of the bullet.[6] Surgically opening abdominal cavities to repair gunshot wounds,[7] Germ theory, and Joseph Lister's technique for "antisepsis surgery" using dilute carbolic acid, which had been first demonstrated in 1865, had not yet been accepted as standard practice by prevailing medical authorities. For example, sixteen doctors attended to James A. Garfield and most probed the wound with their fingers or dirty instruments.[8] Historians agree that massive infection was a significant factor in President Garfield's death.[6][9]
At almost the same time, in Tombstone, Arizona Territory on 13 July 1881, George E. Goodfellow performed the first laparotomy to treat an abdominal gunshot wound.[10]:M-9 Goodfellow pioneered the use of sterile techniques in treating gunshot wounds,[11] washing the patient's wound and his hands with lye soap or whisky.[12] He became America's leading authority on gunshot wounds[13] and was widely recognized for his skill as a surgeon. Goodfellow is credited as the United States' first civilian trauma surgeon.[14]
See also
- Battlefield medicine
- Emergency medicine
- Hydrostatic shock
- Multiple gunshot suicide
- Penetrating trauma
- Stopping power
- Vincent Di Maio
- Stab wound
References
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Wikimedia Commons has media related to Gunshot wounds. |
- ^ Mahoney, P. F., et al. (2004). Section 1 : Introduction, Background and Science p4
- ^ Mahoney, P. F., et al. (2004). The International Small Arms Situation p6
- ^ Wound Ballistic Research of the Past Twenty Years: A Giant Step Backwards
- ^ Negligent discharge page
- ^ http://www.cmaj.ca/content/170/8/1256.full
- ^ a b Schaffer, Amanda (25 July 2006). "A president felled by an assassin and 1880’s medical care". New York Times (New York, New York). Retrieved 29 April 2016.
- ^ Crane, Michael A. (2003). "Dr. Goodfellow: gunfighter's surgeon" (PDF). Retrieved 10 March 2013.
- ^ "The death of President Garfield, 1881". Retrieved 11 March 2013.
- ^ Rutkow, Ira (2006). James A. Garfield. New York: Macmillan Publishers. ISBN 978-0-8050-6950-1. OCLC 255885600.
- ^ Charles E. Sajous, ed. (1890). Annual of the Universal Medical Sciences And Analytical Index 1888-1896 3. Philadelphia: F.A. Davis Company.
- ^ "Come face to face with history" (PDF). Cochise County. pp. 8–9.
- ^ Edwards, Josh (2 May 1980). "George Goodfellow's medical treatment of stomach wounds became legendary". The Prescott Courier. pp. 3–5.
- ^ "Dr. George Goodfellow". Retrieved 8 March 2013.
- ^ "Tombstone's doctor famous as surgeon". The Prescott Courier. 12 September 1975. Retrieved 11 March 2013.
Bibliography
- Mahoney, P. F., Ryan, J., Brooks, A. J., Schwab, C. W. (2004) Ballistic Trauma – A practical guide 2nd ed. Springer:Leonard Cheshire
- Krug E. E., ed. World Report on Violence and Health. Geneva: World Health Organization; 2002.
- World Health Organization (WHO). Small arms and global health. Paper prepared for SALW talks. Geneva: July 2001.
External links
- Virtual Autopsy – CT scans of fatal gunshot wounds
- http://patient.info/doctor/gunshot-injuries
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General wounds and injuries (T08-T35, 870-949)
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| Abrasions |
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| Blisters |
- Blood blister
- Coma blister
- Delayed blister
- Edema blister
- Fracture blister
- Friction blister
- Sucking blister)
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| bruises |
- Hematoma/Ecchymosis
- Battle's sign
- Raccoon eyes
- Black eye
- Subungual hematoma
- Cullen's sign
- Grey Turner's sign
- Retroperitoneal hemorrhage
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| Animal bites |
- Insect bite
- Spider bite
- Snakebite
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| Other: |
- Ballistic trauma
- Stab wound
- Blunt trauma/
superficial/closed
- Penetrating trauma/open
- Aerosol burn
- Burn/Corrosion/Chemical burn
- Frostbite
- Occupational injuries
- Traumatic amputation
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| By region |
- Hand injury
- Head injury
- Chest trauma
- Abdominal trauma
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Trauma
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| Principles |
- Polytrauma
- Major trauma
- Traumatology
- Triage
- Resuscitation
- Trauma triad of death
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| Assessment |
| Clinical prediction rules |
- Revised Trauma Score
- Injury Severity Score
- Abbreviated Injury Scale
- NACA score
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| Investigations |
- Diagnostic peritoneal lavage
- Focused assessment with sonography for trauma
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| Management |
| Principles |
- Advanced trauma life support
- Trauma surgery
- Trauma center
- Trauma team
- Damage control surgery
- Early appropriate care
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| Procedures |
- Resuscitative thoracotomy
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| Pathophysiology |
| Injury |
- MSK
- Bone fracture
- Joint dislocation
- Degloving
- Soft tissue injury
- Resp
- Flail chest
- Pneumothorax
- Hemothorax
- Diaphragmatic rupture
- Pulmonary contusion
- Cardio
- Internal bleeding
- Thoracic aorta injury
- Cardiac tamponade
- GI
- Blunt kidney trauma
- Ruptured spleen
- Neuro
- Penetrating head injury
- Traumatic brain injury
- Intracranial hemorrhage
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| Mechanism |
- Blast injury
- Blunt trauma
- Burn
- Penetrating trauma
- Crush injury
- Stab wound
- Ballistic trauma
- Electrocution
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| Region |
- Abdominal trauma
- Chest trauma
- Facial trauma
- Head injury
- Spinal cord injury
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| Demographic |
- Geriatric trauma
- Pediatric trauma
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| Complications |
- Posttraumatic stress disorder
- Wound healing
- Acute lung injury
- Crush syndrome
- Compartment syndrome
- Contracture
- Fat embolism
- Chronic traumatic encephalopathy
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