Gunshot injuries

Modified on 2009/07/23 10:47 by Ole Losvik — Categorized as: Weapon injuries

The problem¶

The wound care depends on how much force – how much energy – the bullet carries. Different weapons make different wound tracks.

Low-speed injuries¶

Pistol bullets have low speed (less than 500 m/sec). With low speed, the bullet carries less energy. The knife or the pistol bullet damages only what it hits “by its nose” – the tissues to the sides remain uninjured. You do not need to cut clean the wound track, just place a drain to prevent blood from collecting inside.

High-speed injuries¶

These are injuries made by rifles, or shrapnels from shells, bombs and land mines. At close range, these bullets or shrapnels may have a speed at 900-1,200 m/second. That is, they carry an amount of energy five to ten times that of the pistol bullet. Even if the inlet wound is narrow, the wound track inside is wide and the tissue damage extensive. There is high risk of wound infection.

If the bullet stops inside the body, all of its energy will be used to damage the body. The wound track will be wide, and the tissue damage massive. If the bullet just makes a superficial wound and leaves the body still in high speed, just parts of its energy will be used inside the body. The wound track will be less wide and the tissue damage less. The “best” rifle bullet – the one using all its force to destroy the body – is the bullet that stops inside. For this, there are several designs:

“Soft point-bullets” have lead in the nose and become deformed when they hit the body.
“Light jacket-bullets” are open at the base so that lead core pieces are thrown out when the bullet tumbles inside the body (e.g. 5.56 mm M16 rifle bullets).

Fractures¶

Fractures gives maximum damage: If the bullet hits the bone, it stops. Because all its energy is released there and then, it sends out strong waves like an explosion that tears up the tissues. Also the bone fragments are shot as bullets into the tissues and add to the damage.

Weapon history¶

Take the weapon history carefully

What type of weapon, and what type of bullet?
What was the range of the hit?
Is the bone fractured?
When you now this, you will have an idea on what you will find inside and can plan the wound management.

Approach¶

You have to address two different problems:

First, and most important, give life support as soon as you can after the injury.
The next job is to prevent wound infection. If the patient is breathing well and the bleeding has stopped, the wound must be cleaned. You do not need to do this immediately, but it should be done within 8 hours after the injury.