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Gunshot WoundsAccording to the National Safety Council over 1,600 people died in firearm related accidents in 1989, and 900 of those accidents happened in or near the home. Gunshot wounds can range from minor, superficial skin wounds to major organ injury and death. The severity of a gunshot wound is based on the location of injury and the type of weapon used. LOW VELOCITY gunshot wounds (most hand guns, nonmilitary rifles, and low caliber hunting rifles) which do not involve organ damage, bone fracture, body cavity penetration, major blood vessel or nerve damage, can often be managed conservatively, with removal of debris from the wound and aggressive cleansing. Wound tracks must have local debris removed from both exit and entrance sites. Aggressive cleansing, wound irrigation, and sterile dressings should be applied. Lower velocity weapons (.22cal, .32cal, .38cal, and .45cal), for the most part, result in sterile wound tracks. For this reason, secondary infection occurs more commonly at the entrance, or exit site. Bullets will often be left inside the body if they are not wedged within an organ, or interfering with the function of an organ. HIGH VELOCITY weapons (AR-15, AK-47, M-16, or hunting rifles) result in a contaminated wound track, requiring (open) surgical debris removal in the operating room. Evaluation must include an accurate history, including type of weapon, caliber, and range. Physical exam for potential chest or abdominal penetration will be undertaken. Limb examination for nerve and vascular integrity (pulses, feeling, and movement) is crucial. X-rays will aid the physician in revealing any of the above possibilities, as bullets "show up" well on x-rays. Potential vascular injuries can be diagnosed with the use of an angiography. Using a radiopaque contrast injected into the patient's blood stream, this test allows the condition of vessels to "show up" on x-ray studies. Treatment includes debris removal, cleansing, irrigation, tetanus shot update, and preventative antibiotics for low velocity limb injuries, without vascular damage. Major wounds will be treated surgically. Observation in the hospital for high velocity weapon injuries is advised. The greater tissue destruction seen in these cases lead to delayed swelling that can compromise blood flow to an injured limb. The patient who is discharged from the hospital should closely observe the wound for SIGNS OF INFECTION: increased pain, fever, discharge from wounds, and increased swelling or redness. Close follow-up is necessary with a General Surgeon.
|  Hip Dislocation Hip Fracture Insect Stings and Spider Bites Human and Animal Bites Shoulder Injury Fracture Toxic Inhalations and Carbon Monoxide Poisoning Facial Injury Jaw Fracture and Dislocation Kidney Injury Knee Injury General Considerations Knee Injury Contusion Knee Injury Fracture Knee Injury Sprain Stab Wounds Leg Injury Fractures and Contusions Leg Injury Shin Splints Lightning Injury Oral and Tongue Injuries Nasal Fracture or Contusion Neck Injury General Considerations Neck Injury Fracture Neck Injury Spinal Cord Injury Pelvic Bone Fracture Puncture Wounds Chest Injury Rib Fracture Back Injury Sacrococcygeal Injury Scorpion Bites Abrasion Injuries Shoulder Injury Clavicle Fracture Shoulder Injury Strains and Sprains Snakebite Neck Injury Spinal Cord Injury Abdominal Injury Ruptured Spleen Foot Injury Toe Fracture and Sprain Vaginal or Vulvar Injury Drowning and Near Drowning |
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