Gun Shot Wounds

Question 1

Define wound ballistics

Answer 1

Resulting tissue damage

Question 2

Name 4 things that influence terminal ballistics

Answer 2

• Shape of bullet
• speed
• path through air, surfaces and tissues or external ballistics
. Density of tissues-air filled less damaged than fluid filled

Question 3

Name 6 effects of energy transfer by bullets

Answer 3

Missile tract- direct effect of bullet
• tissue contusions and lacerations
• bone fractures
Indirect shock wave effect
• temporary cavitation. Nb fluid filled structures and organs more damage
• projectile fragmentation
• stress waves- disruption of tissue planes
• laceration of blood vessels -ischaemia

Question 4

Management of low energy missile? (4)

Answer 4

• Irrigate
. Compressive bandage to arrest bleed
• analgesia
Do not suture to avoid abscess, only if cause open pneumo or significant bleeding that can’t be controlled with compression

Question 5

Define a high energy bullet wound (4)

Answer 5

• Haematoma or vascular injury
• tissue damage
. Comminuted fracture
. Cavity penetration with organ damage

Question 6

Management of high energy bullet wound?

Answer 6

• Lay open, debride, homeostasis, irrigate, remove foreign bodies and necroses
• leave wound tract open to prevent necrotising soft tissue infections (gas gangrene, fasciitis)
• Tetanus prophylaxis
• negative pressure wound dressings
• prevent and treat vascular injuries, compartment syndrome

Question 7

When should a bullet be removed? (6)

Answer 7

• Inside heart (embolism, thrombosis, damage to valve etc)
• inside or close to major blood vessel that can be eroded and result in major haemorrhage, pseudoaneurysm, distal embolization, ischaemia
. Bullet inside major joint space (pain, cartilage damage, sepsis)
• In brain or spinal cord (meningitis)
. Sitting just under skin causing pain and can be removed without major surgery
• bullet is only forensic evidence in crime