Gunshot Wounds

Question 1

What has the greatest effect on wounding capability of a bullet?

Answer 1

Its kinetic energy

k=1/2mv^2

Question 2

What can be caused by intra-articular gunshot wounds?

Answer 2

Plumbism (lead poisoning)
Symptoms include:
neurotoxicity
anemia
emesis
abdominal colic

Question 3

What is the treatment for a through and through gunshot wound with an associated non-operative fracture?

Answer 3

Local wound care, short course of abx, tetanus

Do NOT close the wound

Question 4

In a patient that sustains a visceral injury and a GSW to the lumbar spine with neurologic deficits but without a retained missile in the spinal canal, what is the treatment?

Answer 4

Broad spectrum IV abx for 7-14 days;
retained bullet fragment within the spinal canal in patients with incomplete motor deficits is a relative indication for surgical excision of the fragment

Question 5

What are indications for operative treatment in low energy GSW?

Answer 5

Retention in the subarachnoid space
Articular involvement (intra-articular bone or missile fragments)
Vascular disruption
Gross contamination
Massive hematoma
Severe tissue damage
Compartment syndrome
Gastrointestinal contamination