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Gunshot wound

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A gunshot wound (GSW) is a penetrating injury caused by a projectile, such as a bullet, being fired from a gun. These injuries are often more devastating than other types of penetrating wounds. This is because the path and fragmentation of a bullet can be unpredictable once it enters the body. Damage from a GSW can include bleeding, bone fractures, and organ damage. It can also cause wound infections or a loss of movement in certain body parts. In many severe cases, these injuries can be fatal.

Abdominal Gunshot Wound
Abdominal Gunshot Wound

The physical damage caused by a bullet is linked to how it moves through tissue. As a projectile passes through, it creates a permanent cavity. This is the actual hole or track left behind by the bullet. High-velocity bullets also create a temporary cavity, or secondary cavity. This is a radial stretching of tissue around the wound track. A pressure wave forces the tissue away from the bullet's path, creating an empty space. This temporary cavity is often many times larger than the bullet itself.

The amount of tissue disruption is related to the projectile's kinetic energy. Kinetic energy is the energy an object possesses due to its motion. It is calculated using the formula KE = 1/2mv², where 'm' is mass and 'v' is velocity. While both mass and velocity contribute to energy, velocity is a much more important determinant. If the mass of a bullet is doubled, the energy doubles. However, if the velocity is doubled, the energy increases four times. This explains why high-speed bullets cause significantly more damage.

Shotgun wound
Shotgun wound

Medical professionals classify these wounds by the speed of the projectile using the Gustilo open fracture classification. Low-velocity wounds travel at less than 335 meters per second (m/s). These are typical of small caliber handguns and usually cause less soft tissue damage. Medium-velocity wounds travel between 360 m/s and 600 m/s. These are often seen with shotgun blasts or large handguns. High-velocity wounds travel between 600 m/s and 1,000 m/s. These are usually caused by powerful rifles and carry a high risk of infection due to the large area of destroyed tissue.

PNI Protocol
PNI Protocol

Global statistics show the scale of firearm-related injuries. In 2016, firearms resulted in 251,000 deaths globally. This was an increase from 209,000 deaths in 1990. Of these 2016 deaths, 161,000, or 64%, resulted from assault. Another 67,500, or 27%, were suicides, and 23,000, or 9%, were accidents. In the United States, guns caused about 40,000 deaths in 2017. These deaths are most common in males between the ages of 20 and 24. The economic cost of gunshot wounds in the U.S. is estimated at $140 billion per year.

When treating a patient, medical teams use the Advanced Trauma Life Support (ATLS) protocol. Before management begins, the area must be verified as safe. The first step is to assess and protect the airway and the cervical spine. Next, teams maintain breathing and oxygenation. They then assess circulation and work to control bleeding. This helps maintain organ perfusion, which is the delivery of blood to organs. Finally, doctors perform a neurological exam and expose the entire body to search for missed injuries.

Abdominal Gunshot Wound
Abdominal Gunshot Wound

One specific and rare type of injury is the Kronlein shot. This is a distinctive headshot wound caused by high-velocity rifle bullets or shotgun slugs. It is believed to be caused by a hydrodynamic effect. The high velocity creates hydraulic pressure within the skull. This pressure can lead to the explosive ejection of the brain from the fractured skull. Preventing such injuries involves various interventions. These include criminal background checks, mental health care, and safer firearm storage. Keeping guns locked and unloaded is associated with a lower risk of injury for all household members.

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