Journal articles on the topic 'Bullet wound trauma'
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Liu, Susu, C. Xu, Y. Wen, G. Li, and J. Zhou. "Assessment of bullet effectiveness based on a human vulnerability model." Journal of the Royal Army Medical Corps 164, no. 3 (December 25, 2017): 172–78. http://dx.doi.org/10.1136/jramc-2017-000855.
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IntroductionPenetrating wounds from explosively propelled fragments and bullets are the most common causes of combat injury. There is a requirement to assess the potential effectiveness of bullets penetrating human tissues in order to optimise preventive measures and wound trauma management.MethodsAn advanced voxel model based on the Chinese Visible Human data was built. A digital human vulnerability model was established in combination with wound reconstruction and vulnerability assessment rules, in which wound penetration profiles were obtained by recreating the penetration of projectiles into ballistic gelatin. An effectiveness evaluation method of bullet penetration using the Abbreviated Injury Scale (AIS) was developed and solved using the Monte Carlo sampling method.ResultsThe effectiveness of rifle bullets was demonstrated to increase with increasing velocity in the range of 300–700 m/s. When imparting the same energy, the effectiveness of the 5.56 mm bullet was higher than the 7.62 mm bullet in this model.ConclusionsThe superimposition of simulant penetration profiles produced from ballistic gelatin simulant has been used to predict wound tracts in damaged tissues. The authors recognise that determining clinical effectiveness based on the AIS scores alone without verification of outcome by review of clinical hospital records means that this technique should be seen more as a manner of comparing the effectiveness of bullets than an injury prediction model.
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Maiden, Nicholas. "Ballistics reviews: mechanisms of bullet wound trauma." Forensic Science, Medicine, and Pathology 5, no. 3 (July 31, 2009): 204–9. http://dx.doi.org/10.1007/s12024-009-9096-6.
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Adibe, Obinna O., Robert P. Caruso, and Kenneth G. Swan. "Gunshot Wounds: Bullet Caliber is Increasing, 1998–2003." American Surgeon 70, no. 4 (April 2004): 322–25. http://dx.doi.org/10.1177/000313480407000411.
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In 1999, Caruso reported data from the level 1 trauma center in Newark, New Jersey, documenting “. . . an ominous trend toward the use of larger caliber firearms in accidents, homicides and suicides.” Those data were derived from measurements of bullets removed from our trauma patients and submitted to the Surgical Pathology laboratory from 1981 through 1997. We further document this trend with measurements of similar source bullets from 1998 through 2002. During the same time, we recorded mortality among gunshot wound victims treated at our trauma center. Bullets submitted to surgical pathology during the years 1998 through 2002 were measured with a millimeter rule to determine caliber or transverse diameter. A total of 367 bullets were studied in this 5-year period. Bullets deformed beyond measurability (∼22%) and shotgun pellets (<5%) were excluded from our study. Bullet calibers were expressed in terms of mean plus or minus standard error ([Formula: see text] ± SE). Mortality figures were derived from analysis of medical records concerning the outcomes all victims of gunshot wounds (E 922, E 965) treated at our hospital during the years studied and expressed as percentages. Linear regression of mean bullet caliber over time was performed, and analysis of variance was used to assess statistical significance of apparent differences in mortality. Bullet caliber continued to increase from 8.47 ± 0.22 to 9.16 ± 0.15 mm during the 5-year observation period. Linear regression reveals R = 0.9649, P < 0.01. Mortality ranged from 4.7 per cent to 10.7 per cent but the differences were not significant ( P > 0.20). These data support a continued trend toward the use of larger caliber firearms in accidents, homicides, and suicides. Mortality does not change during this time and presumably because of improvements in treatment, from resuscitation to definitive surgery and its convalescence.
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Lovasik, Brendan P., Christopher L. Nauser, Nathan J. Klingensmith, and Jonathan H. Nguyen. "Bullet Embolism into the Common Iliac Artery from a Gunshot Wound to the Heart." American Surgeon 88, no. 5 (December 29, 2021): 1014–15. http://dx.doi.org/10.1177/00031348211069794.
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We describe the management of bullet embolism from a penetrating cardiac injury, including the clinical, radiographic, and operative considerations in this challenging trauma scenario. Bullet embolism represents a rare but complex subset of ballistic penetrating trauma, and highlights the importance of radiographic correlation with intraoperative findings.
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O'Connor, James V., James M. Haan, and Joshua L. Wright. "Spent Bullet in the Bronchus." American Surgeon 72, no. 4 (April 2006): 345–46. http://dx.doi.org/10.1177/000313480607200414.
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Penetrating tracheal trauma, although infrequent, varies from minor to life-threatening injuries. Serious injury often results from airway compromise or significant associated esophageal or vascular trauma. Tracheal injuries resulting in a retained ballistic fragment in the airway have been infrequently reported. We report the successful treatment of a patient with a gunshot wound to the anterior cervical trachea resulting in a spent bullet lodged in the left lower lobe bronchus.
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Reilly, Megan, Joshua Luginbuhl, and Joseph Thoder. "Retained Missile to the Foot and Ankle: When Should They Come Out?" Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0035. http://dx.doi.org/10.1177/2473011419s00355.
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Category: Trauma Introduction/Purpose: Gunshot wounds are common injuries encountered by orthopaedists in urban settings. Retained missiles can lead to significant morbidity and functional impairment. Despite the potential for adverse sequelae, controversy remains regarding the role of routine bullet removal. Suggested indications for bullet removal include those leading to infection and lead toxicity. Bullets located in the palm of the hand, sole of the foot, or intraarticularly are commonly removed as well. Given the unlikeliness of a retained missile sparing the many joints or sole of the foot, we question the indications for conservative management. The purpose of this case series of is to further develop indications for bullet removal from the foot. Methods: A medical record search was performed at a single one trauma institution, with high volume of patients with ballistic injury, for patients who underwent bulletectomy from 2008 until 2018. Of the 169 patients originally obtained, 17 patients underwent bulletectomy, with associated irrigation and debridement, of the foot and ankle. The record of each patient in this retrospective case series was individually reviewed for location of retained missile, indications for removal, whether the procedure was performed at the bedside or in the operating room, concomitant injuries or surgeries, and follow up. Results: Of the 17 patients with retained bullets removed from the foot and ankle, four (23.5%) were removed at the bedside versus the operating room. Indications for removal were painful palpable subcutaneous position of the bullet (11 or 64.7%), periarticular or intraarticular bullet (five or 29.4%), and infected wound with removal of foreign body to optimize healing (one or 5.9%). The location of the palpable missiles included three on the plantar foot, four on the dorsal foot, and four located in subcutaneous tissues adjacent to the ankle joint. Nine out of seventeen (52.9%) had fractures associated with the retained missile. Of the patients with OR procedure (13), the majority of them (nine or 69.2%) were in the operating room for another procedure as well. Conclusion: The indications for bulletectomy of the foot and ankle are not definite, however, it is recommended that bullets located in the weightbearing plantar foot or intraarticularly be removed. After analysis of a seventeen patient retrospective case series, we support these indications but also advocate for the removal of any painful subcutaneous or periarticular bullet, whether under local anesthesia or in the operating room. In our experience, the prominent foot and ankle bullet is often removed during a procedure for another anatomic site. Bulletectomy of the foot and ankle in a stable polytrauma patient should be considered.
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Shaqiri, Elmas, Bledar Xhemali, Zija Ismaili, Admir Sinamati, and Gentian Vyshka. "An unusual lethal gunshot wound to the head." Medico-Legal Journal 85, no. 1 (November 12, 2016): 51–54. http://dx.doi.org/10.1177/0025817216678718.
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Atypical gunshot wounds present a challenge for the forensic expert, and sometimes differentiating these from a blunt trauma can be difficult. A careful crime scene investigation can be helpful in finding additional evidence and clarifying the nature of the injuries. We describe a case of an unusual craniocerebral injury that was initially interpreted as a blow from a wooden object. The appearance of the wound lacked the classical characteristics of entrance and exit bullet wounds, but the investigation showed it was due to the ricocheting of a destabilized bullet. Potentially lethal, craniocerebral gunshot injuries are a common occurrence in developing countries even in non-conflict areas, with very bad outcomes even when treated aggressively in specialized neurosurgical facilities. The authors briefly discuss similar cases and opinions in the relevant literature, emphasizing the importance of a rational approach during the reconstruction of the crime scene.
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Brauner, Edoardo, Federico Laudoni, Giulia Amelina, Marco Cantore, Matteo Armida, Andrea Bellizzi, Nicola Pranno, Francesca De Angelis, Valentino Valentini, and Stefano Di Carlo. "Dental Management of Maxillofacial Ballistic Trauma." Journal of Personalized Medicine 12, no. 6 (June 5, 2022): 934. http://dx.doi.org/10.3390/jpm12060934.
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Maxillofacial ballistic trauma represents a devastating functional and aesthetic trauma. The extensive damage to soft and hard tissue is unpredictable, and because of the diversity and the complexity of these traumas, a systematic algorithm is essential. This study attempts to define the best management of maxillofacial ballistic injuries and to describe a standardized, surgical and prosthetic rehabilitation protocol from the first emergency stage up until the complete aesthetic and functional rehabilitation. In low-velocity ballistic injuries (bullet speed <600 m/s), the wound is usually less severe and not-fatal, and the management should be based on early and definitive surgery associated with reconstruction, followed by oral rehabilitation. High-velocity ballistic injuries (bullet speed >600 m/s) are associated with an extensive hard and soft tissue disruption, and the management should be based on a three-stage reconstructive algorithm: debridement and fixation, reconstruction, and final revision. Rehabilitating a patient with ballistic trauma is a multi-step challenging treatment procedure that requires a long time and a multidisciplinary team to ensure successful results. The prosthodontic treatment outcome is one of the most important parameters by which a patient measures the restoration of aesthetic, functional, and psychological deficits. This study is a retrospective review: twenty-two patients diagnosed with outcomes of ballistic traumas were identified from the department database, and eleven patients met the inclusion criteria and were enrolled.
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Dykan, Iryna. "Radiation diagnostics of thoracic gunshot wounds." Radiation Diagnostics, Radiation Therapy, no. 2 (2020): 70–80. http://dx.doi.org/10.37336/2707-0700-2020-2-6.
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The frequency of thoracic injuries in the general structure of combat surgical trauma remains at the level of 7-12 % and unchanged from the time of the Second World War to the current armed conflicts. The overwhelming majority of them (up to 72 %) are shrapnel gunshot wounds. The formation of a gunshot wound occurs due to the action of a shock wave; a wounding projectile; energy of side impact and vortex wake. The shape, size, features of the wound canal are determined by the kinetic energy of the wounding agent and the physical properties of the damaged tissues. The lung parenchyma is loose and elastic, so small-caliber bullets with low energy cause minimal damage. The wound canal is well differentiated on CT-slices. Its cavity is filled with blood, fragments of destroyed tissue, air bubbles. On the periphery, the contusion zone is determined (area of increased attenuation in the lung-ground-glass opacity). Shrapnel wounds can be accompanied by ruptures of the pulmonary parenchyma with hemorrhages, bilateral pulmonary contusion, damage to the bone frame and soft tissues of the chest. Vascular injury with massive hemorrhage into the pleural cavity and tense hemopneumothorax are one of the main causes of mortality in penetrating wounds. Transmediastinal gunshot wounds, armor trauma and bullet embolism require special attention during radiation examination of victims. The purpose of radiation diagnostics of modern combat trauma is to identify and fully characterize injuries and their complications. The amount of diagnostic information is determined by the level of medical care. Key words: gunshot wounds, chest cavity organs, radiation diagnostics.
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Crutcher, Clifford L., John M. Wilson, Anthony M. DiGiorgio, Erin S. Fannin, Jessica A. Shields, Kevin D. Morrow, and Gabriel C. Tender. "Minimally Invasive Management of Civilian Gunshot Wounds to the Lumbar Spine: A Case Series and Technical Report." Operative Neurosurgery 19, no. 3 (March 6, 2020): 219–25. http://dx.doi.org/10.1093/ons/opaa030.
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Abstract BACKGROUND Treatment of penetrating gunshot wounds (GSW) to the spine remains controversial. The decision to operate is often based on surgeon preference and experience. We present a case series of 7 patients who underwent minimally invasive thoracolumbar/sacral decompression and bullet removal at a level 1 trauma center. OBJECTIVE To describe the use of minimally invasive techniques to achieve decompression and bullet removal for GSW to the spine. METHODS From 2010 to 2017, 7 patients with spinal GSW underwent minimally invasive decompression and bullet removal at an academic level 1 trauma center. RESULTS Patient ages ranged from 20 to 55 yr (mean: 31 yr). The mechanisms of injury were GSW to the abdomen/pelvis (n = 6) and direct GSW to the spine (n = 1). Based on the neurological examination, the injuries were characterized as complete (n = 1) or incomplete (n = 6). Decompression and bullet removal were performed using a tubular retractor system. All patients with incomplete injuries who had postdischarge follow-up demonstrated some neurologic recovery. There were no postoperative wound infections, cerebrospinal fluid (CSF) fistulas, or other complications related to the procedure. CONCLUSION Minimally invasive decompression and bullet removal is a safe technique that may help reduce the risk of postoperative infections and CSF fistulas in patients with GSW to the lumbar spine compared to the standard open technique. This approach appears to be particularly beneficial in patients with incomplete injuries and neuropathic pain refractory to medical treatment.
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Laksono, Gerardo, Ferdinand Erwin, Dyana Sarvasti, and Paul Tahalele. "HEMOTHORAX FOLLOWING PENETRATING THORACIC INJURY (GUNSHOT WOUND) IN GERIATRIC PATIENT: A CASE REPORT AND EMERGENCY MANAGEMENT." Journal Widya Medika Junior 3, no. 2 (April 30, 2021): 69–77. http://dx.doi.org/10.33508/jwmj.v3i2.3180.
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Introduction: Penetrating chest trauma is highly lethal. Studies have reported up to 60% mortality depending on the mechanism of injury. While penetrating chest trauma is less common than blunt trauma, it can be more deadly. High-velocity gunshot injury resulting in penetrating thoracic trauma in geriatric patients poses a significant challenge for the traumatic surgeon. Hemothorax is usually a consequence of penetrating chest trauma. It can be caused by intercostal arterial bleeding, especially the posterior part. Initial treatment, including chest tube drainage insertion, is needed to avoid lung compression and to assess future treatment needed. Purpose: To report the patient survival from massive hemothorax caused by penetrating Thoracic injury caused by an air rifle, treated by chest tube insertion and posterolateral thoracotomy to take out the bullet several days after. Case Report: 70-year male patient came to the Emergency Room (ER) Adihusada Hospital Surabaya with a penetrating chest injury caused by an air rifle on the right side of the chest. The patient had chest pain, shortness of breath, and hypoxia. By inserting a chest tube, emergency management was done by a general surgeon due to the massive right hemothorax. An immediate chest tube insertion was needed to overcome the patient’s breathing problem to assess the future treatment needed. Chest X-ray and CT-Scan was done immediately after the patient’s hemodynamic were stable. Three days after hospitalizing, the Cardiothoracic and vascular surgeon performed posterolateral thoracotomy to take the bullet out of the chest. Conclusion: Seven days postoperatively, the patient was discharged from the hospital without any complications and stable hemodynamic. The patient went to the outpatient department for follow-up one week after.
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Ferrada, Paula A., and Dan W. Parrish. "Gunshot Wound to the Box: A Threat even on a Stable Patient." Panamerican Journal of Trauma, Critical Care & Emergency Surgery 1, no. 2 (2012): 137–38. http://dx.doi.org/10.5005/jp-journals-10030-1030.
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ABSTRACT Context Penetrating trauma to the thoracic cavity can result in immediate or delayed injuries to the heart. These injuries include among others contusion of the cardiac muscle, and laceration of the coronary arteries resulting on ischemia. Although, nonoperative management is a tempting option on a stable patient; close monitoring is guaranteed after this type of injury regardless of the initial vital signs. Case report We describe a case of a gunshot wound on a stable patient that was found to have blunt cardiac injury by the bullet. In the previous workup the missile appeared not to be penetrating the cardiac structures. Conclusion Awareness of this rare injury may provide a more rapid diagnosis, thereby preventing potentially catastrophic outcomes. How to cite this article Ferrada PA, Parrish DW. Gunshot Wound to the Box: A Threat even on a Stable Patient. Panam J Trauma Critical Care Emerg Surg 2012;1(2):137-138.
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Nguyen, Peter, Jitsupa Sirinit, David Milia, and Christopher Stephen Davis. "Management of intracardiac bullet embolisation and review of literature." BMJ Case Reports 15, no. 3 (March 2022): e247252. http://dx.doi.org/10.1136/bcr-2021-247252.
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Vascular injury is a common complication in firearm injuries; however, intravascular missile embolism is relatively rare. There are only 38 documented cases of intravascular missile embolisation to the heart. Bullet embolisms are difficult to diagnose even with multiple diagnostic modalities and even once identified, the most optimal choice of surgical management is debated. Our patient presented with a gunshot wound to the right posterior shoulder. Cardiac focused assessment with sonography for trauma, chest X-ray, CT and echocardiogram were performed, showing missile location adjacent to the right ventricle with inconclusive evidence of pericardial injury. Exploratory median sternotomy was performed, revealing intact pericardium and injury to the superior vena cava (SVC) with bullet embolisation to the right ventricle. The patient became temporarily asystolic secondary to haemorrhage from the SVC injury. Cardiac massage was performed, dislodging the missile into the inferior vena cava. A venotomy was performed to retrieve the bullet and vascular injuries were primarily repaired.
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Fassett, Daniel R., James S. Harrop, and Alexander R. Vaccaro. "Evidence on magnetic resonance imaging of Brown–Séquard spinal cord injury suffered indirectly from a gunshot wound." Journal of Neurosurgery: Spine 8, no. 3 (March 2008): 286–87. http://dx.doi.org/10.3171/spi/2008/8/3/286.
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✓The authors describe a rare case of Brown–Séquard syndrome as a result of indirect, concussive trauma to the spinal cord from a gunshot wound (GSW) and present the magnetic resonance (MR) imaging evidence obtained in this interesting case. The patient was shot in the anterior neck and the bullet passed through the lateral aspect of the C-7 lateral mass and transverse process. Bone fragments from the lateral aspect of C-7 were displaced posteriorly into the soft tissues, but no abnormalities were noted within the spinal canal except for high-intensity signal on T2-weighted MR imaging within the right side of the spinal cord. This is the first reported case to provide MR imaging evidence of a Brown–Séquard spinal cord injury as a result of indirect trauma (concussive injury) from a GSW.
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Caushi, Fatmir, Ilir Skenduli, Arian Mezini, and Francesco Rulli. "Extraction of a bullet floating in the pulmonary artery after a gunshot wound." Journal of International Medical Research 49, no. 1 (January 2021): 030006052098566. http://dx.doi.org/10.1177/0300060520985661.
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Background Patients with thoracic trauma caused by gunshots face a high risk of death, and medical staff often encounter technical difficulties in resolving these cases. Most gunshot wounds result in an entrance and exit wound. In cases with no exit wound, missiles are seen in other areas with screening radiographs. The bullet may migrate depending on gravity, coughing, swallowing, blood flow, or local erosion. Case presentation We present the case of a teenager who was hospitalized in critical condition owing to a left hemithorax injury caused by an improvised explosive device. The patient underwent two surgeries: an anterior left thoracotomy during which a hole in the myocardium was sutured, and after radiography, anterolateral right thoracotomy was performed, in which a deformed projectile was found at the level of the intermediate right pulmonary artery. Conclusions This case highlights the crucial importance of repeated imaging to assess the possibility of projectile migration within the cardiovascular system in similar cases of penetrating injury. Immediate surgery was necessary and very important for the survival of our patient, despite the difficulties presented by this complicated case.
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Denisov, A. V., P. E. Krainyukov, S. M. Logatkin, A. B. Yudin, V. V. Kokorin, D. A. Altov, and K. N. Demchenko. "Gunshot wounds to the chest and abdomen when using modern body armor." Bulletin of the Russian Military Medical Academy 22, no. 2 (June 15, 2020): 115–21. http://dx.doi.org/10.17816/brmma50056.
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Based on the analysis of literary sources and the data of our own experimental studies, we examined the features of gunshot wounds of military personnel protected by body armor. The classification of body armor by design is given. In addition, the gradation of body armor according to the protection class according to GOST 34286-2017 is given. It is shown that the widespread use of body armor in modern armed conflicts has led to a noticeable decrease in the frequency of gunshot wounds to the chest. According to the mechanism of the formation of a gunshot injury through a bulletproof vest, three main types of injuries were identified: closed local contusion injury when the bulletproof vest was not broken; a gunshot wound when piercing a bulletproof vest; gunshot wounds due to ricocheting of striking elements from the surface of the body armor (external or internal ricochet). It has been established that closed trauma in case of bulletproof vest penetration can occur both in the form of damage to the skin and subcutaneous tissue with the formation of hemorrhages, and in the form of bruises of internal organs, accompanied in severe cases by ruptures of internal organs (liver, spleen, lungs, etc.), with development life- threatening complications - intense pneumothorax, intra-abdominal bleeding, etc. It is shown that when piercing a bulletproof vest through the wound, in addition to a deformed bullet and clothing elements, fragments of armor can be introduced lei with additional damage. When bullets approach a bulletproof vest at angles of 20 degrees or more, rebound elements of dismantled bullets can occur, which can cause severe damage to both the owner of the bulletproof vest and others.
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Kvasnevskyi, Yevhen, Michailo Kashtalian, Oleh Gerasimenko, and Oleksandr Kvasnevskyi. "Experimental Study of Action Different Kinetic Energy on the Colon." Lietuvos chirurgija 21, no. 2 (May 2, 2022): 105–8. http://dx.doi.org/10.15388/lietchirur.2022.21.61.
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The purpose of the study. To increase the effectiveness of surgical care for the wounded with combat trauma of the colon by studying of ballistic, morphological and functional features of the gunshot wounds. Patients and methods. A study of surgical treatment of 83 wounded with combat injuries of the colon, received in the area of anti-terrorist operation in the period from 2014–2018. For comparative analysis of treatment results, two clinical groups were formed: comparison and main. The comparison group included 42 wounded who were treated from April 2014 to February 2015 (the first and second periods of ATO), who used traditional surgical tactics. The main group included 41 wounded who were treated from March 2015 to 2018. Results. Analysis of the distribution of wounded with combat trauma by type of wound / injury revealed that the vast majority of them in both groups had shrapnel wounds – 49 (59.1%). There were 30 (36.1%) victims with bullet wounds, and 4 (4.8%) with closed injuries. The wounded patients with the battle trauma of the thick bowel by type of injury had missile wounds as a rule – 49 (59.1%). There were 30 (36.1%) patients with bullet wounds, and 4 (4.8%) with closed injuries. Most of the injuries were combined – 58 (69.9%), and with only abdominal injuries – 25 (30.1%), mostly multiple – 21 (25.3%). The great majority of the thick bowel injuries belonged to sigmoid – 32 (38.6%) and transverse colon – 21 (25.3%), which is explained by relatively large size of these parts of the intestine. Conclusions. The choice of surgical tactics and scope of surgical interventions on damaged organs and structures took into account the results of experimental study of mechanogenesis and pathomorphology of gunshot wounds of the colon, obtained in bench studies by modeling gunshot wounds on “thoracoabdominal ballistic material”.
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Stefanou, Christos, Nicolaos Zikos, George Pappas-Gogos, Spyridon Koulas, and Ioannis Tsimoyiannis. "Laparoscopic Bullet Removal in a Penetrating Abdominal Gunshot." Case Reports in Surgery 2016 (2016): 1–3. http://dx.doi.org/10.1155/2016/2712439.
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Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A 32-year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall. The patient had no symptoms or obvious bleeding and was vitally stable. On examination we identified 1 cm diameter entry wound at the left lower abdominal wall. The imaging studies showed the bullet in the peritoneal cavity but no injured intraperitoneal and retroperitoneal viscera. We decided to remove the bullet laparoscopically. Twenty-four hours after the intervention the patient was discharged. The decision for managing gunshot patients should be based on clinical and diagnostic findings. Anterior abdominal injuries in a stable patient without other health problems can be managed laparoscopically.
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Jones, Hunter, and Hassan Ahmed. "One Bullet Causing Five Holes, Laparoscopic Exploration with Repair: A Case Report and Review of the Literature." Case Reports in Surgery 2020 (August 3, 2020): 1–5. http://dx.doi.org/10.1155/2020/8861270.
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Introduction. The proper treatment of penetrating abdominal wounds has been a controversial topic, and the preferred regimen has evolved over time. In recent years, many trauma centers have started using diagnostic laparoscopy in stable trauma patients in an effort to reduce the incidence of nontherapeutic laparotomy. This is more commonly seen in solid organ injuries, and its role is less clearly defined for hollow visceral injuries. Case Presentation. A 19-year-old male presented with a gunshot wound (GSW) to the abdomen with mild peritoneal signs and computed tomography (CT) findings. Diagnostic laparoscopy was performed with the repair of five lacerations to intra-abdominal organs including the sigmoid colon, rectum, bladder, and small bowel. Discussion. To our knowledge, this is the first case report in the literature detailing such a GSW repair. Abdominal GSWs have been repaired laparoscopically in the past, but none have elaborated on the repair of multiple defects of bowel and/or bladder. Conclusion. Therapeutic laparoscopy can be considered in selected cases of penetrating abdominal trauma. Laparoscopy offers several advantages over laparotomy including decreased mortality, complication rate, and length of stay.
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Peled, Micha, Yoav Leiser, Omri Emodi, and Amir Krausz. "Treatment Protocol for High Velocity/High Energy Gunshot Injuries to the Face." Craniomaxillofacial Trauma & Reconstruction 5, no. 1 (March 2012): 31–40. http://dx.doi.org/10.1055/s-0031-1293518.
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Major causes of facial combat injuries include blasts, high-velocity/high-energy missiles, and low-velocity missiles. High-velocity bullets fired from assault rifles encompass special ballistic properties, creating a transient cavitation space with a small entrance wound and a much larger exit wound. There is no dispute regarding the fact that primary emergency treatment of ballistic injuries to the face commences in accordance with the current advanced trauma life support (ATLS) recommendations; the main areas in which disputes do exist concern the question of the timing, sequence, and modes of surgical treatment. The aim of the present study is to present the treatment outcome of high-velocity/high-energy gunshot injuries to the face, using a protocol based on the experience of a single level I trauma center. A group of 23 injured combat soldiers who sustained bullet and shrapnel injuries to the maxillofacial region during a 3-week regional military conflict were evaluated in this study. Nine patients met the inclusion criteria (high-velocity/high-energy injuries) and were included in the study. According to our protocol, upon arrival patients underwent endotracheal intubation and were hemodynamically stabilized in the shock-trauma unit and underwent total-body computed tomography with 3-D reconstruction of the head and neck and computed tomography angiography. All patients underwent maxillofacial surgery upon the day of arrival according to the protocol we present. In view of our treatment outcomes, results, and low complication rates, we conclude that strict adherence to a well-founded and structured treatment protocol based on clinical experience is mandatory in providing efficient, appropriate, and successful treatment to a relatively large group of patients who sustain various degrees of maxillofacial injuries during a short period of time.
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Азизов, Р. Ф. "Features Selection of Phlebosurgery Tactics Depending on the Degree of Injury if Craniofacial Gunshot Wound." Стоматология. Эстетика. Инновации, no. 2 (May 31, 2022): 205–13. http://dx.doi.org/10.34883/pi.2022.6.2.010.
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Цель исследования. Изучение особенностей выбора хирургической тактики в зависимости от степени повреждения при черепно-лицевом огнестрельном ранении (травма, вызванная столкновением пули с инородным телом (оптический бинокль)).Материалы и методы. Представлена хирургическая тактика на примере мужчины – военного офицера, который получил огнестрельное ранение. Операции, проведенные авторами, и исследования показали, что даже при самых тяжелых огнестрельных ранениях краниомаксилло-лицевое качество скорой помощи и правильный выбор хирургической тактики показывают высокий клинический эффект. The purpose of the study. To investigate the features of the choice of surgical tactics depending on the degree of injury if craniofacial gunshot wound (trauma caused by the collision of a bullet from a foreign body (optical binoculars)).The material of the study was a male military officer, received a gunshot wound craniofacial area. Operations conducted by the authors and their research has shown that even under the most severe gunshot wounds craniofacial quality ambulance and the right choice of surgical tactics shows high clinical effect.
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Eckersley, Martyn, Carla Goncalves, Dalip Kumar, and Saman Perera. "A case of a mobile intrathoracic foreign object." Trauma 22, no. 1 (October 15, 2019): 70–73. http://dx.doi.org/10.1177/1460408619880140.
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Penetrating chest trauma to children is rare in the UK, making up 0.8% of wounds to children. When it does occur, it often results in damage to mediastinal structures including but not limited to the heart, lungs and great vessels. Rarely foreign objects can be intrapericardial. We present the case of a 14-year-old boy who presented haemodynamically stable following pellet gun wound to the chest. Multi-modality imaging revealed the bullet to be in the pericardium without associated cardiothoracic injuries, confirmed following surgery. Although a multi-modality imaging approach was used in diagnosing the precise location of the gun pellet, including imaging involving ionising radiation, we argue that early localisation can potentially be achieved with initial imaging and basic anatomical correlation, reducing the time to diagnosis. Using all the images available, including CT scout images, can assist in localisation and identifying important negatives.
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Hamza, Bahaa I. "Axillary Artery Injuries Surgical experience review in a single vascular trauma center." AL-Kindy College Medical Journal 16, no. 1 (July 24, 2020): 4–9. http://dx.doi.org/10.47723/kcmj.v16i1.181.
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Background: Injuries to blood vessels are among the most dramatic challenges facing trauma surgeons because repair is often urgent, the surgeon has to decide between management options (open or endovascular), and gaining control and reconstructing a major arterial injury can be technically demanding .Objective:,To analyze the cause of injury, surgical approach, outcome and complications of axillary artery injuries.Methods A descriptive cross-sectional study on fifty patients at Ibn-Alnafees hospital in Baghdad from January 2005 to December 2010Results Males were more commonly affected than female with ratio of 6.1:1. Most injuries were caused by bullet and shell (84%), followed by stab wounds (10%) and blunt trauma (6%). Patients were divided into three groups according to the involved part of the axillary artery: the first part, the second part and the third part. The second part represents most of the cases (48%), the third part account for (30%), while the least is the first part (22%). Resection and end to end anastomosis was done in 80% of the cases, lateral repair in 8%, graft interposition in 8 % and ligation in 4%.Conclusion: The outcome of the injury in this study was in general good. The morbidity of the patients due to nerve injury and wound infection still problem. Mortality due to associated injury and delayed presentation was 4% which is acceptable as compared with other studies.
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Khalikov, Airat A., Evgeny M. Kildyushov, Kirill O. Kuznetsov, Dmitry S. Komlev, and Gulnaz R. Rahmatullina. "Possibility of determining injury duration based on changes in histomorphometric characteristics of the thymus." Russian Journal of Forensic Medicine 7, no. 2 (July 2, 2021): 96–100. http://dx.doi.org/10.17816/fm401.
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Background: Lymphoid tissue is the first to react to stress, which manifests as characteristic morphological manifestations, based on which it is possible to study the duration of damage. Aims: Study of the dynamics of changes in the histomorphometric characteristics of the rat thymus during regeneration of the musculocutaneous tissue during mechanical thigh trauma. Material and methods: In total, 84 sexually mature rats were enrolled. These were divided into two groups (experiment and control), which were further classified into four subgroups depending on the time elapsed since the injury (1, 3, 15, and 25 days). Mechanical damage was simulated using a setup that transferred kinetic energy (comparable to a 5.6-mm rifle bullet) to tissues. Subsequently, the animals were removed from the experiment by decapitation; their thymus was removed and microscopically examined. In arbitrary units, the total area of the lobules as well as the area of the cortical and cerebral zones was determined. Results: Our research results indicate different phases of changes in the histomorphometric characteristics of the thymus, which correspond to the course of the wound and can be used in forensic practice to determine the duration of the injury. Conclusions: Mechanical trauma, considered as a stress reaction, causes involutive changes in the thymus and is characterized by changes in the area of the thymus cortex and medulla as well as regular dynamics of changes in the thymic lobules at different stages of wound regeneration.
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Wichlas, F., V. Hofmann, G. Strada, and C. Deininger. "War surgery in Afghanistan: a model for mass causalities in terror attacks?" International Orthopaedics 44, no. 12 (September 11, 2020): 2521–27. http://dx.doi.org/10.1007/s00264-020-04797-2.
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Abstract Purpose The aim of the study was to identify solution strategies from a non-governmental (NGO) hospital in a war region for violence-related injuries and to show how high-income countries (HIC) might benefit from this expertise. Methods NGO trauma hospital in Lashkar Gah, Afghanistan. Four hundred eighty-four war victims admitted in a three month period (February 2016–May 2016) were included. Patients´ characteristics were analyzed. Results The mean age was 23.5 years. Four hundred thirty-four (89.9%) were male, and 50 (10.1%) were female. The most common cause of injury was bullet injuries, shell injuries, and mine injuries. The most common injured body region was the lower extremity, upper extremity, and the chest or the face. Apart from surgical wound care and debridements, which were performed on every wound in the operation theatre, laparotomy was the most common surgical procedure, followed by installation of a chest drainage and amputation. Conclusion The surgical expertise and clear pathways outweigh modern infrastructure. In case of a mass casualty incident, fast decision-making with basic diagnostic means in order to take rapid measurements for life-saving therapies could make the difference.
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Lurin, І. A., K. V. Gumeniuk, O. B. Tymchuk, and O. M. Popova. "The gun-shot woundings of large bowel as a predictor of severe course of fighting abdominal trauma." Klinicheskaia khirurgiia 88, no. 7-8 (November 28, 2021): 39–43. http://dx.doi.org/10.26779/2522-1396.2021.7-8.39.
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Objective. Analysis of experience of the medical help delivery to the wounded persons, suffering a gun-shot fighting abdominal trauma and treated in Military–Medical Clinical Centre of Eastern Region, determining a further steps, concerning optimization of the treatment-diagnosis measures in this category of patients.
Materials and methods. Medical cards of 27 stationary patients with a gun-shot penetrating woundings of abdominal cavity, who were operated on the first stage in mobile hospitals with further transportation to Military–Medical Clinical Centre of Eastern Region, were studied. Concerning the missile characteristic, causing the wounding, there were 20 fragmentation woundings (іsolated – 2, multiple – 5, combined – 13), the bullet – 7 (іsolated – 1, multiple – 3, combined – 3). There were also 7 thoraco-abdominal woundings, of them 6 – the fragmentation, 1 – the bullet. In 18 patients the treatment consisted of a one-staged operative intervention performance, in 9 of them –in several stages. Among the wounded persons, who needed multi-staged treatment, 77.8% have had the large bowel damage.
Results. The reoperations performance, which were more characteristic for the wounded persons with the large bowel damages, was folllowed by morbidity (adhesional ileus, peritonitis, etc.), enhancement in 2.6 times of purulent complications of postoperative wound, and in 2 times – of the average index of stationary stay, what have demanded a proportionally enhanced expenses from the health-care military system.
Conclusion. Among the gun-shot penetrating woundings of abdominal cavity the multiple and combined fragmentation woundings prevailed. As a result, a statistically significant association between damages of large bowel and enhancement of prediction for the morbidity development and the treatment duration was established, using the method of correlation-regression analysis.
The large bowel woundings constitute a predictor of more severe course of fighting abdominal trauma and development of complications, what leads to necessity for elaboration of differentiated approach to operative treatment of this wounded persons’ category with objective to reduce a stationary stay and possibility of the morbidity development.
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Agarwal, Shubham, Sabah Patel, Faiza Hammad, and Janice L. Gilden. "Does Pituitary Dysfunction Always Occur Following Penetrating Head Trauma?" Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A583. http://dx.doi.org/10.1210/jendso/bvab048.1189.
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Abstract Background: Pituitary dysfunction and panhypopituitarism remain underdiagnosed in penetrating and blunt head trauma and can occur in both acute and chronic settings. Case: A 56 years old male with no significant PMH was admitted with a gunshot wound to the left T9 rib paraspinally with bullet deflection cranially along the left lung, left sternocleidomastoid, and resting anterior to the suprasellar cistern just above the midline of the sphenoid sinus close to the pituitary gland. Moderate volume pneumocephalus, chest hemopneumothorax, and sudden loss of right-sided vision required neurosurgical and pulmonary intervention. Endocrinology was consulted to evaluate pituitary function in the context of the bullet within the cranium. Physical examination showed intact mental status, non-focal exam, right-sided blindness, and foley catheter with normal urine output. Laboratory hormonal assessment for hypothalamic-pituitary axis (HPA) was performed consistent with normal sodium, potassium, FSH of 14.2 mIU/ml (1.0-13.0 mIU/ml), LH of 4.5 mIU/ml (1.0-9.0 mIU/ml), AM cortisol of 13.6 ug/dl (5-25 ug/dl), free cortisol of 2.06, ACTH of 10 pg/ml (10-60 pg/ml), IGF-1 of 80 ng/ml (78-220 ng/ml), TSH 1.93 mIU/L (0.5-5.0 mIU/L), FT4 1.05 ng/dl (0.8-1.8 ng/dl), Prolactin of 14.2 ng/ml (4-23 ng/ml) and HbA1c 5.1%. He reported no symptoms of adrenal insufficiency and remained hemodynamically stable. He was monitored for symptoms of pituitary insufficiency and suppression of the HPA axis along with urine output which remained normal and reassuring for the absence of central DI. The patient will continue outpatient endocrine surveillance. Discussion: The development of hormone deficiencies is directly related to the severity of head trauma. Mild traumatic brain injury (TBI) patients discharged from the ED, without loss of consciousness or post-traumatic amnesia less than 30 minutes do not require endocrine surveillance. Pituitary dysfunction occurs in 20-40% of patients with moderate to severe TBI. Pituitary ischemia leads to pituitary injury, due to changes in cerebral blood flow, cerebral hypoxia, and increased intracranial pressure. Compressive effects on the stalk from increased intracranial pressure is another indirect mechanism for pituitary dysfunction. Hospitalizations longer than 48 hours following TBI, require pituitary screening at 3-6 months. Chronic hypopituitarism develops in 15-20% of patients within 2-3 years with ACTH and GH deficiencies. Other changes in LH, FSH, TSH, and development of central diabetes insipidus can occur. However, despite severe TBI, acute pituitary hormonal involvement may not always occur, as in our patient. References: Tan CL, Alavi SA, Baldeweg SE, et al. The screening and management of pituitary dysfunction following traumatic brain injury in adults: British Neurotrauma Group guidance. J Neurol Neurosurg Psychiatry. 2017 Nov;88(11):971-981.
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Maslyakov, V. V., Y. G. Shapkin, A. Y. Dadayev, S. A. Kulikov, and M. A. Shikhmagomedov. "Peculiarities of Immidiate Postoperative Period in Abdominal Trauma With Splenic Injuries." Russian Sklifosovsky Journal "Emergency Medical Care" 9, no. 1 (October 20, 2020): 14–20. http://dx.doi.org/10.23934/2223-9022-2020-9-1-14-20.
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INTRODUCTION. Splenic injuries in abdominal trauma is one of the most common injuries in abdominal surgery. The damage to this organ occurs in 22.3–30%. This is the second most common injury among damages to parenchymal organs.AIM OF STUDY. To study the immediate results of treatment and to determine the factors that influence the choice of tactics for open injuries of the spleen.MATERIALS AND METHODS. The study included 75 patients with abdominal wound and damaged spleen. In 54 (72%) patients, stab and slash wounds were revealed, in 21 (28%) patients there were gunshot wounds (bullet or fragment). All patients were divided into two groups: Group A included 44 (58.6%) of patients, where the time gap between the time of injury and the surgery did not exceed 1 hour, and Group B, which included 31 (41.3 %) of cases, where the time gap between the moment of injury and surgical intervention exceeded 1 hour.RESULTS. As a result of the study, it was found that organ-preserving operations for open injuries of the spleen were possible in 33.3% of cases. The choice of surgical tactics for injuries of this organ depended on the type of damage to the organ: in case of gunshot wounds of the spleen, the organ-preserving operation was not possible at all, but this operation was performed for stab/slash wounds in 33.3% of cases. The development of complications and deaths directly depended on the journey time: in the case of that time gap up to one hour, complications developed in 27.3% of cases, and the mortality rate was 15.9%. If the time of journey exceeded 1 hour, the number of complications increased to 77.4%, and mortality rate grew up to 51.6%. According to our data, the number of complications and deaths depended more on the time of admission than on the type of operation performed. In addition, it is necessary to note one more factor that affected the lethal outcome and this was the type of the wound. Therefore, as a result of the study, it was found that mortality in the group with gunshot wounds amounted to 17 out of 21 (80.95%), and for stab/slash wounds it was 6 out of 54 (11.1%). It was found that the journey time and the type of operation performed operation affected the level of D-dimer in patients with splenic injuries. So, the level of D-dimer was 566±0.3 ng/ml in the group of the wounded, delivered within an hour after trauma, and 643±0.2 ng/ml in the group where the journey time exceeded an hour.CONCLUSIONS. 1. Performing organ-preserving operations with open injuries of the spleen is possible in 46.3% of cases and only for stab and slash wounds. Organ-preserving operations cannot be performed for gunshot wounds.2. The number of complications and deaths is more dependent on the journey time to the hospital than on the type of operation performed. If a patient is admitted within an hour after trauma, the complication rate is 27.3%, and mortality rate is 15.9%. If the journey time exceeds one hour, the complication rate is 77.4% and the mortality rate is 51.6%.3. In patients splenic inguries, the journey time and the type of the operation performed affect the level of the D-dimer, which may affect the course of the immediate postoperative period.
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Khomenko, I., I. Tsema, K. Humeniuk, V. Slobodianyk, and D. Rahushyn. "Case of gunshot injury to the liver by a hand-made modified sniper bullet: organ-preserving surgical management with damage control tactics and transpapillary biliary decompression." General Surgery, no. 2 (December 30, 2022): 64–74. http://dx.doi.org/10.30978/gs-2022-2-64.
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Combat penetrating gunshot injuries are frequently associated with damage to the liver. A bile leak and an external biliary fistula (EBF) are typical complications. Biliary decompression is commonly applied for the management of EBF. Furthermore, there is insufficient data available regarding the characteristics of combat trauma and its management in the context of ongoing hybrid warfare in East Ukraine.
A 23yearold male was admitted with a thoracoabdominal penetrating gunshot wound (GSW) that was caused by a highenergy multiple metal projectile (a fragmented sniper bullet). Damage control tactics was applied at all 4 levels of military medical care. Endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy, and placement of a biliary stent were used for evaluation and biliary decompression. Stent occlusion was treated with stent replacement and scheduled ERCP. Partial EBF was diagnosed based on the primary wound defect of the liver and was closed without surgical intervention on the 34th day after injury. Acute cholecystitis was associated with ERCP and was managed with cholecystostomy.
The combination of operative and nonoperative techniques for the management of the combat GSW to the liver is effective, along with the application of damage control tactics. Scheduled ERCP is effective for the management of EBF, so liver resection can be avoided. The transpapillary intervention with stent placement was successfully used for biliary decompression. Early posttraumatic stent occlusion can be diagnosed and effectively managed by scheduled ERCP as well as stent replacement with a largediameter stent inserted as close as possible to the site of bile leak.
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Mahakul, Dibya Jyoti, Ramesh Doddamani, Rajesh Meena, and Deepak Agrawal. "Analysis of Surgical Outcome in Patients with Firearm Injury to Spine." Indian Journal of Neurotrauma 15, no. 02/03 (August 2018): 051–56. http://dx.doi.org/10.1055/s-0039-1677669.
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Abstract Aim of Study To see whether surgical intervention in gunshot injuries to the spine leads to recovery in neurologic status. Methods It is a retrospective study conducted at the Jai Prakash Narayan Apex Trauma Centre (JPNATC), All India Institutes of Medical Sciences (AIIMS), New Delhi, where case records of 20 patients with gunshot injury to the spine, admitted between January 2013 to March 2018, were analyzed. Result Out of 20 patients, 17 underwent surgical intervention. Entry wound was most common on the back, with the thoracic vertebrae being the most common segment involved. Nine patients had complete spinal cord injury (SCI) at the time of presentation and seven of them underwent surgery. However, only one of these patients showed neurologic improvement at follow-up. Seven patients with canal compromise underwent surgery, and only two of them showed improvement in neurologic status at follow-up. Early surgery was done in 8 out of 16 patients. All 16 patients underwent decompressive procedure, and 3 underwent additional stabilization procedure. Bullet was removed in nine cases. Intraoperative blood loss was minimal in 9 cases, and dural breach was noticed in 14 cases. At follow-up, 56.25% patients showed improvement in neurologic status. Conclusion Surgical intervention, timing of surgery, amount of intraoperative blood loss, and dural breach had no significant impact on the overall surgical outcome. Neurologic status at the time of presentation is the single most important factor that determines the ultimate outcome. Indication and type of surgical intervention is still an ambiguous topic. Owing to lack of conclusive evidence, we believe that there is role for surgery when it is done with an intention to restore the neurologic function.
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Grechanyk, O. І., R. Ya Abdullaiev, І. A. Lurin, K. V. Gumenuk, V. V. Negoduiko, and D. O. Sliesarenko. "Modern aspects of diagnosis of the abdominal gun-shot woundings. Experience of a hybrid war in the East of Ukraine." Klinicheskaia khirurgiia 88, no. 5-6 (October 28, 2021): 42–52. http://dx.doi.org/10.26779/2522-1396.2021.5-6.42.
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Objective. To raise the efficacy of radiological diagnosis of the gun-shot abdominal woundings, using modern highly informative methods of medical visualization with determination of their sensitivity and specificity.
Materials and methods. Retrospective analysis was done of the results of radiological diagnosis, endovideosurgical and invasive interventions under the radiological methods guidance in 70 injured persons with the gun-shot abdominal woundings, to whom a qualified surgical aid with some elements of specialized help was delivered in 2014-2020 yrs. Average age of the injured persons have constituted 30 complete years old. There were 68 (97.1%) men and 2 (2.9%) women. The results of digital roentgenography, ultrasonographic diagnosis, laparoscopy/laparocentesis, thoracoscopy/thoracocentesis, the puncture-draining interventions under the radiological methods guidance in the injured persons with the gun-shot abdominal woundings were compared to results of the multidetector computed tomography with dynamical contrasted enhancement as a “gold standard” of diagnosis of the gun-shot abdominal woundings and criterion of the foreign bodies visualization (metallic shrapnel, bullets, fragments of bone, drains etc.).
Results. The main mechanism of damage in the affected persons with the gun-shot abdominal woundings were shrapnel, created as a result of application of various kinds of the gun-shot and explosive weapons. The part of the gun-shot shrapnel woundings statistically significantly prevailed over part of the bullet and explosive woundings. In accordance to the wound channel kind, the part of blind woundings have had prevailed over parts of the through and multiple woundings statistically significantly (p < 0,05). On a mobile tactical level the rate of application of ultrasonic diagnosis and digital roentgenography for primary selection and diagnostic monitoring was statistically significantly (p < 0.05) higher, than of other methods of medical visualization, what may be explained by improvement and optimization of the treatment and diagnosis tactics, application of urgent sonography in trauma and other modified protocols. Optimal diagnostic system was determined in accordance to indices of sensitivity and specificity of the medical visualization methods, endovideosurgical and puncture-draining interventions under the radiological methods of control - the multidetector computed tomography with dynamical contrasted enhancement.
Conclusion. High sensitivity (99%) and specificity (98%) of the multidetector computed tomography with dynamical contrasted enhancement permits to apply it as a method of medical visualization of the gun-shot abdominal woundings for diagnostic selection of wounded persons and the diagnosis establishment.
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Divya, Aabha, Niti Dalal, Mona Swain, and Juhi Baktavar. "The Curious Case of Retained Bullets - Asymptomatic Gunshot Wounds to the Heart with Delayed Presentation and Management Strategies." Journal of Evidence Based Medicine and Healthcare 8, no. 18 (May 3, 2021): 1322–25. http://dx.doi.org/10.18410/jebmh/2021/252.
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Penetrating trauma to the thorax involving the heart is usually fatal. Discovery and management of intrathoracic missiles especially in the close vicinity of the heart is a major challenge. Retained intracardiac missiles are exceptionally unusual, and there are 322 reported cases over 60 years, from 1940 to 2009.1 We present two patients who presented with penetrating gunshot wounds to the chest with retained intracardiac bullets. The management of hemodynamically stable patients with retained intrapericardial foreign body remains controversial. Management options of thoracic firearm injuries are based on patient stability, course and location of the missile. We report our experience of two patients with delayed presentation of a retained intrapericardial bullet from firearm injuries. In this paper, we discuss the management strategies of such injuries in light of the available literature and summarize our clinical experience.
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Reychler, H. "Bullet wounds and facial trauma in civilian practice." International Journal of Oral and Maxillofacial Surgery 28, no. 1 (February 1999): 77. http://dx.doi.org/10.1016/s0901-5027(99)80688-2.
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Kennedy, Frank, Jim Sullivan, Debra Arellano, and Rachelle Roulier. "Evaluating the Role of Physical and Radiographic Examinations in Assessing Bullet Tract Termination for Gunshot Victims." American Surgeon 66, no. 3 (March 2000): 296–301. http://dx.doi.org/10.1177/000313480006600314.
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Knowledge of the path of a bullet and how it terminates is critical for expeditious assessment and optimal management of patients with gunshot wounds. To assess the accuracy of physical examination and X-rays in these patients, a prospective study was undertaken for all gunshot victims seen for a 1-year period on a single trauma service. The paramedics and trauma surgeons' physical examinations were evaluated for whether a bullet tract could be accurately categorized as 1) through and through, 2) graze, 3) palpable under dermis, or 4) retained (ie, not palpable). The impact of X-rays was assessed with regard to how it affected the trauma surgeons' categorization. A total of 78 patients were seen with a total of 120 bullet tracts. Seventy-seven per cent were injured by assault, and 64 per cent were shot with a 9-mm or .38-caliber handgun. Twenty of 60 (33%) bullet tracts on the torso terminated with a missile that was palpable under dermis, but only 2 of 10 neck (20%), 1 of 28 extremity (4%), and 1 of 22 head/face (5%) did so. Paramedics evaluated 15 torso bullet tracts that ended palpable under dermis, of which they detected 5 (33%). Upon initial examination, the trauma surgeon detected 11 of 20 torso bullet tracts that ended palpable under dermis (55%), and detected 14 of the 20 after X-rays were done (70%). Overall, obtaining X-rays changed the categorization for 15 of 111 bullet tracts (13%). We conclude that bullet tracts on the torso result in a subcutaneously palpable bullet one-third of the time, much more frequently than in other body regions. Paramedics only detect one-third of subcutaneously palpable missiles on the torso. X-rays change the categorization of bullet tracts infrequently. We recommend that a careful examination of the skin of the torso to detect palpable missiles be incorporated into the secondary survey of patients with wounds to that body region.
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Usenko, O. Yu, I. A. Lurin, K. V. Gumenuk, V. V. Nehoduiko, R. M. Mykhaylusov, and R. V. Saliutin. "Оrgan-preserving operations in the abdominal gun-shot penetrating woundings of large bowel. Experience of the medical help delivery in military environment Аntiterroristic operation/The Joint Forces Operation." Klinicheskaia khirurgiia 88, no. 11-12 (January 12, 2022): 3–7. http://dx.doi.org/10.26779/2522-1396.2021.11-12.03.
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Objective. To improve the results of treatment in injured persons with a gun-shot penetrating abdominal woundings with damages of large bowel, using introduction of principle for compliance between volumes of the damage and the primary operative intervention through organ-preserving operations.
Materials and methods. There were analyzed 164 gun-shot abdominal woundings of large bowel in 151 injured persons. All the wounded persons were men, aged from 19 to 58 yrs old, (34 ± 5.2) yrs old at average. Penetrating cross-cutting abdominal woundings have occurred in 48 (31.8%) patients, the blunt – in 103 (68.2%). In accordance to character of the large bowel damage there were: deserozation - in 8 (5.3%) injured persons, the blunt wounding – in 57 (37.7%), and a through one – in 86 (57.0%). The bullet woundings have occurred in 31 (20.5%) injured persons, while the comminuted – in 120 (79.5%). The large bowel woundings have had following localizations: coecum – in 37 (24.5%) patients, ascending colon – 19 (12.6%), transverse colon – 32 (21.2%), descending colon – 18 (11.9%), sigmoid colon – 33 (21.9%), and several perts of large bowel – 12 (7.9%). The wounded persons were distributed into two groups, depending on volume of the operative intervention performed: the main – 49 (32.4%) wounded persons, in whom organ-preserving operations were performed, and a control one – 102 (67.6%) wounded persons, in whom resectional methods were applied. The large bowel wall defects suturing with or without formation of unloading colo- or enterostomy were considered as organ-preserving operations.
Results. Definite decision, concerning the operative intervention volume, was made immediately after revision of the abdominal cavity organs, estimation of the damages character (special attention was drawn to dimensions, localization and quantity of intestinal defects, the state of its mesenterial edge and adequacy of a blood flow), presence and remoteness of extended peritonitis, general state of a wounded person (the blood loss volume, the sepsis features presence, hemodynamicac indices and common character of the woundings). Оne or several woundings of large bowel, including big in dimensions, were considered as indications for performance of organ-preserving operations (the intestinal wound suturing, the intestinal wound suturing with colo- or jejunostomy, extraperitonization). In patients of the main group, comparing with those of the control group, the stationary stay and the complications rate were reduced. After rehabilitation and staged closure of unloading stomas all wounded persons of the main group went back to service in Military Forces of Ukraine.
Conclusion. Selecting the surgical treatment method for the gun-shot woundings of large bowel, it is necessary to base on complex analysis of the battle trauma character, the patient’s state and the risk for іntra- and postoperative complications. The first-line application of organ-preserving interventions as more physiological and those, which permit mostly rapid come back to the service duties functioning, is expedient. While choosing the organ-preserving operation volume, the surgeon must adhere to principle of compliance between the damage volume and prevalence, general state of a wounded person and the operative intervention volume.
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Iverson, Katherine R., Eleanor Curtis, Ian E. Brown, Edgardo S. Salcedo, and John T. Anderson. "New fragmenting bullet leads to unexpected injury pattern: A case report involving the Radically Invasive Projectile." Trauma 21, no. 1 (March 25, 2018): 73–76. http://dx.doi.org/10.1177/1460408618759365.
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New developments in bullet technology are challenging what is commonly known about penetrating injuries from gunshot wounds. The so-called ‘bullet-rule’ posits the number of wounds and projectiles associated with a patient should add to an even number. This trauma paradigm is being shattered by the advent of new fragmenting projectiles. These frangible rounds break into several pieces after soft tissue penetration changing the expected trajectory, injury location, and extent of tissue damage. In this case report, the authors describe the case of a 15-year-old boy injured by a G2 Radically Invasive Projectile (RIP). The patient’s resultant pattern of injuries and the diagnostic utility of imaging were imperative for guiding his clinical management. The case serves as a useful example of the challenges and recommended strategies in managing a patient injured by a new fragmenting bullet.
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Klevno, V. V., Yu V. Chumakova, D. P. Pavlik, and S. E. Dubrova. "POTENTIAL OF THE VIRTUAL AUTOPSY IN CASE OF FIREARM INJURY." Russian Journal of Forensic Medicine 5, no. 3 (October 15, 2019): 33–38. http://dx.doi.org/10.19048/2411-8729-2019-5-3-33-38.
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The article presents the cases observed in the practice of the Office of medico-legal examinations of the Moscow Region when computed tomography (CT) was used for the first time in Russia for pre-autopsy examination (virtual autopsy) of three corpses with gunshot wounds followed by imaging-anatomical comparison of the results.Objectives. Determination of the injury volume, visualization of the wound tracts, localization of the bullets.Material and methods. Computed tomography was performed in radiology department using CT Scanner Hitachi Eclos‑16 (16 slices per rotation, slice thickness 1.5 and 2.0 mm) followed by multi-planar reconstruction of the images.Results. 3D reconstruction of the CT scans of the corpses has visualized the whole volume of the trauma. Firearm perforating skull fractures, crushing injuries of the brain, injuries of the thoracic and abdominal organs along the wound tracks, bullets at the ends of the blind wound tracks were revealed on CT-scans.Conclusion. Pre-autopsy CT with 3D-reconstruction has allowed to determine localization of the bullets in the bodies accurately. This allowed to choose the optimal examination tactics in each particular case and provided invaluable assistance in the search for the bullets. Virtopsy in the cases of firearm injury has great diagnostic opportunities in visualization and 3D presentation of the wound tracks and their direction. 3D CT has recorded the original position and characteristics of the skull fractures under the undamaged tissues. The authors made the assumption that a virtual autopsy could be a reliable alternative to traditional autopsy in the foreseeable future in cases of firearm injuries.
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Klyackiy, Yu P., O. V. Tribyshnoy, I. I. Tryfanov, and V. V. Kosilo. "TREATMENT OF PURULOUS-INFLAMMATORY COMPLICATIONS OF BULLET AND MINE EXPLOSIVE INJURIES OF EXTREMITIES." Modern medical technology, no. 3(54) (September 30, 2022): 60–65. http://dx.doi.org/10.34287/mmt.3(54).2022.11.
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The aim of the study. To provide an analysis of the development of purulent-inflammatory complications in gunshot wounds and mine-explosive trauma and to develop tactics for the treatment of infectious complications at the stage of specialized medical care.
Materials and methods. An analysis of the treatment of 57 patients with purulent-inflammatory complications of the limbs after gunshot bullet wounds and mine-explosive trauma was conducted. Of them, 34 (59.6%) military personnel and 23 (40.4%) civilians were treated in the bone-purulent surgery department. 44 (77.1%) of the patients had a mine-explosive injury, and 13 (22.9%) had bullet wounds.
Research results. It was revealed that the cause of infectious complications was severe trauma, and in some cases irrational both general and local treatment during the evacuation stages. The therapy was not aimed primarily at the elimination of signs of traumatic shock, anemia, and detoxification of the body. In most of the victims, the initial surgical treatment of wounds was performed poorly and insufficiently, repositioning and stable fixation of fractures was not performed. As a result of the treatment, 2 (3.5%) patients with severe mine-explosive injuries of the lower limbs, pelvis and spine died, 6 (10.5%) victims underwent limb amputation at the level of the middle third of the thigh. The rest of the patients from the first day of hospitalization received complex treatment aimed at eliminating the purulent-inflammatory process of the extremities. In 41 (71.9%) fractures were fixed with external fixation devices. After elimination of the inflammatory process, all patients were transferred to outpatient treatment in a military hospital or at their place of residence.
Conclusion. Modern combat trauma of the limbs in the course of treatment is complicated by severe purulent-inflammatory processes in 35% of cases. According to the clinical course, gunshot wounds differ significantly from mine-explosive injuries. One of the formidable infectious complications is gunshot osteomyelitis, the course of which exhausts the body and leads to sepsis and death. Stabilization of fractures against the background of purulent-inflammatory processes should be performed with external fixation devices.
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Stahl, Chad A., John T. Fangman, and Thomas J. Fangman. "PSIII-4 Determining the Efficacy and Safety of Differing Caliber/Ammunition Combinations for the Humane Euthanization and Subsequent Mass Depopulation of Market Weight Pigs." Journal of Animal Science 99, Supplement_1 (May 1, 2021): 156–57. http://dx.doi.org/10.1093/jas/skab054.268.
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Abstract The objective of this proof of concept exercise was to validate a field applicable methodology designed to objectively assess the multiple caliber/ammunition combinations available for the safe and humane euthanization of market weight pigs during mass depopulation events. Heads of an equal number of barrows and gilts (n = 64) were randomly assigned to one of four caliber/ammunition combinations consisting of the .22 LR, .22 Mag, 0.38 Special, and 9mm. Fully jacketed (FMJ) ammunition was discharged from each of four unique firearms while ensuring that the distance from the muzzle to the forehead was consistent. The MIXED procedure of SAS was used to test the fixed effects of sex and caliber. No differences in skull thickness existed between sex (P = 0.32) or caliber/ammunition combination (P = 0.34). There was no difference in entrance wound diameter between the .38 Special and the 9mm (P = 0.15) yet the entrance wound diameter of the .38 Special and 9mm was larger than both the .22 LR and .22 Mag, respectfully (P < 0.0001). The 9mm bullets traveled further into the ballistic gel (P < 0.0001) and the furthest total distance (P < 0.0001). Bullets from the .38 Special traveled further into the ballistic gel and a further total distance than both the .22 LR and .22 Mag (P < 0.0001). There was no difference in the measurable trauma area of the brain for the 9mm bullets compared to .38 Special bullets (P = 0.83). The measurable trauma area of the brain was greater for the 9mm and .38 Special bullets when compared to both the .22 LR and .22 Mag (P < 0.0001). In conclusion, the efficacy and safety of the multiple caliber/ammunition combinations available for use in the euthanization of market weight pigs can be objectively quantified, replicated, and reported.
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Cripps, Michael W., Alexander Q. Ereso, Javid Sadjadi, Alden H. Harken, and Gregory P. Victorino. "The Number of Gunshot Wounds Does Not Predict Injury Severity and Mortality." American Surgeon 75, no. 1 (January 2009): 44–47. http://dx.doi.org/10.1177/000313480907500109.
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It is presumed that as the number of gunshot wounds (GSWs) increases, so do the Injury Severity Score (ISS) and mortality risk. We hypothesized that the number of bullet wounds relates to ISS and death; however, a single GSW to the head is ominous. We reviewed the charts of all GSW patients admitted to a trauma center from 2004 to 2006 (n = 531). We analyzed patient demographics, ISS, and mortality. There was no correlation with the number of GSWs with either ISS or mortality. There was only a 0.3 per cent increased risk of death for each additional GSW ( r2 = 0.12). Patients with a single GSW versus multiple GSWs had no difference in mortality (9.1 vs 8.4%, P = 0.8). A single GSW to the head carried a 50 per cent mortality risk. For those who sustained both head and body GSWs, each additional GSW did not increase mortality ( r2 = 0.007). Our study shows that the number of GSWs has no affect on mortality or ISS. Internal triage and management of gunshot victims should not be affected by the categorization of patients as having a single versus multiple GSWs.
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Duda, T., A. Sharma, Y. Ellenbogen, H. Shakil, and S. Sharma. "P.110 Systematic review of civilian pediatric intracranial gunshot wounds." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, s1 (June 2019): S42. http://dx.doi.org/10.1017/cjn.2019.203.
Full textAbstract:
Background: Pediatric craniocerebral gunshot wounds occur in the context of both accidental and intentional trauma. Unique physiologic factors merited research into prognostic factors and treatment priorities in the pediatric population. Methods: A systematic search of MEDLINE, EMBASE, Web of Science, LILACS, Cochrane Registered Trials and Systematic Reviews, ISRCTN, and ClinicalTrials.gov was conducted. Selection criteria included all studies published in any language since 2000 which described intracranial isolated gunshot wounds in a civilian individual or population of pediatric age. Post-mortem and epidemiological studies were excluded. Screening was conducted through Covidence. Results: Initial database search revealed 349 unique studies for abstract and title screening. Fifty studies were selected for full text screening. Nine studies were included in the final review. Study quality was assessed with the Newcastle-Ottawa Scale. Case series noted bullet migration, pituitary deficiency, neurovascular and neuropsychological concerns. Three single-center retrospective studies of 71, 30, and 48 pediatric patients suggested multiple negative prognostic signs on initial presentation. Early aggressive surgical treatment was recommended by some authors. Conclusions: This systematic review analyzed the best current understanding of evidence for prognostic factors and treatment considerations of intracranial gunshot wounds in the pediatric neurotrauma context. Areas for future research with larger multi-center studies were highlighted.
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Juwarna, Wijaya, and Delfitri Munir. "Endoscopic trans-nasal removal of impacted bullet in the sphenoid sinus: a case report." International Journal of Otorhinolaryngology and Head and Neck Surgery 7, no. 1 (December 24, 2020): 148. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20205637.
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<p>Foreign body of the sphenoid sinus is a rare condition and most of the documented cases are shrapnel wounds. The most cases of sinuses foreign bodies are in maxillary and frontal sinus. Very few cases have been reported of lodgment of foreign body in paranasal sinuses. Garces and Norris reported that 70% of these foreign bodies usually appeared after maxillofacial traumas and 30% appeared during or after dental procedures of maxilla. A bullet impacted in the sphenoid sinus case in nineteen-year-old man was reported involving the anterior skull base. The bullet was safely removed with the trans-nasal endoscopic approach preserving the structures around the sphenoid sinus. Proximity of the sphenoid sinus to vital structures such as the optic nerve and internal carotid artery may render life-threatening complications. Adequate knowledge of the anatomical variations with regard to the sphenoid sinus and good preoperative planning are essential to ensure safe removal of foreign bodies, thereby avoiding catastrophic complications.</p>
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Pannell, William C., Nathanael Heckmann, Ram K. Alluri, Lakshmanan Sivasundaram, Milan Stevanovic, and Alidad Ghiassi. "Predictors of Nerve Injury After Gunshot Wounds to the Upper Extremity." HAND 12, no. 5 (October 24, 2016): 501–6. http://dx.doi.org/10.1177/1558944716675294.
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Background: The purpose of this study is to examine the incidence of nerve injury, clinical variables associated with nerve palsy, and predictive factors of nerve laceration after gunshot wounds to the upper extremity. Methods: Forty-one patients from a level I trauma center with gunshot wounds to the upper extremity who underwent surgical exploration between 2007 and 2014 were identified retrospectively. Patients with proximal ipsilateral injuries, inadequate documentation, imaging, or with a pre-existing neurologic deficit were excluded. Patient demographics, clinical sensory and motor examination, the presence of retained bullet fragments, fracture, vascular injury, and compartment syndrome were recorded. Univariate analysis was performed to determine significant predictors of intraoperative nerve laceration. Significance was set at P < .05. Results: Fifty-nine nerves were explored in 41 patients. There were higher frequencies of fractures, retained fragments, vascular injury, and compartment syndrome in patients with nerve palsies, although none were associated with nerve laceration. Patients with palsies on presentation were significantly more likely to have a nerve laceration found intraoperatively. Conclusions: Gunshot wounds to the upper extremity with focal nerve deficits remain a difficult problem for orthopedic surgeons. The present study provides evidence that may help guide operative decision making in treatment of these injuries.
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Khomenko, I. P., S. O. Korol, S. V. Khalik, V. Yu Shapovalov, R. V. Yenin, O. S. Нerasimenko, and S. V. Tertyshnyі. "Clinical and Epidemiological analysis of the structure of combat surgical injury during Antiterrorist operation / Joint Forces Operation." Ukrainian Journal of Military Medicine 2, no. 2 (June 30, 2021): 5–13. http://dx.doi.org/10.46847/ujmm.2021.2(2)-005.
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I
Introduction. In generalizing the experience of providing medical care to the wounded in armed conflicts, a special place belongs to the analysis of the magnitude and structure of casualties, which depend on the conditions, forms and methods of hostilities.
The purpose. Conduct a clinical and epidemiological analysis of the proportion of gunshot and mine injuries in the structure of combat surgical trauma during the Anti-terrorist operation / Joint Forces operation.
Materials and methods. The total number of wounded as a result of the armed conflict in eastern Ukraine in the period from 2014 to 2019 was more than 41 thousand people, from them killed among the civilian population – 3350 people and 4100 – servicemen.
Results. It was proved that the wounded with non-severe combat surgical trauma are 36.5%, severe – 48.9%, extremely severe – 14.6%. Shrapnel wounds were received by 35.3%, bullet wounds – 48.3%, mine injuries – 16.6%. Isolated combat surgical trauma was found in 16.8%, multiple – in 34.3%, combined – in 48.9% of the wounded. Impenetrable combat surgical trauma was diagnosed in 63.7% of the wounded, penetrating into the pleural cavity – in 17.2%, in the abdominal cavity – in 16.0%, in the pelvic cavity – in 3.1%.
Conclusions. In the structure of sanitary losses of the surgical profile during the ATO / OOS, the wounded with injuries of the extremities are 56.7%, with injuries of the chest – 10.1%, abdomen – 5.1%, pelvis – 3.0%.
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Quader, Mohammad Abdul, Sheikh Shahidul Islam, Md Abdul Hamid, Mahbubur Rahman, and Khan Nazmul Islam. "Surgical Management of Gunshot Wound at Level-II Hospital in Central African Republic in 2019/2020." Community Based Medical Journal 10, no. 1 (January 10, 2022): 4–8. http://dx.doi.org/10.3329/cbmj.v10i1.58649.
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Background: Gunshot wounds (GSW) are common in Central African Republic (CAR). There are about eighteen rebel groups in Central Africa. Arms are available among the rebel groups and also the civilians. For the very simple region they open the fire against the opponent. The aim of this study is outcome of surgical management of gunshot wounds at Bangladeshi Level-II hospital in the CAR during our tenure.
Methods: This was a prospective study of 14 patients with gunshot wounds who were treated at level-II hospital, Kagabandoro, CAR from Dec 2019 to Nov 2020 for a period of 12 months. Wound debridement and removal of bullets were done in 8 (57.14%) cases, keep bullets in situ position in 2(14.29%) cases and surgical toileting followed by primary closure of wound were done in 3 (21.42%) cases and one female patient transferred to level-III hospital in Bangui.
Results: Out of 14 patients there were 13 male and 1 female patients. Mean age of the patients was 32.21 (18-55 years). High velocity injuries were common in 10 (71.43%). Injuries involved the limbs in 10 (71.43%), chest in 2 (14.29%), abdomen in 1 (7.14%) and external genitalia in 1(7.14%). Most of the patients 12 (85.71%) presented to the hospital within 12 hours of the injury. The average length of stay in the hospital was 14 days (Range 2- 60 days). Fractures of the long bone were in 5 (35.71%) cases. Open reduction and internal fixation was done in 3 (21.43%) cases. One female patient was transferred to level-III hospital in Bangui due to fracture neck of femur following gunshot injuries with 9 months of pregnancy. Mean follow-up was 5 months (Range 1-12 months). Post trauma pain developed in 3 (21.43%) cases, deformities of the extremities was found in 2 (14.29%) cases.
Conclusion: Outcome of surgical management of the gunshot wounds were depends on the nature of tissue injury and availability of the resources with promptness of intervention.
CBMJ 2021 January: vol. 10 no. 01 P: 04-08
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Breeze, John, J. G. Combes, J. DuBose, and D. B. Powers. "How are we currently training and maintaining clinical readiness of US and UK military surgeons responsible for managing head, face and neck wounds on deployment?" Journal of the Royal Army Medical Corps 164, no. 3 (May 16, 2018): 183–85. http://dx.doi.org/10.1136/jramc-2018-000971.
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IntroductionThe conflicts in Iraq and Afghanistan provided military surgeons from the USA and the UK with extensive experience into the management of injuries to the head, face and neck (HFN) from high energy bullets and explosive weaponry. The challenge is now to maintain the expertise in managing such injuries for future military deployments.MethodsThe manner in which each country approaches four parameters required for a surgeon to competently treat HFN wounds in deployed military environments was compared. These comprised initial surgical training (residency/registrar training), surgical fellowships, hospital type and appointment as an attending (USA) or consultant (UK) and predeployment training.ResultsNeither country has residents/registrars undertaking surgical training that is military specific. The Major Trauma and Reconstructive Fellowship based in Birmingham UK and the Craniomaxillofacial Trauma fellowship at Duke University USA provide additional training directly applicable to managing HFN trauma on deployment. Placement in level 1 trauma/major trauma centres is encouraged by both countries but is not mandatory. US surgeons attend one of three single-service predeployment courses, of which HFN skills are taught on both cadavers and in a 1-week clinical placement in a level 1 trauma centre. UK surgeons attend the Military Operational Surgical Training programme, a 1-week course that includes 1 day dedicated to teaching HFN injury management on cadavers.ConclusionsMultiple specialties of surgeon seen in the civilian environment are unlikely to be present, necessitating development of extended competencies. Military-tailored fellowships are capable of generating most of these skills early in a career. Regular training courses including simulation are required to maintain such skills and should not be given only immediately prior to deployment. Strong evidence exists that military consultants and attendings should only work at level 1/major trauma centres.
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Chen, Amy Y., Michael G. Stewart, and Glenn Raup. "Penetrating Injuries of the Face." Otolaryngology–Head and Neck Surgery 115, no. 5 (November 1996): 464–70. http://dx.doi.org/10.1177/019459989611500519.
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We reviewed 78 consecutive cases of penetrating facial injuries treated at Ben Taub General Hospital in Houston, Texas, between 1992 and 1994, and we analyzed injury patterns on the basis of (1) the mechanism of injury, and (2) the entry zone of the wounds. We found that gunshot wounds were more likely to require emergent airway establishment than shotgun wounds or stab wounds ( p = 0.03). We noted a higher prevalence of globe injury among shotgun wounds than among gunshot wounds ( p = 0.02). Nine (12%) patients had intracranial penetration of a bullet or shotgun pellet. Patients with gunshot wounds required open reduction and internal fixation of facial bone fractures more frequently than patients with shotgun wounds ( p = 0.01). Thirty patients underwent arteriograms, and 10 demonstrated positive findings. Although there were only 3 deaths in our series, 29 (37%) patients overall had some complication caused by their penetrating facial trauma, including blindness in 12 patients. There was no significant difference in the prevalence of complications between gunshot, shotgun, and stab wounds ( p = 0.18). With these injury patterns in mind, we describe an algorithm for evaluation and management of penetrating injuries of the face.
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Murano, Tiffany, Alicia M. Mohr, Robert F. Lavery, Catherine Lynch, Adena T. Homnick, and David H. Livingston. "Civilian Craniocerebral Gunshot Wounds: An Update in Predicting Outcomes." American Surgeon 71, no. 12 (December 2005): 1009–14. http://dx.doi.org/10.1177/000313480507101204.
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Given the high mortality in patients sustaining intracranial injury secondary to gunshot wounds (GSWs), predictors to identify patients at increased risk of death are needed to assist clinicians early in determining optimal treatment. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients, which do not allow for adequate prediction of mortality. A retrospective chart review of 298 patients who sustained GSWs to the head between 1992 and 2003 was conducted at a level 1 trauma center. Demographics, bullet trajectory, admitting Glasgow Coma Scale (GCS), head Abbreviated Injury Score (AIS), as well as admission blood pressure and respiratory rate were evaluated. Univariate testing followed by multivariate logistic regression was performed to identify independent predictors of death. In-hospital mortality for patients with intracranial injury secondary to GSW was 51 per cent. A GCS <5 on admission and a high Injury Severity Score (ISS >25) was associated with mortality as compared with survivors ( P < 0.05). Of those patients presenting with a GCS of 3, there were seven survivors to discharge. Logistic regression identified the following variables as predictors of death: respiratory arrest on admission, hypotension on admission, transhemispheric and transventricular GSW. Identification of those patients at the highest risk of death secondary to a craniocerebral GSW allows clinicians to better predict outcome and prognosis. This is not only important in determining treatment algorithms for physicians but also for appropriate counseling of family members to educate them with regard to patients’ outcomes.
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Agarwal, A., A. Kumar, M. Goel, P. Puri, and K. Priya. "Management of Intraoral Gunshot Injury – A Case Report." Journal of Oral Health and Community Dentistry 8, no. 1 (January 2014): 58–61. http://dx.doi.org/10.5005/johcd-8-1-58.
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ABSTRACT Oral and Maxillofacial gunshot injuries are usually lethal due to close proximity with the vital structures. The severity of injury varies according to the caliber of the weapon used and to the distance from which the patient is shot. A case of gunshot injury that was successfully managed by surgical exploration and removal of bullet from left maxillary antrum under local anesthesia is presented. The initial care of facial gunshot wounds strictly adheres to the basics of trauma resuscitation. Early and appropriate surgical management have proved to be influential on the final outcome and aesthetic result. Treatment of gunshot injuries should be planned and carried out carefully. It takes different stages and procedures to achieve the targeted treatment plan. Prevention and control of infection are important in the success of the treatment.
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Graham, Kathleen R., Bethany R. Rohr, and Victor J. Marks. "Blistering Rash over Broken Ribs." SKIN The Journal of Cutaneous Medicine 4, no. 5 (August 29, 2020): 449–51. http://dx.doi.org/10.25251/skin.4.5.11.
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Fracture blisters are painless fluid-filled bullae most commonly located over fractures of the distal tibia and humerus. They are diagnosed clinically. Invasive procedures and treatments increase the risk of wound infection and should be avoided. While there is no consensus on management, evidence supports leaving the blisters intact and treating erosions with topical barrier ointments or topical antibiotics. We present a rare case of a 55-year-old man with fracture blisters located superficial to trauma-induced rib fractures that were successfully treated with topical mupirocin.