GUNSHOT WOUNDS (1).pptx

Gunshot wounds

1. GUNSHOT WOUNDS

2. DEFINITION A gunshot wound (GSW) is a penetrating injury caused by a projectile (e.g. a bullet) from a gun. Damages may include bleeding, bone fractures, organ damage, wound infection, loss of the ability to move part of the body and, in more severe cases, death. Damage depends on the part of the body hit, the path the bullet follows through the body, and the type and speed of the bullet. Long-term complications can include lead poisoning and post-traumatic stress disorder (PTSD).

3. Gunshot wounds are among the most common causes of death and injury in industrialized countries. The analysis and interpretation of gunshot wounds is critical, and the forensic pathologist must have a thorough knowledge of the features of theses injuries.

4. CLASSIFICATION Gunshot wounds are classified according to the speed of the projectile using the Gustilo open fracture classification: Low-velocity: Less than 1,100 ft/s (340 m/s) Low velocity wounds are typical of small caliber handguns and display wound patterns like Gustilo Anderson Type 1 or 2 wounds

5. Medium-velocity: Between 1,200 ft/s (340 m/s) and 2,000 ft/s (610 m/s) These are more typical of shotgun blasts or higher caliber handguns like magnums. The risk of infection from these types of wounds can vary depending on the type and pattern of bullets fired as well as the distance from the firearm. High-velocity: Between 2,000 ft/s (610 m/s) and 3,500 ft/s (1,100 m/s) Usually caused by powerful assault or hunting rifles and usually display wound pattern similar to Gustilo Anderson Type 3 wounds. The risk of infection is especially high due to the large area of injury and destroyed tissue.

6. FEATURES OF MODERN COMBAT INJURY In modern warfare, the combat injury pattern is complicated and always combines several injuries, including extensive burns, multiple trauma, bone fracture, hemorrhage, infection, sepsis, and organ damage, each of which can activate the immune response. In a severe and combined injury, immune response disturbance occurs, and finally, immunosuppression leads to sepsis and multiple organ dysfunction syndrome (MODS). In the wake of revealing a possible mechanism concerning immune dissonance, we have understood that immune modulation is vital and indispensable in the treatment of sepsis and MODS, which should not be limited in exploring cytokines and molecules directly regulating immune cells.

7. Other factors involved in immunomodulation must also be considered; for instance, cellular biological processes are markedly changed in acute insults and contribute to the responsiveness of immune cells, including metabolism, apoptosis, necroptosis, autophagy, and intercell communications. Taken together, the reviews and research in the current thematic series shed light on the exploration of novel interventional strategies for better therapy for combat injury. Although there remains a gap between the bench and the bedside or battlefield, it is our belief that a comprehensive consideration must lead to the significant development of clinical therapies in the future.

8. ESSENTIAL FEATURES Determining the range of fire is one of the most critical parts of the forensic pathologist activity; secondary effects of the discharge surrounding the entrance wound (muzzle imprint, soot deposition, stippling or blackening of the skin edges) can help estimate the firing range Entrance wounds can be round, oval or irregular (atypical); an abrasion ring is almost always present Exit wounds are usually irregular and there is no abrasion ring in the vast majority of cases; there are no secondary effects of the discharge Wound mechanism and injury severity are mostly related to the kinetic energy transferred by the bullet to the tissues with the development of 2 cavities within the body: the permanent and temporary cavities At autopsy, it is essential to provide proper documentation (by photographs and body diagrams) of the gunshot wound's features

9. BALLISTICS Ballistics is the science of mechanics that deals with the flight, behaviour and effects of weapons and bullets. INTERNAL BALLISTICS TERMINAL BALLISTICS (WOUND BALLISTICS) EXTERNAL BALLISTICS

10. Internal ballistics: The study of motion of projectile inside the barrel of the gun. Ballistic experts deal with internal ballistics. External ballistics: The study of motion of the projectile after it leaves the barrel and before it hits the target. This too comes in purview of the ballistic experts. Terminal ballistics: also called wound ballistics is the study of projectile’s impact on the tissues. This comes in domain of the doctor treating a patient with a firearm injury or in case of death, a forensic expert. As a doctor is the first person to evaluate the wounds of a person injured by a firearm, it is his responsibility to record the wound precisely so as to help the law enforcing personnel in investigating the crime.

11. FIREARMS Firearms of forensic interest can be generally classified as: Handguns (pistols and revolvers) Long guns (shotguns and rifles) Rifled: the barrel contains spiral lands and grooves into the inside of the barrel that grips the bullet as it exits the firearm, providing spin and stabilization along its path Smoothbore: the barrel is not rifled; typically found in shotguns

12. HANDGUNS RIFLED SMOOTHBORE SHOTGUN

13. BULLETS During its travel, the bullet is subject to rotational forces causing: Yawing: oscillation of the bullet along its longitudinal axis Tumbling: bullet loses its gyroscopic stability, presenting a continually changing surface to the direction of motion Precession: rotation of the bullet around the center of mass Nutation: circular movement of the tip of the bullet

14. Bullet shapes , types and callibres

15. PREVENTION Medical organizations in the United States recommend a criminal background check being held before a person buys a gun and that a person who has convictions for crimes of violence should not be permitted to buy a gun. Safe storage of firearms is recommended, as well as better mental health care and removal of guns from those at risk of suicide. In an effort to prevent mass shootings greater regulations on guns that can rapidly fire many bullets is recommended.

16. MANAGEMENTS Initial assessment for a gunshot wound is approached in the same way as other acute trauma using the advanced trauma life support (ATLS) protocol. These include: A) Airway - Assess and protect airway and potentially the cervical spine B) Breathing - Maintain adequate ventilation and oxygenation C) Circulation - Assess for and control bleeding to maintain organ perfusion including focused assessment with sonography for trauma (FAST) D) Disability - Perform basic neurological exam including Glasgow Coma Scale (GCS) E) Exposure - Expose entire body and search for any missed injuries, entry points, and exit points while maintaining body temperature Depending on the extent of injury, management can range from urgent surgical intervention to observation. As such, any history from the scene such as gun type, shots fired, shot direction and distance, blood loss on scene, and pre-hospital vitals signs can be very helpful in directing management.

17. PRE HOSPITAL CARE Prehospital management of gunshot wounds varies somewhat based on the location of the injury, but almost all ballistic injury patients require immediate transport to a trauma center . Emergency medical services (EMS) providers should follow common ATLS® prehospital guidelines to control the airway, provide oxygen as needed, and control bleeding with direct pressure as well as obtain vital signs and intravenous (IV) access as soon as possible.

18. HOSPITAL TREATMENT Treatment depends on the severity and location of the wound and other individual health factors. Treatment for a gunshot wound might include: 1) surgery to remove the bullet and fix damaged internal structures 2) an IV to administer antibiotics, fluids, and other medications 3) blood transfusion to replace lost blood 4) sedation or painkillers

19. WOUND CARE If the wound was severe, you may have had surgery to: Stop bleeding
Clean the wound
Find and remove bullet pieces
Find and remove pieces of broken or shattered bone
Place drains or tubes for body fluids
Remove portions of, or whole, organs

20. AFTER EFFECTS Being shot by a gun is traumatic. Patient may feel shock, fear for your safety, depression, or anger as a result. These are completely normal feelings for someone who has been through a traumatic event. These feelings are not signs of weakness. Other symptoms may be Anxiety
Nightmares or trouble sleeping
Thinking about the event over and over
Irritability or being easily upset
Not having much energy or appetite

21. QUESTIONS What are the damages caused by gunshots? Name the three types of ballistics. Was the presentation interesting? On a scale of 1 to 10 what would you rate the presentation.

22. ANSWERS Damages may include bleeding, bone fractures, organ damage, wound infection, loss of the ability to move part of the body and, in more severe cases, death. Internal, external and terminal (wound) ballistics. Yes it was great. 100