Gunshot Wounds & Puncture Wounds
Written by Rhiana Devadasan
Vulnus sclopetarium = wounds caused by the penetration of a bullet from a gun.
Characteristics of the wound:
- Depends on the firearm, bullet, velocity, distance, entry point (i.e. the tissue resistance) & trajectory size.
- Entry wound is smaller than the exit wound
- Burns from the very high temperature
Possible complications of Gunshot wounds:
- Trajectory & fragmentation of bullet after entry can be unpredictable.
- Severe bleeding w/ potential for hypovolemic shock.
- Could cause pneumothroax (therefore eventually hypoxia), catastrophic injury to the heart & large BVs, damage to the brain/CNS.
- Some gunshot wounds can cause major disfigurement and/or permanent disability.
Classification of Gunshot wounds (according to speed of projectile)
- Low-velocity: < 1,100 ft/s (340 m/s)
- Medium-velocity: 1,100 ft/s (340 m/s) to 2,000 ft/s (610 m/s)
- High-velocity: > 2,000 ft/s (610 m/s)
Treatment:
- Firstly, advanced trauma life support (ATLS) work up required to assess vital functions – ABCDE
- Initial dressing and antibiotics must be provided until the wound can be further inspected in an operating theatre
- Wound surgery:
- a. Incision and irrigation
- Incision must pass through skin wound, trimming only grossly damaged areas; subcutaneous fat and deep fasica must be incised to allow exploration and relieve pressure within wound.
- Irrigation with copious volumes of saline is used to reduce the number of bacteria, and pulsating high-pressure irrigation may be even more effective.
- b. Excision
- Muscle is assessed for colour, consistency, contractility and capacity for bleeding.
- Muscle tissue which is no longer considered viable must be excised to prevent spreading of infection.
- c. Dressing and Closure
- Dressing the open wound with fluffed-out gauze allows drainage with no need for a surgical darin.
- d. Splintage
- Even when there is no fracture, injured limbs needs support and stabilisation by a plaster cast or backslab, to protect the soft tissues.
Vulnus punctum = wounds caused by a sharp object piercing the skin & creating a small hole (e.g. splinter wound, nail, needle).
Characteristics of the wound:
- Sharp edges
- Small surface, but they can be very deep, depending on the source & cause
Complications:
- Very dangerous for internal hemorrhage
- A puncture wound does not usually result in excessive bleeding and normally these wounds close fairly quickly without any intervention
Treatment:
- May be necessary to prevent infection in some wounds: