Air Rifles Are More than Toys: BB Gun-Related Traumatic Brain Injury

Abstract

Gunshot wounds are traumatic events that emergency departments around the country treat on a daily basis. An increasing number of these wounds are being caused by air rifles that shoot ball bearings (ie, BB guns) and, although uncommon, the results can be fatal. The general public and most practitioners may not realize the damage these "toys" can inflict. This article highlights an unfortunate event involving a BB gun accidentally discharged at close range and the consequences. Data from recent and older studies are discussed regarding the firepower of these guns and their potential for injury.A ir rifles that shoot ball bearings (ie, BB guns) have been in production for decades and are considered by most to be not much more than a toy. This leads to the perception that these guns may be safe for children to use unsupervised; however, modernization has made BB guns into weapons with potentially lethal power. Accidental injuries from BBs can cause a wide variety of complications because of their ability to penetrate the skin, eyes, skull, thorax, and abdomen. This article presents a case of a BB gun-related traumatic brain injury and further discusses BB gun injuries and their prevention. CASE REPORTA 10-year-old boy was shooting his BB gun at targets in the backyard with his 12-year-old brother when they ran out of BBs. Assuming that the gun was empty, the older brother pointed it toward the victim and discharged it approximately one foot away from his head. Unfortunately, there was one BB left in the gun and it struck the 10-yearold brother above his right ear. The mother was summoned immediately by the older brother and they found the younger brother lying on the ground, unconscious, unresponsive, and with agonal breaths. Emergency medical services arrived, intubated him, and flew him via helicopter to the emergency department (ED).Initial examination in the ED revealed a small entrance wound over the right temporal region and above the ear. After sedation was discontinued, the patient was unresponsive with 4-mm reactive pupils, decerebrate positioning, and hypertonic reflexes. A head computed tomography (CT) exam without contrast revealed bone fragments displaced into the right temporal lobe, extensive parenchymal, intraventricular, and subarachnoid hemorrhages. The scan also showed a projectile tract traversing from the right to left temporal lobe with possible Circle of Willis involvement, and a metallic BB in the left temporal lobe (Figures 1 and 2). A cerebral angiogram showed no evidence of vascular injury.The neurosurgery department was consulted and the patient was taken to the operating room (OR) for a right temporal craniectomy with debridement of bone fragments and placement of an intracranial pressure monitor. Immediately after, a left frontal burr hole with placement of a ventricular drain was completed. The patient was admitted to the pediatric intensive care unit (PICU) for further management. His intracranial pressures (ICPs) and cerebral perfusion pressures (CPPs) were managed with tem...

Pediatric Air Gunshot Penetrating Head Injury with Good Outcome: A Case Report

“…The ongoing number of fatalities raises concern about the amount that may occur in the future. 6 Limitation of this case report CT Scan Control after operation wasn't performed on the patient because there are limitations for the payment cost.…”

“…About 80-90% of air gun injuries occur in population with age under 19 years, especially boys, with most of them are caused by the gun's careless use. 5,6 A total of 191 cases were identified: 53 children from Cincinnati, 27 children from Kansas City, 9 children from Harborview Medical Center, and 12 children from Children's Hospital and Medical Center. Males made up 81%, and the median age was 10.9 years (range, 0.5 to 18.8).…”

Young boy with a head wound

“…1 There has been an increasing number of reported injuries in the last few years, some of them lethal. 2,3 With air guns' modernisation, projectiles can reach speeds higher than low-velocity handguns and penetrate the skin, skull and other organs, causing significant morbidity. 1,4 Children are at a higher risk of intracranial injury as they have a less thick skull and a thinner overlying soft tissue.…”

“…Air guns are dangerous objects, often marketed as children's toys 1 . There has been an increasing number of reported injuries in the last few years, some of them lethal 2,3 . With air guns' modernisation, projectiles can reach speeds higher than low‐velocity handguns and penetrate the skin, skull and other organs, causing significant morbidity 1,4 .…”

Study protocol: developing and evaluating an interactive web platform to teach children hunting, shooting and firearms safety: a randomized controlled trial

“…Reliable data sources are lacking, but injury rates appear to be lower also. Accurate reports of child injuries from nonpowder guns (e.g., BB, pellet, air guns) are available and indicate over 14,000 annual injuries requiring medical treatment, almost all of them unintentional and involving children, and many of them serious head and eye injuries [23][24][25]. Several of the risks present while hunting with childrenadverse weather conditions, need for patience and impulse control, adult alcohol use, and sloppy safety upon return home, for examplemay emerge during and after shooting excursions just as they do with hunting.…”