Effects of a fragmenting handgun bullet: Considerations for trauma care providers

Hakki, Lynn; Smith, Alison; Babin, Jonathan; Hunt, John P.; Duchesne, Juan; Greiffenstein, Patrick

doi:10.1016/j.injury.2019.01.033

Cited by 12 publications

(9 citation statements)

References 3 publications

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“…Fragmentation can cause increased local tissue destruction, 11 decrease the likelihood of complete extraction of the foreign bodies, and increase the total surface area exposed to internal tissue. 12 , 13 Firearm injuries to the brain are some of the most lethal, with approximately 90% of patients dying prior to arrival and up to 50% of surviving patients succumbing to their injuries in the emergency department. 14–16 More recent evidence suggests that with modern trauma recommendations, such as prioritizing blood products over crystalloid, survival rates for cranial gunshot wounds (GSW) are increasing.…”

Section: Discussionmentioning

confidence: 99%

Lead toxicity due to retained intracranial bullet fragments: illustrative case

Aaronson

Awad

Hedayat

2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Lead toxicity (plumbism) secondary to retained lead bullet fragments is a rare complication in patients with gunshot wounds. To the authors’ knowledge, there has been no definitive case reported of lead toxicity due to retained intracranial bullet fragments. OBSERVATIONS The authors reported the case of a 23-year-old man who presented after being found down. Computed tomography scanning of the head revealed bullet fragments within the calvaria adjacent to the left transverse sinus. During follow-up, he developed symptoms of plumbism with paresthesias in his bilateral hands and thighs, abdominal cramping, labile mood, and intermittent psychosis. Plumbism was confirmed with sequentially elevated blood lead levels (BLLs). The patient opted for surgical removal of the bullet fragments, which led to reduction in BLLs and resolution of his symptoms. LESSONS Although rare, lead toxicity from retained intracranial bullet fragments should be considered in patients who have suffered a gunshot wound to the head and have symptoms of lead toxicity with elevated BLLs. For safe and accessible intracranial bullet fragments in patients with plumbism, surgical intervention may be indicated.

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Section: Discussionmentioning

confidence: 99%

Lead toxicity due to retained intracranial bullet fragments: illustrative case

Aaronson

Awad

Hedayat

2022

Journal of Neurosurgery: Case Lessons

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“…14 The shape of individual fragments may indicate special types of bullets that are designed to fragment in a predictable manner, such as the Radical Invasive Projectile (RIP), which has been frequently encountered in recent years. [15][16][17][18] This frangible bullet consists of a solid base ('base slug') and six or eight trocar-shaped petals ('trocars'), depending on its calibre. [15][16][17][18] The 'trocars' expand radially after entering tissue, while the 'base slug' further penetrates the tissue along its trajectory.…”

Section: Extended Ct Scalementioning

confidence: 99%

“…[15][16][17][18] This frangible bullet consists of a solid base ('base slug') and six or eight trocar-shaped petals ('trocars'), depending on its calibre. [15][16][17][18] The 'trocars' expand radially after entering tissue, while the 'base slug' further penetrates the tissue along its trajectory. [15][16][17][18] The detection of these 'trocars' of the same shape enables the identification of these special bullets.…”

Section: Extended Ct Scalementioning

confidence: 99%

“…[15][16][17][18] The 'trocars' expand radially after entering tissue, while the 'base slug' further penetrates the tissue along its trajectory. [15][16][17][18] The detection of these 'trocars' of the same shape enables the identification of these special bullets. The 'base slug' may be used for calibre measurements in addition to the number of detected 'trocars'.…”

Section: Extended Ct Scalementioning

confidence: 99%

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Lodged bullets on computed tomography: Three classification procedures for the virtual investigation of bullets or their fragments that cannot be recovered from the living patient

Gascho

2020

Med Sci Law

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“…Furthermore, improvised explosive devices and bullets that have been manually modified for sniper rifles by cutting an «X» on their tips are frequently used and associated with severe trauma due to their ballistic characteristics [7]. Such a bullet is a kind of deformed ammunition, causing fragmentation upon striking the target and creating more severe damage, including liver injury [8].…”

mentioning

confidence: 99%

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

Хоменко¹,

Tsema

Гуменюк³

et al. 2022

ЗХ

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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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Effects of a fragmenting handgun bullet: Considerations for trauma care providers

Cited by 12 publications

References 3 publications

Lead toxicity due to retained intracranial bullet fragments: illustrative case

Lead toxicity due to retained intracranial bullet fragments: illustrative case

Lodged bullets on computed tomography: Three classification procedures for the virtual investigation of bullets or their fragments that cannot be recovered from the living patient

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

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