The early hospital management of gunshot wounds. Part 1: head, neck and thorax

Abstract

The management of gunshot wounds is an increasing problem for UK emergency doctors, but not to an extent where it has become routine or allowed individuals to gain significant experience in their treatment. This article reviews the pathophysiology of gunshot injury in general before examining the evidence available concerning the management of gunshot wounds to the head neck and thorax. Figure 1Typical appearance of a close range shotgun injury. There is an obvious central mass effect with 'peppering' around the periphery

Penetrating Thoracic Injury

“…9,[16][17][18] If these patients have a normal initial CXR, a shortterm follow-up examination in 3 to 6 hours should be obtained to rule out development of a delayed pneumothorax, 14,15 though a recent series suggests that interval may be further decreased to 1 hour. 19 Imaging evaluation of patients with suspected mediastinal or cardiac injury depends on the patient presentation.…”

“…An initial ballistic pressure wave, often referred to as a shockwave, will precede the bullet, although its capacity and contribution to injury is debated. [7][8][9] A second phase caused by pressure gradients results in tissue separation in a radial direction, forming a temporary cavity to develop along the trajectory. [7][8][9] Of note, depending on bullet design and energy, the temporary cavity can be many times larger than the caliber of the projectile.…”

“…[7][8][9] Mechanisms, as depicted in Fig. 1, include Direct tissue laceration and contusion will occur along the trajectory, referred to as the permanent cavity.…”

The early management of gunshot wounds Part II: the abdomen, extremities and special situations

“…This article continues to describe the early management of gunshot wounds (GSWs). Injuries to the head, neck, and thorax have been described previously, as has the pathophysiology of gunshot injuries (Garner, 2005). Despite increasing United Kingdom gun crime (Porteous et al, 1997;Persad et al, 2005), the majority of published experience still arises from large centres in the United States and South Africa -their experiences with the increasing use of conservative management protocols require cautious appraisal in the UK.…”

Index for Volumes 1—11

“…2002;. 4: 125-126 The early hospital management of gunshot wounds.Part 1: head, neck and thorax Garner, J. 2005;.…”