Gun shot wounds - Revision history

Rossdonaldson1: /* See Also */

2022-08-03T18:27:54Z

Rossdonaldson1: /* See Also */

2022-08-03T18:26:23Z

Rossdonaldson1: /* Evaluation */

2022-07-27T20:20:24Z

Evaluation

← Revisión anterior		Revisión del 20:20 27 jul 2022
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	==Evaluation==		==Evaluation==
	[[File:PMC3369416 crg-0006-0243-g03.png\|thumb\|For intra-articular retained bullet, consider risk ~~or later~~ [[lead poisoning]].]]		[[File:PMC3369416 crg-0006-0243-g03.png\|thumb\|For intra-articular retained bullet, consider risk of developing [[lead poisoning]].]]
	*ATLS/FAST/Trauma Labs		*ATLS/FAST/Trauma Labs
	*CT Scan as needed depending on location		*CT Scan as needed depending on location

Rossdonaldson1: /* Evaluation */

2022-07-27T20:16:29Z

Evaluation

← Revisión anterior		Revisión del 20:16 27 jul 2022
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	==Evaluation==		==Evaluation==
			[[File:PMC3369416 crg-0006-0243-g03.png\|thumb\|For intra-articular retained bullet, consider risk or later [[lead poisoning]].]]
	*ATLS/FAST/Trauma Labs		*ATLS/FAST/Trauma Labs
	*CT Scan as needed depending on location		*CT Scan as needed depending on location

Zipdoc: /* See Also */

2018-02-03T08:04:27Z

Neil.m.young: /* Clinical Features */

2018-01-18T13:22:54Z

Clinical Features

← Revisión anterior		Revisión del 13:22 18 ene 2018
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	==Clinical Features==		==Clinical Features==
	*Assess for number of wounds to help determine if projectile still present in body		*Assess for number of wounds to help determine if projectile may still present in body
	**Exit wound may not follow logical trajectory		**Exit wound may not follow logical trajectory
	**Strongly consider not documenting "entrance" vs. "exit" given medicolegal implications if not completely sure		**Strongly consider not documenting "entrance" vs. "exit" given medicolegal implications if not completely sure

Mholtz at 17:00, 27 December 2017

2017-12-27T17:00:03Z

← Revisión anterior		Revisión del 17:00 27 dic 2017
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	==Background==		==Background==
	*Bullets		*Bullets
	**~~Lead alloy~~		**Composed of a full or partial metal "jacket" around a lead alloy core
	**Full metal or partial metal jacket around lead core		**Shape depends on caliber and tip type (pointed, flat, hollow, soft)
	**~~Tip variation~~ (pointed, flat, hollow, soft)
	*General caliber classification		*General caliber classification
	**Small (.22, .25)		**Small (.22, .25)
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	*Shotgun pellets, small to large		*Shotgun pellets, small to large
	**Birdshot (shotshells) - many small pellets, large kill spread		**Birdshot (shotshells) - many small pellets, large kill spread
	**Buckshot - fewer ~~pellets,~~ larger pellets		**Buckshot - fewer but larger pellets
	**Slug, sabots - single large solid slug		**Slug, sabots - single large solid slug

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	[[File:Bullet.png\|thumb]]		[[File:Bullet.png\|thumb]]
	====High Velocity Bullets====		====High Velocity Bullets====
	*Examples: ~~M-16~~ or 30/06 Springfield		*Examples: .223 or 30/06 Springfield
	*Very high kinetic energy		*Very high kinetic energy
	*Little deformity when fired		*Little deformity when fired
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	==Clinical Features==		==Clinical Features==
	*Assess for ~~entrance and exit wound~~		*Assess for number of wounds to help determine if projectile still present in body
	**Exit wound may not follow logical trajectory		**Exit wound may not follow logical trajectory
	**May be absent, especially with low velocity GSWs
	**Strongly consider not documenting "entrance" vs. "exit" given medicolegal implications if not completely sure		**Strongly consider not documenting "entrance" vs. "exit" given medicolegal implications if not completely sure
	*Missiles refer to fragments of bone or other tissue, secondary to the bullet		*Entrance wound (typical features)
	*Refer to specific systems for additional information
	*Entrance
	**Round, punched out hole		**Round, punched out hole
	**Marginal abrasion or abrasion ring		**Marginal abrasion or abrasion ring
	**+/- fouling (soot)		**+/- fouling (soot)
	**+/- stippling (punctate abrasions from gunpowder impact)		**+/- stippling (punctate abrasions from gunpowder impact)
	*Exit		*Exit wound (typical features)
	**Usually larger (except head)		**Usually larger (except head)
	**Wound edges may be reapproximated		**Wound edges may be reapproximated
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	**Irregular due to loss of kinetic energy, bullet deformation, yaw		**Irregular due to loss of kinetic energy, bullet deformation, yaw
	*Range of fire		*Range of fire
	**Contact - < 12 ~~in,~~ fouling/soot, muzzle stamp (tight contact)		**Contact (< 12 inches) → fouling/soot, muzzle stamp (tight contact)
	**Intermediate - 2.5-3.5 ~~ft,~~ +/- fouling, stippling		**Intermediate (2.5-3.5 feet) → +/- fouling, stippling
	**Distant - > 3.5 ~~ft, marginal abrasion~~ only		**Distant (>3.5 feet) → wound only
	*Shotgun extrance wounds		*Shotgun extrance wounds
	**Marginal abrasion, fouling, stippling		**Marginal abrasion, fouling, stippling
	**Plastic wad found in body in range < 5-10 ft		**Plastic wad may be found in body if range <5-10 feet
	**Close range < 12 inches ~~with~~ ~1 inch diameter single hole with fouling		**Close range (<12 inches) may have ~1 inch diameter single hole with fouling
	**3 ft - round hole, scalloped edges, stippling		**3 feet - round hole, scalloped edges, stippling
	**4 ft - round hole, scalloping, satellites		**4 feet - round hole, scalloping, satellites
	**Distant (> 10 ft) - pellet spread		**Distant (>10 feet) - pellet spread

	==Region Specific Information==		===Region Specific Information===
	*[[Head Trauma (Main)]]		*[[Head Trauma (Main)]]
	*[[Penetrating neck trauma]]		*[[Penetrating neck trauma]]
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	*Admission/Obs for less concerning injuries		*Admission/Obs for less concerning injuries
	*Minor injuries may be discharged		*Minor injuries may be discharged
	*GSW Protocol allows lower extremity wounds to be discharged from ED after 9 hours without invasive imaging if they have normal ABIs<ref>Sandjadi, Javid. Expedited treatment of lower extremity gunshot wounds. </ref>		*GSW Protocol allows lower extremity wounds to be discharged from ED after 9 hours without invasive imaging if they have normal ABIs<ref>Sandjadi, Javid. Expedited treatment of lower extremity gunshot wounds.</ref>

	==See Also==		==See Also==

Rossdonaldson1: /* References */

2016-08-02T06:23:45Z

References

← Revisión anterior		Revisión del 06:23 2 ago 2016
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	*Minor injuries may be discharged		*Minor injuries may be discharged
	*GSW Protocol allows lower extremity wounds to be discharged from ED after 9 hours without invasive imaging if they have normal ABIs<ref>Sandjadi, Javid. Expedited treatment of lower extremity gunshot wounds. </ref>		*GSW Protocol allows lower extremity wounds to be discharged from ED after 9 hours without invasive imaging if they have normal ABIs<ref>Sandjadi, Javid. Expedited treatment of lower extremity gunshot wounds. </ref>

			==See Also==
			*[[Missile embolus]]

	==References==		==References==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T20:59:32Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 20:59 23 jul 2016
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	*[[Spinal Trauma (Main)]]		*[[Spinal Trauma (Main)]]

	==~~Diagnosis~~==		==Evaluation==
	*ATLS/FAST/Trauma Labs		*ATLS/FAST/Trauma Labs
	*CT Scan as needed depending on location		*CT Scan as needed depending on location

Neil.m.young at 11:27, 13 April 2016

2016-04-13T11:27:07Z

← Revisión anterior		Revisión del 11:27 13 abr 2016
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	===Types===		===Types===
			[[File:Bullet.png\|thumb]]
	====High Velocity Bullets====		====High Velocity Bullets====
	*Examples: M-16 or 30/06 Springfield		*Examples: M-16 or 30/06 Springfield

← Revisión anterior		Revisión del 18:27 3 ago 2022
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	*[[Missile embolus]]		*[[Missile embolus]]
	*[[Wound ballistics]]		*[[Wound ballistics]]
			*[[Trauma (main)]]

	==References==		==References==

← Revisión anterior		Revisión del 18:26 3 ago 2022
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	==See Also==		==See Also==
	*[[Missile embolus]]		*[[Missile embolus]]
	*[[Wound ~~Ballistics~~]]		*[[Wound ballistics]]

	==References==		==References==

← Revisión anterior		Revisión del 08:04 3 feb 2018
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	==See Also==		==See Also==
	*[[Missile embolus]]		*[[Missile embolus]]
			*[[Wound Ballistics]]

	==References==		==References==