Through‐and‐through gunshot wound to the head in a rare case of survival

We describe the case of a 42‐year old Caucasian male who presented for follow‐up treatment of refractory epilepsy. He suffered a cranial trauma 13 years before when a bullet from a pistol, (presumably accidentally) entered the right frontal side of the cranial vault and exited contralateral, causing severe neurological damage.     

The fate and behaviour of gunshot residue: recreational shooter distribution

ABSTRACT

Despite continued improvements in gunshot residue (GSR) detection and analysis, there are still challenges in the interpretation of GSR evidence. The level and distribution of GSR present on an individual can be influenced by many factors, dependent upon the context of any given case. Due and diligent attention must therefore be placed upon fate and behaviour processes in relation to GSR when assessing and interpreting any case findings. The distribution of GSR upon the body of a recreational shooter was assessed. Samples were taken from 17 positions across a shooter’s body immediately after the discharge of one round of ammunition. The shooting hand prevailed as the most GSR-contaminated area, with as many as 351 characteristic GSR particles identified. The face and supporting hand also exhibited high levels of GSR contamination. This level of contamination raises questions concerning the fate and behaviour of GSR particles within the general environment, specifically with regard to transfer processes.     

Automatic acoustic gunshot sensor technology’s impact on trauma care

IntroductionAs cities nation-wide combat gun violence, with less than 20% of shots fired reported to police, use of acoustic gunshot sensor (AGS) technology is increasingly common. However, there are no studies to date investigating whether these technologies affect outcomes for victims of gunshot wounds (GSW). We hypothesized that the AGS technology would be associated with decreased prehospital transport time.MethodsAll GSW patients from 2014 to 2016 were collected from our institutional registry and cross-referenced with local police department data regarding times and locations of AGS alerts. Each GSW incident was categorized as related or unrelated to an AGS alert. Admission data, trauma outcomes, and prehospital time were then compared.ResultsWe analyzed 731 patients. Of these, 192 were AGS-related (26%) and 539 were not (74%). AGS-related patients were more likely to be female (p < 0.01), have a higher injury severity score (ISS) (p < 0.01), and require an operation (p = 0.03). Ventilator days (p < 0.05) and hospital length of stay (p < 0.01) was greater in the AGS cohort. Mortality, however, did not differ between groups (p = 0.5). On multivariable analysis, both total prehospital time and on-scene time were lower in the AGS group (p < 0.01).ConclusionOur study suggests reduced transport times, decreased prehospital and emergency medical service on-scene times with AGS technology. Additionally, despite higher ISS and use of more hospital resources, mortality was similar to non-AGS counterparts. The potential of AGS technology to further decrease prehospital times in the urban setting may provide an opportunity to improve outcomes in trauma patients with penetrating injuries.     

MUSKETS,MUSKET BALLS AND THE WOUNDS THEY MADE

Gunshot wounds are a common occurrence today in both military and civilian situations. This paper discusses the development of the weapons, their capabilities, the type of wounds produced and their management in earlier times. A brief comparison is made with the wounds produced by modem firearms. It may be concluded that the earlier wounds were simpler due to the lower velocity of the projectile and therefore a more conservative approach to treatment was acceptable.     

Surgical treatment for rabbits' femoral arteries subjected to gunshot wounds combining with seawater immersion

Ianser easew oaaftt eearnn,d in gjwurhoreoudsned b y wm faiarrifeanarrem,psa gtahrenodalot gt haicretanelr iiem csmh aoenfrsg leeidm biinssobvious swelling of the periarterial cells andintercellular space.The surgical treatment for suchinjuries,which is n…     

Laceration of the thoracic aorta from a .22 lr bullet

A gunshot wound (.22 long rifle) to the chest including perforation of the aorta ascendens is presented. The small wound tract in soft tissue was characteristic for this type of ammunition and did not show any special peculiarities. However, arterial injury was not restricted to two small perforations, as expected in the light of previous wound ballistic findings. Three large longitudinal ruptures (3.0–4.5 cm in length and two of them independent of the perforations) additionally occurred, which led to rapid exsanguination. This extraordinary extent of vascular injury can be explained by perforation of the artery during the ventricular ejection phase, which causes a considerable dilation of the aorta analogous to a windkessel. The pre-existing dilation enables intraluminal temporary cavitation to have an “explosive” effect despite the high elastic tolerance of the vessel wall. The importance of tissue characteristics in gunshot wounds in general and the possible role of temporary cavitation inside the vessel in vascular gunshot wound production in particular are stressed. Received: 7 November 1996     

高温高湿环境肢体火器伤肌组织能量代谢变化

目的探讨高温高湿环境下火器致伤后动物组织损伤特点,判断组织损伤的程度及转归,旨在为这一特殊环境下 火器伤后软组织清创的时机、方法及抗生素的应用提供实验依据。方法将８只犬随机分为高温高湿（ＨＨＥ）组和常温 常湿（ＮＥ）组。分别于火器伤前、伤后０、４、８、１２、２４ ｈ测定挫伤区、震荡区和震荡外区组织的ＡＴＰ、ＡＤＰ、ＡＭＰ及能荷含 量。结果（１）ＡＴＰ值：伤后 ８ ｈ,ＨＨＥ组挫伤区明显较 ＮＥ组低（Ｐ＜０．０５）, １２ ｈ后进行性下降,较 ＮＥ组有更显著差异 （Ｐ＜０．０１）;（２）ＡＤＰ值：ＨＨＥ组挫伤区伤后 ８ ｈ及震荡区伤后 １２ ｈ较 ＮＥ组低（Ｐ＜０．０５）;（３）ＡＭＰ值：伤后 １２ ｈ,ＨＨＥ组 挫伤区明显高于 ＮＥ组（Ｐ＜０．０１）;（４）能荷：伤后 ８ ｈ,ＨＨＥ组挫伤区明显低于 ＮＥ组（Ｐ＜０．０５）,伤后 １２ ｈ较 ＮＥ组降低 更为显著（Ｐ＜０．０１）。结论高温高湿环境肢体火器伤后肌组织能量储备匮乏且随时间延长显著下降,处理应强调及早、 彻底的清创和使用有效的抗生素。     

Arteriovesical fistula as a complication of a gunshot wound to the pelvis: Treatment dilemma

The case is reported of an arteriovesical fistula after a gunshot wound to the pelvis in a 29-year-old man. It developed 20 days after an exploratory laparotomy with primary suture of the bladder. The patient presented with intermittent gross hematuria and diagnosis was made through cystoscopy and arteriogram. Treatment was initially performed through open embolization. Re-treatment with endovascular procedures was twice necessary. Further evolution led to complete recovery from symptoms after an open procedure. Virtually all forms of treatment were tried and the resolution was finally achieved after more than 7 months.     

枪伤病理分区与枪伤治疗

20世纪80年代初我国学者首先提出,枪伤伤道及其周围组织可分为原发伤道区、挫伤区和振荡区3区,其中挫伤区为紧靠原发伤道的组织坏死区,挫伤区之外为振荡区.笔者课题组于近年来采用磁共振成像(MRI)扫描和常规病理学观察相结合的方法研究发现,枪伤组织应分为原发伤道区、凝固性坏死区、组织碎裂区和组织变性区4区.其中凝固性坏死区和组织碎裂区相当于挫伤区,但凝固性坏死区为不可逆坏死,需清创切除;而组织碎裂区仍具有修复能力,应予保留,故将两者分开命名.4区分区法明确了枪伤清创范围,对解决枪伤保守疗法和彻底清创疗法的争端有一定指导意义,但各区形成机制还有待进一步研究.     

Anterior ulnohumeral compression plate arthrodesis for revision complex elbow injury: a case report

Elbow arthrodesis can be used for complex elbow injuries that are complicated or fail other conventional treatment methods. We present a case report of an anterior ulnohumeral compressive plate elbow arthrodesis for a patient with a complex elbow injury from a gunshot wound that failed initial open reduction and internal fixation and posterior ulnohumeral arthrodesis secondary to numerous complications.