Gunshot Wounds Management [Micro Lecture]

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about how to manage the Gunshot Wounds.

In today’s micro lecture, we are going to talk about gunshot wounds. Now unfortunately, both gunshot and knifing incidents are on the rise. Now when you attend somebody who’s been shot, there’s lots of different things going on here. Now when you’re attending these patients, of course you have to still follow your danger, your response, your airway, and breathing and circulation to exposure. Because that really is the thing that’s going to save your patient.

Now there’s obviously the changes to that mnemonic when there’s catastrophic hemorrhaging involved. So for example, if somebody’s got extreme catastrophic hemorrhage, you would always stop the bleeding first. As quickly as possible. Now the idea is to stop the hemorrhage because if there’s no blood in the system, the patient cannot survive. It’s as simple as that.

So remembering that you’ve got to follow your danger, your response, airway, breathing, circulation but stopping catastrophic hemorrhage first. Now when somebody fires a handgun, there’s lots of different variation as to what can happen with that bullet. The first thing to consider is that the severity of the injury depends on the distance away from the actual gun itself. The type of gun, the size of the bullet, and as you can see on here, there’s two scientific terms: the acceleration of gravity.

So gravity is trying to pull the bullet down. And there’s always going to be some deceleration due to air friction. In other words, it’s quite a bit of resistance pushing the bullet backwards. The other thing you need to be mindful of is that bullets are highly unstable as they fly through the air. Meaning that they roll, and not massively like that, but there’s quite a bit of movement. So they’re not 100% accurate. There’s a range of forces and pressures that are pushing on the bullet, as you can see here.

Now what they also say is that bullets make small entrance holes and large exit holes. This is always a good sign for you guys as paramedics, because if you see a small entrance hole, and you first gotta look for the exit hole, and there isn’t an exit hole. It means that the bullet is still inside the patient. So there’s only complications of that, including infection, internalized bleeding. But now that you understand that bullets don’t always come through the other side, then that gives you a understanding of how serious these really are.

Now a couple of other terms I want to talk to you about are cavitation. Both temporary and permanent. So cavitation really does involve that the projectile. Imagine this bullet, going through tissue. And it’s creating this permanent cavity here. But this one here, the temporary cavity, it’s the skin and tissue being pushed out of the way by the bullet, and it expands like this. But eventually will come back into its normal position. However, the permanent cavity generally won’t go back into its position without some kind of medical intervention. So there is this notion of temporary and permanent cavitation.

So managing this patient consists of following the primary survey approach, arresting major hemorrhage, looking to see if the bullet has come out the other side, keeping the patient still if it’s still inside the body, including keeping the patient still by immobilizing them through your process of immobilisation. If you’re suspecting internal hemorrhage, follow your protocols and guidelines with regard to fluid therapy. And of course managing any pain.

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