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Thread: Gunshot wounds
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13-06-2014, 19:51 #1
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Gunshot wounds
http://www.thesurvivaldoctor.com/2012/07/26/gunshot-wounds/This is a short post to hopefully open up an informative discussion about gunshot wounds, earlier I was asked how to treat a headshot herein is a very basic summary of it.
The complications with head injuries are significant and often fatal.Sadly your head is often the most difficult place to protect and sometimes “keepingit down” is not enough.
What I aim to do here is highlight some key factors regarding a gunshotwound (GSW) to the head.
Please I am going to keep this basic as not everyone on the forum ismedically qualified so those who are will you please not tear me to pieces if Iomit something or under explain it (if you wish to have in depth discussionplease PM me) I am not mentioning complex things like RSI/Intubation, fluid rescusitation or intercranial pressure concerns.
Right so lets get to the juicy bit, Head shots, you are all aware thatthe head houses the brain, a very vital organ! Should it experience trauma ofany kind it can often have lethal consequences.
Some of the first things emergency workers are taught is when dealingwith a shooting always as far as possible make sure the scene is safe. If thatmeans calling for SAPS or Security or even NHW representitives so be it butsomeone has to watch your back while you’re treating. Now I want to try andconvey that to you guys! If you should ever be so unfortunate to happen upon ashooting please keep your good intentions in check and make sure the scene isnot active. No good being a dead good Samaritan.
Once you have satisfied yourself it is all ok, then proceed to assistthe patient/person.
Remember head injuries are complicated and can cause fluctuating vitalsigns. Some of the first things to do after you have put on gloves are
· Examine the scalpfor entrance and exit wounds.
· Look for blood,fluid or vomitus in the ears and mouth. Observe for postauricular ecchymosis(Battle signs) and periorbital ecchymosis (“raccoon eyes”) which may indicatinga basal skull fracture.
· Wounds to the head,face, mouth or neck suggest cervical spine injury be careful of excessive movement.
· Airway compromisefrom maxillofacial injuries is potentially lethal due to hemorrhage, swellingand
debris.
You will all haveprobably heard of ABC’s?
Airway, Breathing, Circulation.
These are valuableguidelines to follow, but the first and foremost thing to do is stop any Lifethreatening bleeding! When it comes to the head direct pressure is about the only option, if there is any brain matter visible take note andremember to tell the first responders. Bandages, SOS dressings etc are allsuitable for stopping the bleeding. Once that is done move on to assessing thepersons airway and breathing (by now help should be close) If the person ispresenting no response and has no palpable pulses it is safe to safe it is a goodidea to begin CPR (hands only CPR is fine)
That is about as much as you can do without further medical training. However some things to be awareof would be symptoms associated with GSW head are often;
Loss or decrease ofconsciousness, massive bleeding, airway compromise, unequal or fixed or dilatedpupils. I have had patients start to seize and/or vomit after sustaining a Gsw to the head.Don’t let the gsw to the head put blinkers on you take a look to see if thereare any other wounds to the rest of the body.
I know this is not themost well written article, however I am multitasking at home by being on thelaptop, cooking and chatting to the wife. Not to mention winding down from arough day. I did not see the need to get into intubation/RSI, ventilation orany other advanced procedures as I feel it is superfluous.
I would like this threadto become the one where we discuss gunshot wounds and would appreciate anyother medical professionals to chime in please. If you guys have any questionsplease post them here so someone can answer.
Get to know your local EMS guys, get them to link up with your local neighborhood watch so in the event of an emergency it cuts out call center time. Keep a stocked kit with you always and train as often as you can.
Some links for furtherreading-
http://neurosurgery.ucla.edu/body.cfm?id=134
http://www.emsworld.com/article/10319706/gunshot-wounds - very good.
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13-06-2014, 19:55 #2
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Re: Gunshot wounds
Guys I apologize for some reason my PC is screwing up the paragraphs. I did not space it so badly on purpose.
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13-06-2014, 20:40 #3
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Re: Gunshot wounds
Still good information. Thank you.
"Trespassers will be welcomed, and served a light lunch"
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13-06-2014, 20:49 #4
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Paragraphs are fine but maybe a bit of training to hit the spacebar button properly? Lol
Thanks for the write up! This gives someone like me, with very limited first aid knowledge, an idea of what to do if I ever find myself in a situation like that. Again, thanks for your time!
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13-06-2014, 21:15 #5
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13-06-2014, 21:28 #6
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13-06-2014, 22:00 #7
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Re: Gunshot wounds
Thanks for this, much appreciated.
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14-06-2014, 02:46 #8
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Re: Gunshot wounds
Mr Medic thanks for your efforts to educate the group, most of us non medical citizens would b frozen if we ever see a GSW closeup im thinking. Ive seen the resident ER docs at Bara take pics of injuries, I assume for training purposes.Do you have entry/exit wound pics yo go with the protocols? I have seen a 9mm frontal upper left quadrant cardiac wound with powder burns on an elderly gentleman who passed on in front of us, with minimal bleeding and no exit wound. He succumbed to massive internal haemorrhaging.
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14-06-2014, 07:03 #9
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Re: Gunshot wounds
As far as pictures go I do have some but you can find alot of images online however this would need to be approved by a mod before I'll post as they are graphic.
Regards the gentleman you saw passing on, it is possible the bullet deflected after penetrating his thoracic cavity and as a result it may of perforated various organs and vessels which would cause sever bleeding and ultimately death.
A saying I tell the new guys who ride with me is "not all bullets enter and not all bullets exit." Never assume because you only see 2 holes he has been shot once.
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14-06-2014, 07:23 #10
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Re: Gunshot wounds
Thank you for the write up!!
As for the photos I would like to see them. Maybe once mods allow you could post a link so the user has the option of clicking on it to open?
Thanks again for this thread!
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