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Thread: Gunshot wounds

  1. #21
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    Default Re: Gunshot wounds

    Quote Originally Posted by Ryno Albrecht View Post
    Nice read even for a fellow medic thanks man. Nicely written.
    Thank you very much, please add anything if you feel I have left something out.

  2. #22
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    Default Re: Gunshot wounds

    So I have a few spare minutes and thought I would add to the existing thread, except I want to go into another common injury in SA, Stab wounds. These can be attained through an attack or by accident, can be superficial or severe penetrating.

    The location of the wound and style of the blade are often good indicators of underlying damage. So first off the location, Abdomen (anterior and posterior), Chest (anterior and posterior), Head and extremities.

    Abdomen: Contains vital organs and often a stab or cut to this area will result in a bowel evisceration or internal bleeding. These are immediate and short term issues that can be treated in the prehospital area whereas a more serious problem is if there is any perforation of the intestines as this will lead to septicemia and is very serious. As a result any penetrating wound to the abdomen should be treated with urgency and take to hospital for further care. Included is a picture detailing the anatomy of the abdomen giving you an idea of organs that can be damaged when stabbed.



    Chest: This area is protected by your ribs and intercostal muscles, however it is not infallible. Stab chests are often fatal due to the major organs and vessels present eg; heart, lungs, superior and inferior vena cava, aorta etc. Damage to these is generally going to leave you or the patient in a critical condition. Assosciated injuries include; haemothorax, pneumothorax and tensioning of both as well as cardiac tamponade and rupture of major vessels (Can find a heap of info on these if you Google). The treatment of these injuries is highly limited in the prehospital arena and as a result not reccomended without advanced training.



    Head: I will take liberties and include the neck here as well. The head itself is rather well protected by the skull (cranium) although not impenetrable it will sometimes cause blade deflection and result in major avulsions. The eyes are vulnerable and the neck and throat is fairly unprotected. The neck houses more important vessels as well as the trachea and oesophogus, the vessels that are most commonly injured are the jugular and corotid veins and arteries in the prehospital enviroment these are very often fatal unless whitnessed by first responders.
    Penetrating injuries to the head will often cause death or unconsciousness immediatley depending on how sever the trauma to the brain is. Again in the prehospital arena these injuries are difficult to treat unless you have advanced training.



    Extremities: These include arms and legs, getting defensive cuts to the arms is very common in knife related attacks, while there are no major organs in the extremities there are major vessels and tendons and ligaments that if damaged can kill or permanently damage the limb. Treamtment of these in the prehospital arena are not as difficult as the others. Deeper lacerations will normally yield greater damage and require more aggresive treatment then a superficial laceration.

    Now for the treament options, abdominal lacerations or penetrations that result in protruding organs or intestines should be covered with moist sterile dressing followed by a four sided window dressing. It is important to be aware that this type of injury can often lead to a drop in body temperature so be aware of that and keep the patient covered. At no time EVER try and push the protruding tissue back into the abdominal cavity.
    Chest injuries are not easily treated by people without advanced training however window dressings and semi-occlusive dressings are still an option here to buy time for first responders to arrive. I am not going into the treatment of tension pneumo/haemo thorax nor the possible field treatment of a suspected tamponade. These treatments are widely available on youtube and other sites but should never be attempted without the required training. When dealing with wounds to the head or neck bleeding is often profuse and as a result can make a simple wound look life threatening but this does not mean you should be complacent. Firm pressure dressings to the head are usually good, however when dealing with the neck it is not advised to wrap anything circumfrentially around it as you do not want the airway compromised. Rather use direct pressure ontop of a dressing by applying it with a hand directly onto the wound.
    The extremities are easier to treat firm compression wraps, FAD/SOS/trauma dressings can be used here to stop bleeding, a tourniquet can be applied if bleeding is uncontrollable. But remeber the usual steps, direct then indirect and if this is not helping or not possible use the tourniquet. The tourniquet can also be used to apply direct pressure so you can have your hands free to treat other injuries. With wounds that bleed a lot pressure is your friend but be aware of tying dressings to tight.
    It is important to never remove any impaled objects but to rather stabilize with a ring bandage/container, as if removed there can be major complications.

    A simple google of stab wound images will show you how serious these are, as a result of the graphic nature I have not included actual patient images here.

    Always remeber that shock is a killer, and prompt calling for medical assistance can save lives. Do not give sugar water or any other oral "remedies" and keep patients warm with a real blanket. Space blankets are over rated IMHO. Remember that if you come across a gunshot, stabbing or assault that these are crime scenes as well and try not to move things around to much, careful where you step etc. Monitor the patients level of consciousness and regularly inspect the dressings to make sure bleeding is not coming through.

    Again I have omitted a great deal of procedure and treatment options due to me attempting to keep it simple.
    This is by no means an online "how-to" guide I aim only to inspire an interest in self preservation and hopefully get a few people to do some basic training.

    Please chime in with your thoughts.

  3. #23
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    Default Re: Gunshot wounds

    I love this thread! !

    Thank you so much and please keep all the great info coming!

  4. #24

    Default Re: Gunshot wounds

    Awesome contribution Mr medic. Loving this thread and will definitely be an asset to any first responder. keep up the great and informative posts

    Dylan

  5. #25

    Default Re: Gunshot wounds

    What would you recommend to carry in your fak for this sort of trauma in stabbings or gunshot wounds.

    Dylan
    Last edited by eagle eyrie; 17-06-2014 at 10:24. Reason: .

  6. #26
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    Default Re: Gunshot wounds

    Stickied.
    Because a thing seems difficult to you, do not think it impossible for anyone to accomplish - Marcus Aurelius

  7. #27

    Default Re: Gunshot wounds

    The golden question Mr Medic. Once the wound is packed, airway is clear, breathing is evident and to a lay person the wound isnt gushing, is it not a better option to rush this Gsw victim to the operating room instead of waiting out 10-20min at the scene?
    With reference to an elderly gentleman killed last year, the medics arrived within 10 min and began cpr within 5min but continued resuscitation attempts for a further 45min at the scene even though the GSW was sure to cause major internal bleeding. It was a point blank 9mm shot to the upper right chest. Surely resuscitation attempts should be made en route to the ER?

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    Default Re: Gunshot wounds

    Quote Originally Posted by eagle eyrie View Post
    What would you recommend to carry in your fak for this sort of trauma in stabbings or gunshot wounds.

    Dylan
    Well a basic trauma setup is always useful, however I will recommend gauze, 2 small field dressings and 2 large field dressings, 2 100mm conforming bandages 2 tourniquets (not the cheap ones you buy at camping type shops, the real deal IE: CAT or swat t etc) 3 pairs nitrile gloves a roll of 3m transpore, and some duct tape. This is a basic foundation to build on. I also throw a role of cling wrap in my boot as that stuff is magic.

  9. #29
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    Default Re: Gunshot wounds

    Quote Originally Posted by Thorkind View Post
    Stickied.
    Honoured, thank you.

  10. #30
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    Default Re: Gunshot wounds

    Quote Originally Posted by fivefivesix View Post
    The golden question Mr Medic. Once the wound is packed, airway is clear, breathing is evident and to a lay person the wound isnt gushing, is it not a better option to rush this Gsw victim to the operating room instead of waiting out 10-20min at the scene?
    With reference to an elderly gentleman killed last year, the medics arrived within 10 min and began cpr within 5min but continued resuscitation attempts for a further 45min at the scene even though the GSW was sure to cause major internal bleeding. It was a point blank 9mm shot to the upper right chest. Surely resuscitation attempts should be made en route to the ER?
    I'm going to answer your question in 2 parts, firstly about rushing the victim to theatre, this is often done by members of the public (bystanders) it's an act of good will however what happens if there is an underlying injury? Something ruptures and the patient goes into cardiac arrest? It's going to be a bleak outcome sadly. So its better to keep the victim on scene till ems arrives, unless its an active shooter situation then the rapid removal of patient will take preference.

    Second part, about the gentleman who passed away, it is a catch 22 situation sadly some medics will attempt cpr in a moving Ambo, some won't. I'm not inclined to do it as I feel I have more space and better ability while I'm not being thrown around the back of a speeding vehicle, trust me I've tried in my earlier years rushing an attempted suicide lady who shot through the roof of her mouth with a .32 it did not end well, it all depends on the paramedic in charge. Traumatic injuries don't respond well to violent movement add to it a ventilated and intubated patient whilst doing cpr it is not easy. Hospitals generally make a fuss if you brig them "dead" patients sadly.

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