Firearm and Arrow Injuries/Fishhook Injury

Published on 14/03/2015 by admin

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Last modified 14/03/2015

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Firearm and Arrow Injuries/Fishhook Injury

Firearm Injury

The type and severity of wounds inflicted by a firearm depend on the amount of energy (a function of velocity) the bullet (projectile) has when leaving the firearm. The higher the velocity of the bullet, the greater the energy and potential for injury. Firearms with muzzle velocities greater than 762 m/sec (2500 ft/sec) are considered high velocity, 457.2 to 762 m/sec (1500 to 2500 ft/sec) medium velocity, and less than 457.2 m/sec (1500 ft/sec) low velocity.

The energy of a bullet may be transmitted to the tissue in part or total depending on the surface area the bullet presents to the tissue. Bullets that yaw, expand, or fragment present more surface area than do bullets that stay in one axis and maintain shape. Hunting ammunition is designed to expand on impact up to two or three times its diameter, resulting in a larger wound channel, greater tissue damage, and rapid incapacitation and death. In addition to direct tissue destruction by the deforming bullet, fragmentation may occur when a bullet strikes bone and sends bone and bullet fragments in different directions. These secondary missiles cause injuries within the body similar to those from the original bullet and may even exit the body to injure bystanders.

Other problems are explosions that occur within the firearm itself. These can cause burns or fragment types of injuries. When firearms are loaded with excessive amounts of powder or when the wrong powder is used in reloading bullets, the resultant detonation may cause the frame or cylinder of the firearm to explode. Obstruction of the barrel of the firearm by snow, mud, or other foreign material may cause an explosion.

Treatment

1. Follow the basic principles of trauma care and resuscitation concerning airway, breathing, circulation, control of bleeding, immobilization of the spine and fractured extremities, wound care, and stabilization of the patient for transport (see Chapter 12).

2. Remove the weapon from the vicinity where you are giving medical care. Remove the ammunition, and leave open the firing chamber.

3. Perform endotracheal intubation as soon as possible if the patient has a neck wound and expanding hematoma. If endotracheal intubation is not possible and the airway becomes obstructed, perform a cricothyrotomy (see Chapters 10 and 12).

4. Provide immediate relief of a tension pneumothorax with a needle or tube thoracostomy, or occlusion of a sucking chest wound with petrolatum-impregnated gauze (see Chapter 15).

5. Control external bleeding by direct pressure and compression wraps.

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