Gunshot wounds to the head have become a leading cause of traumatic brain injury TBI in many urban areas in the U. Other cases involve suicide and unintentional accidents. Suicide-related gunshot wounds to the head are associated with a very high mortality rate and severe disability in the few who survive.
There is a greater chance of death and poorer outcome for victims with TBIs caused by self-inflicted gunshot wounds, compared to victims injured by gunshot wounds that are accidental or delivered in an assault. In people ages , firearms are a leading cause of TBI. Brain Injury A wound in which the projectile enters the cranium , but does not exit, is referred to as a penetrating wound. An injury in which the projectile enters and exits the cranium is referred to as a perforating wound.
Both bleeding and damage from this pressure wave results in brain swelling, which can also lead to death. A number of factors determine the extent of damage caused by a gunshot wound. These include the caliber of the gun, size and speed of the bullet, the trajectory and site of the injury.
A bullet wound going through the right frontal lobe tip toward the forehead and well above the base of the skull is likely to cause relatively mild clinical damage, because it passes through no vital brain tissue or vascular structures. If these symptoms are ongoing, they may be signs of post-traumatic stress syndrome, or PTSD. There are treatments that can help you feel better. Wound management principles.
Philadelphia, PA: Elsevier; chap Gunshot wounds and blast injuries. Updated by: Jacob L. Editorial team. Gunshot wounds - aftercare. Gunshot wounds can cause serious injury, including: Severe bleeding Damage to tissues and organs Broken bones Wound infections Paralysis The amount of damage depends on the location of the injury and the speed and type of bullet.
If the wound was severe, you may have had surgery to: Stop bleeding Clean the wound Find and remove bullet pieces Find and remove pieces of broken or shattered bone Place drains or tubes for body fluids Remove portions of, or whole, organs Gunshot wounds that pass through the body without hitting major organs, blood vessels, or bone tend to cause less damage.
Keep these tips in mind: Keep the dressing and area around it clean and dry. Take any antibiotics or pain relievers as directed. Gunshot wounds can get infected because material and debris can get pulled into the wound with the bullet. Try to elevate the wound so it is above your heart. This helps reduce swelling. You may need to do this while sitting or lying down.
You can use pillows to prop up the area. Prevention strategies such as child access prevention laws and gun lock distribution have the potential to prevent many of these injuries, but their true impact will remain unknown if only deaths are counted. To that end, Rinad S. But more efforts are needed. The team aims to expand their prior work on firearm policy to also measure the impact of policy on nonfatal injuries. Morrison, PhD. The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 20 years, according to U.
Penn Medicine is powered by a talented and dedicated workforce of more than 44, people. Broad-spectrum antibiotics should be administered early with any abdominal injury. Nerves, tendons and vessels are endangered, so examine the limb in a good light. Test for pulses but their presence does not exclude arterial injury. Note sensation and sweating. Any damage identified will need formal surgical repair although In select patients, non-operative treatment with wound care and antibiotics may be sufficient for preventing infection after gunshot-related traumatic arthrotomies [ 4 ].
Significant tissue damage can occur with both low- or high-velocity bullets. Some high-velocity bullets particularly those from military rifles are designed to stay intact after impact, limiting wound severity and the need for massive wound debridement.
However, many low-velocity gunshot wounds can be safely managed with local wound care and outpatient review, dependent on the absence of any bony or vascular injuries. High-velocity bullets suck foreign material normally clothing through both entry and exit wounds and it can be spread along dissected tissue planes.
Wide excision or fasciotomy may be required to clear foreign material and dead tissue. Primary suture is frequently delayed for high-velocity injuries, with grafting and suture at days. Gunshot wounds are particularly prone to anaerobic infection, especially tetanus and gas gangrene. Ensure tetanus cover is up-to-date, and intravenous antibiotic prophylaxis of hours' duration is usual following fractures caused by high-velocity weapons or shotguns.
The General Medical Council GMC issued supplementary guidance concerning the reporting of gun- and knife-related injuries. These state that [ 5 ] :. Healthcare professionals also have a duty to preserve potential forensic evidence when dealing with the victims and perpetrators of violence. To this end, ensure that all the patient's clothes, belongings and any missile fragments are retained, bagged, labelled and kept secure until passed on to the police, ensuring the 'chain of custody'.
Doctors are not required to act as cosignatories or referees for firearm or shotgun licences. Body armour offers some protection against injury from high-velocity weapons but has considerable limitations.
The protection offered is graded I to IV. Like mediaeval armour they are rather heavy and cumbersome. Moderating the injury and death caused by the violent use of guns is a very valid public health issue.
The right to bear arms in the USA is enshrined in its constitution and has been ardently and effectively protected by the National Rifle Association, whilst the UK has some of the strictest gun control laws in the world. The massacre of school children and their teachers in Dunblane caused public outcry and subsequent legislation to impose even tougher restrictions on the legal owners of handguns, although there is little evidence that this has saved any lives.
Amnesties allowing people to hand in illegal firearms often produce impressive responses but those who hand weapons in are unlikely to use them.
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