gunshot wounds

Monday, July 23, 2012

The Aurora shootings are a sad reminder that bullets inflict a great amount of damage to the body. The nation mourns not only the loss of life but the knowledge that towns in America are no longer as safe as they thought they were. It’s not only the US: shooting rampages in Norway, killings in Vancouver and Toronto in Canada and terrorist acts around the world fill hospitals and cemeteries. Whether it is a disturbed loner or side splash from gang warfare, ERs and operating rooms are using the lessons learned on the battlefield to help save lives in civilian life.

It all has to do with physics. The energy that the gun imparts to the bullet (Energy= ½ mass X velocity ²) is all based on the muzzle speed. The faster the velocity, the more energy the bullet has when it hits the body and the more damage that it can inflict. There is the permanent cavity or pathway that the bullet causes as it passes into the body but there is also a temporary cavity where the energy is transferred to surrounding tissue. It’s like trying to stab a bowl of jello, there are the track marks from the fork but the rest of the jello also wobbles. The body, it seems, doesn’t like to wobble. The slower the bullet velocity, the less damage inflicted but it’s all about location.

The problem with gunshot wounds is that once the bullet enters the body, there is no guarantee where it will go. In the head, it can pass straight through the brain or it can ping pong back and forth inside the skull causing significantly more damage and swelling. In the chest, a bullet can bounce around and affect not only heart and lung, but can even bounce down and end up in the abdomen causing issues far away from the bullet entry site. Injuries to the extremities can be just as disastrous. A small entry wound can end up having a large exit and the path of the bullet and its temporary cavity can damage arteries and nerves.

In World War one, penetrating wounds to the chest and abdomen were untreatable and doctors made patients comfortable as they watched them die. In World War two, anesthetics and antibiotics allowed surgeons to operate on gunshot and stabbing victims and half lived. Now the average survival rate at a level one trauma center is 95% because of a “damage control” approach to the patient’s care. The initial surgery is meant to stop bleeding and clean up any major contamination to get the patient physiologically patched up. Later planned operations allow reconstruction of any injured organs. Add better technical skill in repairing major arteries, new ways of looking inside the body with CT to look for potential problems, and the aggressive use and understanding of blood transfusion and chances for survival increase.

Regardless of statistics, the injuries sustained by each victim are unique and the potential for survival and rehabilitation depend upon how much damage has been done to vital structures. Quantity of life isn’t good enough. It’s easy to measure survival rates but returning quality of life is the real goal. What can’t be returned is the sense of peace that has been taken from a community. Time may heal all, but memories last forever.

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