What Is A Gunshot Wound?

Introduction 

Gunshot wounds are usually considered medical emergencies. The severity of injuries is determined by a variety of factors, including the location of the wound, the size of the bullets and the type of gun used.

Gun-related injuries have different incident rates across the world. They are not uncommon in the United States. According to the Centres for Disease Control and Prevention (CDC), 45,222 firearm-related fatalities were reported in the United States in 2020. More than 40% of these were homicides.

Gunshot wounds occur when a person is struck by a bullet or other object fired from a weapon. Gunshot injuries occur in several settings, including criminal and terrorist occurrences (including bullets fired by law enforcement officers), attempted suicides and unintentional firearm accidents. 

Despite media coverage of gun killings, gun crime in the UK is neither frequent nor ubiquitous, and the majority of doctors will see gun injuries very rarely. If someone is shot, call your local emergency services as soon as it is safe to do so. While you wait for an ambulance, administering first aid can save a person's life. Quick action can help reduce the bleeding and prevent life-threatening consequences. Continue reading to learn about first aid, medical care, and healing from gunshot wounds.^1,2

Causes and mechanisms 

There are several types of bullets, but the most common variant is made up of a lead core and a casing. Depending on the ammo and the kind of cannon, the projectile element can move at speeds of up to 1,500 meters per second when struck. Their location and projectile course are the most crucial elements in causing major harm or death. The head and torso are the most susceptible, with injuries to the brain and vital internal organs leading to blood loss and fatality.¹

The mechanism of a gunshot wound is complex. To begin, the projectile smashes structures along its path. Similar to physical trauma, temporary cavitation induces shearing and compression, occasionally shredding structures or stretching inelastic tissue (the brain is particularly vulnerable). As tissues rebound and heated gasses disperse, soft tissue compresses inwards, resulting in a permanent cavity. 

Secondly, kinetic energy transfer occurs, which may cause injury outside of the path of the bullet. Projectiles are often classed as low-velocity (300 hm/s) or high-velocity (>300 hm/s). On this basis, bullets travelling at a higher velocity may be predicted to release more energy into surrounding tissue as they decelerate and inflict more tissue damage. 

Contamination from a secondary source and infection can also occur in the wound.^1,3

Clinical presentation

When dealing with gunshot injuries, healthcare professionals usually do head-to-toe examinations and look for signs and symptoms in this way. An individual may experience any one of the following signs and symptoms:^1,3,4 

• The airway can be injured if the gunshot wound is made in the head or neck area. If there is a risk of cervical spine damage, avoid tilting the head or moving the neck
• If the torso gets injured, breathing can be affected, along with pain and a flailing chest. Diaphragmatic injuries can cause respiratory difficulties after a gunshot wound
• Following a gunshot wound, internal bleeding can be significant and hard to detect. After a delay, an individual may experience a fast heartbeat, palpitations, and very low blood pressure, causing the person to feel lightheaded and dizzy. This indicates significant blood loss 
• Numbness and an inability to move parts of the body can occur due to the shock or from nerve injury
• Burns can be present if the projectile was fired from close proximity

Treatment 

First-aid 

Gunshot wounds necessitate rapid medical intervention. An injured individual needs to be assisted by calling the local emergency services for them.

Check to verify if the individual is awake and responding, and gather identifying information from them. Apply as much pressure as possible with a clean towel to halt the bleeding until professionals arrive.

If the victim is heavily bleeding from an arm or leg, consider using a commercial or handmade tourniquet. CPR or the use of an automated external defibrillator may be required if you find that the victim is unresponsive.

Hospital management

All patients with non-trivial gunshot wounds require:^1,4,5 

• Six units of cross-matched blood
• Robust fluid replenishment
• An X-ray needs to be performed to visualise the area of the wound, as well as the region above and below it to look for any more embedded bullets
• A CT scan 
• An ECG 
• Monitoring of vital signs and blood gases

Chest injuries

Chest injuries require a large chest drain to remove fluids that collect in the chest cavities. In case an artery is injured, which quickly leads to severe haemorrhage, a surgical procedure called a thoracotomy is needed. 

Sometimes, the injury can be a sucking chest wound and will require a Vaseline gauze pad to form a 3-side seal. 

Other times a chest injury can cause pneumothorax (where the pressure in your chest increases on one side). This is treated by inserting a needle into the affected side to relieve the pressure.

Blood collecting around the heart is another possibility and this also requires urgent management. Treatment involves inserting a needle aimed towards the heart to let excess blood flow out.

Finally, Infection is a major problem that can arise after sustaining a gunshot wound. Antibiotics play an important role in preventing bacterial infections.¹

Abdominal injuries

Abdominal gunshot wounds are coupled with a high incidence of internal injuries and often require a surgical procedure called an exploratory laparotomy to be performed.

An X-Ray and a CT scan are first performed to assess the damage. These are followed by serial monitoring of haemoglobin and white blood cell counts, along with fluid replacement and antibiotics.

Gunshot wounds are highly vulnerable to infections from anaerobic bacteria, notably bacteria that are responsible for causing tetanus and gas gangrene. It is important to make sure your tetanus vaccine is up to date. Intravenous antibiotic treatment for 24-48 hours is standard after fractures caused by high-velocity weapons or shotguns.⁴ 

Complications and prognosis 

Survivors of firearm-related injuries may have long-term physical and emotional difficulties, including:

• Physical disability
• Memory problems
• PTSD  (post-traumatic stress disorder)

Specific complications are determined by the location of the wound and the extent of the injury. For example, a head injury might result in cognitive and physical symptoms such as:

• Headaches
• Light and noise sensitivity
• Confusion
• Memory problems
• Difficulties with balance and motor coordination

Infection is a potentially fatal complication that might occur as a result of a gunshot wound or corrective surgery. To limit the risk of infection, always take drugs as prescribed by your doctor and carefully follow post-operative instructions.

Amputation may be necessary in rare situations if a limb is severely injured. If a bullet hits your spinal cord, it might cause partial or complete paralysis. Even if the organ is preserved, organ damage induced by gunshot wounds might result in substantial long-term health issues.^1,6

Forensic implications 

Since gunshot wounds are usually seen in medico-legal scenarios, the healthcare team taking care of you has an obligation to the rule of law and the interest of the general public. Hence, they have to follow the guidelines below.

Reporting gunshot wounds

The General Medical Council (GMC) of the UK has published instructions on reporting gun and knife-related injuries:

When a person arrives at a hospital with a gunshot wound, the police should be notified since they are responsible for performing a risk assessment and ensuring that essential statistical information concerning gun crime is recorded.

Regarding the collection of personal information about the patient by the police, a professional decision should be made. Personal information disclosure without consent may be permissible in the public interest if failing to do so may expose others to danger. Medical personnel, on the other hand, should seek the patient's agreement whenever feasible.

The patient should always be the priority of the medical team, and the presence of the police should not delay or impede treatment or jeopardise the patient's recovery. If the patient's health enables them to talk to the police, they should be asked if they want to, and the repercussions of refusing to speak to the police should be outlined to them. 

Forensic evidence

When dealing with victims and perpetrators of violence, healthcare workers must also preserve any forensic evidence. They must ensure that all of the patient's clothes, possessions and any projectiles retrieved from the body are bagged, marked, and kept safe until they are handed over to the authorities.

FAQs

What should I do if someone has been shot?

Call your local emergency number to report the incident or visit the nearest Accidents & Emergency immediately if you have been shot.

How can the severity of a gunshot wound be assessed at the scene? 

Severity can be assessed by observing if there is any major bleeding or if the person has lost vital signs, like a pulse and breathing.

What are the potential complications of gunshot wounds?

The potential complications of a gunshot wound include bleeding, infection, injury to internal organs, scarring of local tissue, burns and nerve damage.

Can gunshot wounds be treated non-surgically?

Yes, a gunshot wound can be treated non-surgically if the patient is stable and no vital organs have been damaged.

Summary

Gunshot wounds are life-threatening injuries that require immediate care. First aid assistance should be given to manage bleeding. Patients must receive an X-ray and a CT scan and then be treated with a variety of surgeries and therapies to minimise complications and prevent infection. Following discharge, a person with a gunshot wound may require medicine, physical rehabilitation and, in rare situations, further surgery. Both shooting witnesses and survivors frequently experience emotional and psychological distress. During rehabilitation, it is critical to treat both physical and emotional symptoms. Recovery from a gunshot wound varies greatly depending on the magnitude and location of the damage. A doctor or care team will collaborate to develop a more detailed picture of a rehabilitation plan that is tailored towards you.