Gunshot wounds I have tended
Posted: Tue Jul 03, 2012 7:37 am
While talking to CC one night, recalling some of the more interesting gunshot wounds I have come across, he suggested that I start a thread on that subject. I do happen to be in a unique position to talk about such things. So, for tonight, let me present the inaugural case:
26 year old male shot at close range (so known because of the stippling near the entrance wound). The round struck the left chest between the middle and distal third of the clavicle. He presented alert and awake, and in pain. There was no exit wound. The entrance wound was a little under 9mm across at its narrowest, so it was probably a nine millimeter. The bullet had struck the clavicle, shattering both. The bullet broke into two large fragments with several small ones. One large fragment stopped near the clavicle. The second one appears to have tracked more or less straight back in a line, missing the lung by millimeters, and ending on the underside of the scapula without noticeably damaging it.
He was neurologically intact, and there was no sign of vascular compromise.
He was quite lucky since not only the lung was unscathed, the neurovascular bundle under the clavicle appears to have survived intact. Had this been compromised, especially had the subclavian artery been transected, it would have been a major vessel bleed in a location which is not compressible. So, bleeding would have been about impossible to control. This is one of those times when a tampon might be useful in the field. The patient, in that case, would have needed definitive surgical care quite rapidly to survive.
Any questions or comments are welcome!
26 year old male shot at close range (so known because of the stippling near the entrance wound). The round struck the left chest between the middle and distal third of the clavicle. He presented alert and awake, and in pain. There was no exit wound. The entrance wound was a little under 9mm across at its narrowest, so it was probably a nine millimeter. The bullet had struck the clavicle, shattering both. The bullet broke into two large fragments with several small ones. One large fragment stopped near the clavicle. The second one appears to have tracked more or less straight back in a line, missing the lung by millimeters, and ending on the underside of the scapula without noticeably damaging it.
He was neurologically intact, and there was no sign of vascular compromise.
He was quite lucky since not only the lung was unscathed, the neurovascular bundle under the clavicle appears to have survived intact. Had this been compromised, especially had the subclavian artery been transected, it would have been a major vessel bleed in a location which is not compressible. So, bleeding would have been about impossible to control. This is one of those times when a tampon might be useful in the field. The patient, in that case, would have needed definitive surgical care quite rapidly to survive.
Any questions or comments are welcome!