Ballistic trauma
The term ballistic trauma (generally referred to by the type of weapon, such as gunshot wound, etc.) refers to a form of physical trauma sustained from the discharge of arms or munitions.[1] The most common forms of ballistic trauma stem from firearms used in armed conflicts, self-inflicted injury, criminal activity, and civilian sporting and recreational pursuits, in that order.[2]
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[edit] Introduction
Although there are several causes for ballistic trauma depending upon the situation in which they occur, priorities for physicians lie in ascertaining the likelihood of survival for the patient based upon damage caused by the projectile upon entry – whether the object strikes or shatters a bone, and if shattered bone or shrapnel has punctured vital organs or has damaged the spinal cord of the patient.[1] Alongside estimation of the patient's survival, another key determinant is the future health of the patient, dependent upon the severity of the injury so that preventative measures can be approximated, due to the benefits of preventing death or injury outweighing those of a purely treatment-based approach. [1]
[edit] Destructive effects
The degree of tissue disruption caused by a projectile is related to the size of the temporary versus permanent cavity it creates as it passes through tissue.[3] The extent of cavitation, in turn, is related to the following characteristics of the projectile:
- Kinetic energy: KE = mv2/2 (where m is mass and v is velocity). This helps to explain why wounds produced by missiles of higher mass and/or higher velocity produce greater tissue disruption than missiles of lower mass and velocity.
- Yaw
- Deformation
- Fragmentation
The immediate damaging effects of the bullet are typically bleeding, and with it, the potential for hypovolemic shock, an inadequate amount of blood in the circulatory system. More immediate effects can result when a bullet strikes a critical organ such as the heart or damages a component of the central nervous system such as the spine or brain. Common causes of death following gunshot injury include exsanguination, hypoxia caused by pneumothorax, heart failure and brain damage. Non-fatal gunshot wounds can result in serious disability.
Gunshot injuries can vary widely from case to case since the location of the injury can be in any part of the body, with wide variations in entry point. Also, the path and possible fragmentation of the bullet within the body is unpredictable. The study of the dynamics of bullets in gunshot injuries is called terminal ballistics.
Even non-fatal gunshot wounds frequently have severe and long-lasting effects, even after the victim has made a successful recovery.[4] Typically, the consequences involve some form of major disfigurement and/or permanent disability. As a rule, all gunshot wounds are considered medical emergencies that require immediate hospital treatment.
[edit] See also
[edit] References
- ↑ 1.0 1.1 1.2 Mahoney, P. F., et al. (2004). Section 1 : Introduction, Background and Science p4
- ↑ Mahoney, P. F., et al. (2004). The International Small Arms Situation p6
- ↑ Wound Ballistic Research of the Past Twenty Years: A Giant Step Backwards
- ↑ Negligent discharge page
[edit] Bibliography
- Mahoney, P. F. , Ryan, J., Brooks, A. J., Schwab, C. W. (2004) Ballistic Trauma - A practical guide 2nd ed. Springer:Leonard Cheshire
- Krug E. E., ed. World Report on Violence and Health. Geneva: World Health Organization; 2002.
- World Health Organization (WHO). Small arms and global health. Paper prepared for SALW talks. Geneva: July 2001.
