Gunshot wounds

[Lenny]

An interesting article in the TOI which I think would be informative to all

[hamiclar01]

Hmmm, funnily enough, I was wondering when this topic might creep up. Not in the locker room bonhomie of my-scar’s-bigger-than-yours, but to put it simply, “What to do saar ,Pappu pager’s pistol has gone off, in his shorts…come quick saar”

So, based on my own Casualty responder experience and the ATLS ethos, here are a few suggestions (bit my tongue on CPR for dummies), to manage the scene on site when poor Pappu finds himself on the wrong end of a speeding bullet.

Gunshot wound : Bystander management

1. Assess : is it safe to approach? Is anyone firing at you. You are not going to be much help to the groaning mass on the floor if you get hit yourself. This might be the time that someone peels off to phone the Police and the Ambulance. If you are alone, you might do just that. (except if the victim is a child, when you would stay and try to stabilise it before leaving the scene).Only when you are sure you’re not in the sights of the Secundrabad sniper , move on to :

2. Assess(2) : Is the victim conscious? Ask a few simple questions :how are you….is a good opener, even if it seems a silly question at the time (how the **** do you think I am ?). if conscious, on to the next bit , if not you might have to brush up your BLS skills, (see the link below)

3. Immobilise : make sure his neck stays neutral, no twisting, no turning. a couple of bricks gathered from around should do that. Also, resist the temptation to turn him on his side to look for the exit wound. Keep him perfectly still and as neutral as you can (difficult with bony fractures), on his back, otherwise you may accentuate any spine injury he might have received.

4. Bleed : Apply direct, firm continuous pressure to visible bleeding points….this might be a few fingers to his wrist, or your whole fist on his groin, smaller bleeds do well with a bit of bandage…..but avoid tourniquets…they accentuate bleeding, since very few people know how to tie them properly.

Keep the pressure on till someone relieves you….either the paramedics or another good samaritan.Take turns with the pressure, don't let it come off. Telling you this seems an insult to your intelligence, but I know of one instance in Delhi where a DTC conductor bled to death in the bus itself after being injured by pickpockets……sadly avoidable, because simple, firm pressure on his groin would have stopped the femoral artery bleed and bought time.

5. Other injuries : try to spot any obvious problems, but keep him still and on his back. If he has knives/axes/tree trunks/arrows sticking out of him at odd angle: DO NOT TOUCH THEM. They need to be removed in the operating theatre. Any attempt to remove them before will only increase the damage.

6. The Rest : there is a lot to gunshots, which is why everyone in A/E, ITU and theatres groans when one is brought in. But, a sensible , basic outline, started in the field by you, will certainly help in limiting damage. Also, this is the link to the Resuscitation council BLS scheme.

http://www.resus.org.uk/pages/bls.pdf

Reading it will give you a rough idea, but please enrol yourself in a local bystander BLS (bystander CPR) course. In case you’ve done one, make sure you go for a refresher every three years….remember the guidelines have changed recently.

All in all, keep cool. An Ounce of common sense will go a long way to help you, and poor Pappu pager

Anand

[Vikram]

Lenny, thank you very much for bringing up a very important, albeit of a darker shade, topic to the notice of our readers.

Anand, thank you very much for the very well written and informative post. BTW, How is your coursework proggressing?
Best-
Vikram

[Lenny]

Thanks Anand
From what you have put together that article should have come with your input
side by side.
Thanks again

Lenny

[hamiclar01]

thanks guys. just thought i'd do my duty towards mankind (really? i hear someone say )

Vikram, end of june should hopefully bring good tidings, and a well deserved break(so i think). btw, SWMBO and i were planning a weekend at stratford upon avon , and thinking of adding Warwick as well. Will you be around this summer....July-Aug?

Lenny, you guessed it. My input .....side by side indeed. Interestingly, with all our stringent gun control laws in India (compared to U.K.), I've actually seen a lot more gunshot wounds in India that in England !!

[mundaire]

Fantastically informative post! Information which could actually someday help save a life. Thank you Lenny for starting the thread and to you Anand for contributing some excellent medical/ first aid advice!

Cheers!
Abhijeet

[Olly]

Guys, came across an interesting graphic to show how different cal. bullets can cause damage to the body.

[snIPer]

This has already been posted by Lenny much earlier - Under a different heading i guess

[Olly]

Oh, guess I missed it out... sorry !!

Mods may pls remove the thread...

[snIPer]

here it is http://indiansforguns.com/viewtopic.php ... ight=lenny

[Olly]

i was abroad during this time.. so i missed it...

[snIPer]

no worries mate. It was like a refresher.

[mundaire]

Both threads merged...

Cheers!
Abhijeet

[OverUnderPump]

The more distortion a bullet experiences whilst inside the body magnifies the amount of tissue damage it causes.In that regard I believe hollow points cause more damage than other point types.

The other kind is a shotgun blast from close range,that would really shred things to bits. Keema ban jata hai.

[The Doc]

The other kind is a shotgun blast from close range,that would really shred things to bits. Keema ban jata hai.

Correction O/U Pump,

It all depends upon like you rightly said the distance, but then please consider the ammo being used. I sincerely hope that you never get to see one for real .

I got to treat 15 patients on a Saturday afternoon after a gun fight ( rather battle) about a month back. Approx 90% had skin/muscle deep pellets. They were as they said and from the concentration of the palettes that I could see all around a guys knee joint , at close quarters. The ammo went PHUSS , thank God.

Flip side , shot guns can be very very nasty. Have seen some guys who have tried to end their lives by firing a shot gun inside their mouths. Asif, I am sure you know the grief .

RP.