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I've been working as an EMT in a fairly rural setting. Now I'm moving to a more urban (large) city. I'm brushing up on things like gunshot wounds and how they are treated. Can you direct me to any reading materials that might help?
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Even in urban areas, gunshot wounds are not your everyday, ordinary problems. But they do occur with some regularity in the United States. In fact, there are a reported 80,000 nonfatal gunshot wounds every year. The average EMT, orthopedic surgeon, and other health care professionals won't see a steady flow of these patients, but still must be prepared for any that do show up.
Orthopedic surgeons from the Henry Ford Hospital in Detroit, Michigan have put together an instructional course with a review of musculoskeletal injuries from gunshot wounds. In particular, joint injuries affecting the shoulder, wrist, hip, and ankle are discussed. A separate section is included with a discussion of long-bone fractures affecting the humerus (upper arm bone), forearm, femur (thigh bone), and tibia (lower leg bone).
Of course, your role as the EMT is different from that of the surgeon. You will be stabilizing the fracture site for patient transport and responding to any immediate threat to life and limb. The surgeon will be cleaning up and removing all debris from the wound. The joint will be carefully inspected before stabilizing the bone fracture. Bullets and bullet fragments must be removed to prevent lead toxicity from developing. Any foreign body left in the joint can interfere with normal joint mechanical movement. Over time, this can lead to arthritis.
The extent of damage may be determined by the type of gunshot wound (low- versus high-velocity). Low-velocity gunshot wounds occur when the speed of the bullet is less than 1.5 meters per second. The amount of energy transferred to and through the body at the time of impact determines whether the gunshot wound is a low- or high-velocity injury. Soft tissue defects caused by high-energy gunshot wounds may be severe enough to need skin grafts.
Complications of gunshot wounds are many and varied. Infection, the formation of a fistula (pocket of blood and/or pus), fractures that don't heal, and loss of blood circulation resulting in osteonecrosis (death of bone) are the main concerns early on. Anyone with a significant positive health history for diabetes, heart disease, peripheral vascular disease, or alcohol abuse is at increased risk for delayed wound healing and impaired recovery.
Nerve injuries take a long time to heal. Recovery is slow as the nerve regenerates. Unstable fractures that don't heal increase the risk of a second surgery later on. In some cases, amputation becomes the final treatment required. This is especially likely when blood vessels have been damaged and blood loss to the area causes necrosis (death of soft tissues).
The authors offer details about each type of bone fracture and what to expect. Common patterns of soft tissue involvement for each fracture type are discussed. Treatment approaches such as open vs- closed surgery, internal vs. external fixation, and wound care for war wounds are also discussed at length.
You may be able to glean ideas from the information presented that will help you focus your triage and stabilization procedures. Anything that can be done out on the field to reduce the risk of infection is a huge step in the right direction.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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