Gunshot wounds remain one of the most common traumatic injuries on our planet.

In recent months, we have seen on TV screens a mass of people who received gunshot wounds in peacetime on the territory of Ukraine. Therefore, we understand that no one is immune from this. In order not to be confused in a difficult moment when a trouble happened with you or with people nearby, you need to know certain rules for providing assistance.

In this material, we deliberately avoid real photos of gunshot wounds, our goal is to tell what to do, and not to shock readers with photos that, if desired, can be found on their own.

It is difficult to assess the degree of damage to the body caused by a gunshot wound, and in most episodes everything will be much more serious than it might seem at first glance.

In this case, the best option for the victim is to get to the nearest medical facility as soon as possible.

What is important when providing first aid:

Correctly determine the severity and nature of the damage

Take the right steps to keep the victim alive

Among the gunshot wounds, bullet wounds predominate, shrapnel wounds are less common. For bullet wounds, the inlet is smaller than the outlet.

Once in the human body, a bullet inflicts certain damage on it, which in turn may differ from other traumatic injuries to the body.

The wounds are usually deep, and most often the bullet does not pass through the body and remains inside the body. Contamination of the wound may also occur due to the ingestion of a foreign body.

The severity of damage should be assessed by the following factors:

The place of injury;

The type of injury;

The victim's behavior

Injured arms and legs

Before providing first aid measures for injured limbs, it is necessary to determine whether the victim has bleeding. If an artery is injured when a shoulder or hip is injured, then death can occur within two minutes from blood loss.

You can determine arterial bleeding by the scarlet color of blood and knocking it out in the form of a fountain. Venous blood is dark in color, and its flow is less intense. You can stop bleeding with a tourniquet, pressure bandage, or wound tamponade.

A tourniquet cannot be applied for more than two hours, but usually this time is enough for qualified assistance to arrive or to deliver the wounded to the hospital. It should also be borne in mind that in case of venous or arterial bleeding, a tourniquet is applied above the wound. A pressure bandage should be applied over the wound, directly at the bleeding site. Tamponade of the wound is performed in rare cases. To apply this method, you need some kind of narrow, long object and a sterile bandage, with which you need to fill the wound as tightly as possible, until the bleeding stops visible.

With a fire wound, the victim may develop painful or hemorrhagic shock due to profuse blood loss.

1. Stop bleeding

2. It is necessary that the limbs were slightly raised, for this, the victim should be provided with an appropriate body position

3. Use blood substitute fluids to replace blood loss

4. Apply pain relievers and antishock medications, if available.

5. Cover the victim

The next thing to do is examine the victim for possible bone fractures. If you find them, you need to immobilize the limb, this will help minimize the possibility of damage to muscles, blood vessels, ligaments. Wrap a sterile bandage around the fracture site to secure the limb and prevent wound contamination.

Head wound

A gunshot wound to the head does not cause instant death in about 20% of cases. Due to the large number of vessels in the face of the head, these wounds are usually accompanied by severe bleeding.

A concussion may also occur. Often such injuries are accompanied by a raush state or loss of consciousness, but these moments are not necessarily caused by brain damage.

First of all, place the victim in a horizontal position and ensure a state of rest. In such cases, it is advisable not to touch the wound itself (if it is not a facial one) until the ambulance arrives, the only thing that can be done is to apply a sterile napkin to the wound site.

With a gunshot injury to the head, respiratory arrest or cardiac arrest may occur, then you should resort to indirect heart massage, artificial respiration.

During severe bleeding, if the face is injured, it is necessary to clamp the wound with a sterile swab. Trying to take the patient to the hospital yourself is highly discouraged. If you do decide to carry out the transportation yourself, then you need to take all available precautions to provide the wounded with maximum rest.

Spine injury

With a gunshot wound to the spine, a brief loss of consciousness may occur. The victim is bandaged to stop bleeding and gently moved to a horizontal position. As in the case of a head injury, first aid is limited to stopping the bleeding and establishing a state of rest for the victim. In order to avoid aggravating the condition of the wounded, it is not recommended to independently deliver him to the hospital.

Neck injury

If the neck is injured, damage to the carotid artery, larynx, and spine can occur. If the larynx is affected by a gunshot wound, then you need to immobilize (lay) the victim and stop the bleeding with a sterile bandage.

If the artery was damaged during the injury, then in this case it is worth immediately pinching it with your fingers and tamponade the wound with a sterile bandage. Since death with such an injury can occur within 30 seconds, the above procedure should be carried out as soon as possible. A tourniquet should be applied around the neck as shown in the photo to prevent the person from suffocating. It is also possible to transport the victim in a gentle manner.

Wounds to the chest and abdomen

In the human body, there are three sections in which all organs are located. These departments are the pleural cavity, abdominal cavity and pelvic organs. The first two sections are separated by a diaphragm, and the second two - by the peritoneum. With gunshot wounds to the chest or abdomen, hemorrhage does not always occur outward, because blood can accumulate in these sections. This makes it extremely difficult to determine the severity of the injury.

If the organs of the pleural cavity are injured, then such damage is fraught with the following complications:

1. Pneumothorax - a term meaning the entry of air into the pleural cavity through the opening of the wound

2. Hemothorax - a condition in which blood accumulates in the pleural cavity due to injury

3. Pneumohemothorax occurs when both air and blood accumulate in the pleural cavity.

To avoid getting air into the pleural cavity, apply a gauze napkin to the wound, which must be anointed with petroleum jelly or boric ointment, you can also use a piece of polyethylene or cover the wound with your hand.

The victim should be helped to take a half-sitting position. It is very difficult to stop bleeding, so it is worth calling an ambulance as soon as possible or sending the victim to the hospital (while ensuring complete rest).

If the wound has touched the abdominal organs, then measures should be taken to prevent bleeding and infection. The victim must be placed in a half-sitting position. If necessary, apply anti-shock therapy.

To prevent infection from entering the body, you need to treat the edges of the wound with a disinfectant, and then apply a sterile bandage on it.

Injury to the pelvic organs

With a gunshot wound to the pelvic organs, the following complications can occur:

- nerve damage,

- bone fractures,

- ruptured arteries and veins.

Stopping heavy bleeding is carried out with a tight tamponade at the wound site. If there is a fracture of the pelvic bone, then it is necessary to create immobility conditions for the damaged part of the body. It is also worth preventing infection from entering the body. With such injuries, the transportation of the wounded should be carried out in a sparing mode.

Useful Tips

When providing first aid, a dressing is always needed. When he is not at hand, you have to use a handkerchief, pieces of clothing; but if you have found a place to store the pistol, then maybe the sterile bag will fit in your pocket. A first aid kit is required in the car. At home, it is advisable to have a first aid kit no worse than a car one. The most necessary thing for blood loss is blood substitution solutions, sold in pharmacies without a prescription, along with an intravenous injection machine.

Do not forget that some advice can be obtained by phone when calling an ambulance. It is better if by the time you call an ambulance you have correctly identified the injury and the condition of the victim. Remember that it is not uncommon for the victim to be unable to be saved due to the fact that, based on the message from the ambulance, the operator directed a doctor of another profile to the scene of the accident.

In some cases, self-delivery of the victim to the hospital is preferable (faster). City hospitals take turns on duty. The address of the hospital on duty can be obtained by calling the ambulance. The dispatcher can warn the emergency room of the hospital where you intend to take the wounded about the nature of the injury so that the medical staff can prepare to receive the victim.

Gunshot wounds of the upper limb

What is Gunshot wounds to the upper limb -

Exceptional variety gunshot wounds to the upper limbs is determined, on the one hand, by the characteristics of the wounding projectile, on the other, by the features of the bone structure. The complexity of diagnosing the true nature of the damage, the severity of soft tissue injuries associated with fractures, the general severe reaction of the body to any gunshot injury are characteristic of gunshot wounds. There are many classifications for gunshot fractures.

Healing of wounds and consolidation of gunshot fractures of the upper limb are more favorable than those of the lower ones. Widespread purulent, anaerobic infection, osteomyelitis are less common. The conditions for this are wide incisions, thoroughness in performing the procedure for excising non-viable tissues, if necessary, timely secondary necrectomy, which should not be postponed if indicated. In the event of open wound and granulating surfaces, an early secondary or late secondary suture cannot always be applied, therefore, in such situations, it is imperative to keep in mind the use of free skin grafting, and if necessary, use the skin stem according to Filatov.

Pathogenesis (what happens?) During Gunshot wounds of the upper extremities:

• Shoulder fractures

Gunshot wounds with fracture of the humerusaccount for about 4/3 of all shoulder injuries. In addition to deformation or vicious position of the limb, pathological mobility at the site of the fracture, dysfunction of the limb, pain in the fracture zone, the results of measuring the length of the limb, one should take into account such a sign as the presence of fat droplets in the wound discharge.

With gunshot wounds to the shoulder region, especially in the upper third of the shoulder, combined wounds are not so rare, when the same wounding projectile: a bullet, a splinter - first causes a fracture of the humerus, and then penetrates the pleural cavity, causing injury to the lung, blood vessels, other anatomical structures. In some cases, together with a fracture of the humerus, the scapula may be injured, and bone fragments seriously injure the muscles above and below the scapula. Since the direction of soft tissue injury does not always correspond to the true direction of the wound channel, it is especially important to thoroughly physical and X-ray examination of the patient, including chest X-ray in two projections, and, if necessary, in a larger number of projections.

The question of the need for thoracotomy for such injuries should be decided on the basis of the firmly established principles of military field surgery: thoracotomy is indicated only with ongoing intrapleural unstoppable bleeding, large hemothorax and valvular pneumothorax, unavoidable by conservative measures.

• Forearm injuries

2/3 of the wounded in the forearm are admitted to the hospital without signs of suppuration. Subject to thoroughly performed surgical treatment and stable fixation of bone fragments, the results of treatment of this category of wounded can be considered quite satisfactory. Apparatus for transosseous osteosynthesis should be considered the method of choice for immobilization of fragments. With gunshot wounds to the forearm, it is often necessary to resort to free skin grafting to close skin defects.

Feature of gunshot wounds to the forearm is a frequent nerve injury requiring subsequent neurolysis and nerve suture.

• Injured hand

The variety of gunshot injuries to the hand is very large. Not uncommon - wounds by shrapnel with the main localization of the injury in another area. Extensive damage to bone, muscle and tendon structures occurs when the left hand is wounded at close range.

Treatment of gunshot wounds to the upper extremities:

• Shoulder fractures

Most often, during the surgical treatment of a gunshot shoulder fracture, the wound is dissected, bone fragments and foreign bodies are removed, and then soft tissues are excised. Thus, when the shoulder is injured, relatively simple surgical manipulations are performed, which is explained by the relatively small volume of muscles, the absence of dense fascial layers, less contamination of the wound, and a relatively high percentage of through wounds.

In severe, finely splintered fractures of the upper third of the humerus, it may be necessary to completely remove the proximal end of the humerus. In this case, complete wound healing is achieved and subsequently resorted to endoprosthetics of the proximal end of the humerus. Since with such fractures it is not always possible to fix the fragments with the help of an external fixation device, one has to resort to an abduction splint, a thoracobrachial bandage. Submersible osteosynthesis for gunshot fractures of the forearm bones, and not only them, can be used only in extremely favorable situations: with the general good condition of the wounded, carefully performed surgical treatment, a sufficient number of well-supplied muscles, with the possibility of closing the wound without tension, good drainage, monitoring the patient by the operating surgeon.

Gunshot fractures of the shaft of the shoulderare usually cross-cutting. Surgical treatment of such fractures is carried out according to the general rules, carefully protecting the radial nerve from additional trauma. In case of a gunshot shoulder fracture, the best fixation methods are the Ilizarov apparatus, as well as a plaster cast thoracobrachial bandage.

For through fractures of the shoulderand large outlets can be limited to surgical treatment of only the outlet. In this case, sufficient access, conditions for excision of non-viable tissues, matching of bone fragments and subsequent drainage are provided.

A significant number of gunshot fractures of the humerus can be repaired after surgical debridement on a discharge splint fixed to the body with plaster rings. The same rings are used to fix the shoulder with the forearm on the splint.

If an external fixation device is not used for gunshot wounds to the shoulder or forearm for any reason, a thoracobrachial bandage can be used in the position of the arm in the abduction. The bandage is relatively easily tolerated by patients, simplifies their subsequent management and, when the hand is fixed for 2-3 weeks, does not cause stiffness in the shoulder joint. It is convenient to apply such a bandage at the end of the operation under general anesthesia. In the interval from the 5th to the 8th day in a thoracobrachial bandage, if necessary, cut out a "window" in the projection of the wound and carry out the necessary therapeutic measures, such as the application of delayed sutures or free skin grafting.

It is advisable to divide the shortening of the upper limb segments into functionally compensated (up to 4 cm), conditionally compensated (4-6 cm) and uncompensated (more than 6 cm).

• Forearm injuries

A technique has been developed for introducing the needles on the bones of the forearm, as well as a special conductor that allows the needles to be inserted at the desired angle.

Using conservative and surgical methods of treatment, it is possible to restore the anatomical integrity of the bones in almost 90% of the wounded. Approximately 10% of the wounded have persistent defects, false joints; a high percentage (more than 20) of contractures is characteristic.

• Injured hand

The main condition for a successful operation for a gunshot fracture of the hand is its production in a specialized hospital using special instruments, an operating microscope, etc.

It should be considered proven that the intervention on the hand should be final, in other words: the operation should be performed by a specialist who knows the techniques of interventions on the hand. Therefore, such victims should be left in a specialized institution, and operate at other stages only with the aim of stopping bleeding, prophylactic administration of antibiotics, bandaging and transport immobilization.

Hand injury is of particular importance in terms of the importance of the organ and the features of the anatomical structure. It should be considered quite reasonable in most cases to divide the treatment of hand injuries into two stages - primary surgical treatment and final reconstructive interventions in specialized medical institutions. American surgeons in Vietnam, with sufficiently good equipment and trained personnel, used a two-stage technique for wounds of the hand.

When determining the time and type of surgical intervention, one should proceed primarily from the nature of the injury and its severity, the time elapsed since the moment of injury or injury, and evacuation capabilities. It is also necessary to take into account the patient's age, his general condition, profession.

Gunshot wounds of the hand, as a rule, are accompanied by bone fractures, and with injuries to the fingers, tendons and very often joints are almost certainly affected, with the formation of external or intra-articular fractures.

In itself, an injury to the hand can rarely be the cause of the shock state of the wounded, in such cases one or more injuries should always be looked for. Delay in surgical treatment of the hand is justified with a good primary medical dressing and reliable immobilization, although purulent infection is a frequent companion of hand wounds, especially with damage to the wrist bones.

First aid for wounds of the handconsists of applying a sterile bandage, sometimes a pressure bandage. With common injuries of the hand, immobilization with a scarf or with the help of standard tools is indicated. The wounded hand must be fixed in a functionally advantageous position, for which the wounded person is put in a tight lump of cotton and fingers are placed on it, the entire hand is bandaged to a ladder or mesh tire modeled on the palmar surface.

Rendering surgical carewounded in the hand should be limited at the stage of qualified surgical care only by stopping bleeding and immobilization, since without an X-ray image it is impossible to proceed with complex surgical treatment of a hand wound.

When surgical treatment of large wounds of the hand, general anesthesia is preferable; conduction or intraosseous anesthesia can be used.

The surgeon should perform hand operations with the help of an assistant. The prerequisites are a well-lit surgical site, sufficient time and a good surgical instrument and suture material.

Thorough preparation of the surgical site is very important: nails should be cut short, hair shaved off, the entire brush should be thoroughly washed with warm water and soap.

Good hemostasis is very important for hand interventions, which is controlled by periodically removing the tourniquet; the tourniquet should be on the arm for no more than 1 hour continuously.

If the ulnar or radial arteries are injured, one of them can be bandaged, but in no case both, as this will cause necrosis.

The skin on the hand can be excised only if it is indisputably unviable; in other cases, even heavily contaminated skin should be preserved.

During surgical treatment, it is necessary to carefully examine the deep formations of the hand, to determine the degree of damage to all structures. For severe hand injuries, a transverse incision of the transverse carpal ligament is advisable.

Necrotic muscles, blood clots, foreign bodies are removed. It is advisable to save not very dirty bone fragments. Obviously unviable tendons should be removed, but literally every millimeter of viable tissue must be fought for.

Amputation of fingers is indicated in cases of obvious necrosis. This is especially true for the first finger. Sometimes at least some of the skin from the amputated toe should be retained to close the defect in the remaining one.

When the fingers are amputated, a flap is cut out, carefully ligating the blood vessels and sawing the phalanx with a thin file. After crossing, the tendons should be sutured to the periosteum.

The ends of the damaged nerves usually extend far to the sides. They should not be sought during initial surgical debridement, but if possible, nerve ends should be brought closer to relatively healthy tissue and the nerves should be fixed with non-absorbable suture material.

In most cases, it is better to close the wound with a delayed primary suture. The use of thin Kirschner wires for fixing fractures and dislocations of the phalanges of the fingers is shown. With intra-articular fractures of the interphalangeal or metacarpophalangeal joints, in cases where the articular ends of the bones are completely crushed, one should resort to very economical removal of these areas. We must not forget about the mandatory immobilization of the hand after any intervention on it.

The dressing should cover the entire wound, but not pinch it. Healthy fingers should be visible. The hand is fixed in a functionally advantageous position.

Surgical treatment of a gunshot wound to the hand is not indicated for through wounds of the hand and fingers with pinpoint inlet and outlet holes, with tangential injuries to the fingers and hand, provided that the wound has smooth edges, as well as for superficial fine-splintered wounds.

In the postoperative period, physical therapy is especially indicated for wounded with injuries of the hand and fingers.

Which doctors should you contact if you have gunshot wounds to the upper limb:

• Traumatologist
• Surgeon

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Other diseases from the group Injury, poisoning and some other consequences of exposure to external causes:

Arrhythmias and heart block in cardiotropic poisoning

Depressed skull fractures

Intra- and periarticular fractures of the thigh and lower leg

Congenital muscle torticollis

Congenital malformations of the skeleton. Dysplasia

Lunate dislocation

Dislocation of the lunate bone and the proximal half of the scaphoid (de Quervain fracture dislocation)

Tooth dislocation

Dislocation of the scaphoid

Dislocations of the upper limb

Dislocations of the upper limb

Dislocations and subluxations of the radial head

Dislocations of the hand

Dislocations of the foot bones

Dislocations of the shoulder

Dislocations of the vertebrae

Dislocation of the forearm

Dislocations of the metacarpal bones

Dislocations of the foot in the Chopard joint

Dislocations of the phalanges of the toes

Diaphyseal tibial fractures

Diaphyseal tibial fractures

Old forearm dislocations and subluxations

Isolated fracture of the shaft of the ulna

Curvature of the nasal septum

Tick \u200b\u200bparalysis

Combined damage

Bony forms of torticollis

Posture disorders

Knee instability

Gunshot fractures in combination with soft tissue defects of the limb

Gunshot injuries to bones and joints

Gunshot injuries to the pelvis

Gunshot injuries to the pelvis

Gunshot wounds of the lower limb

Gunshot wounds of joints

Gunshot wounds

Burns from contact with a Portuguese boat and jellyfish

Complicated fractures of the thoracic and lumbar spine

Open injuries of the shank diaphysis

Open injuries of the shank diaphysis

Open injuries to the bones of the hand and fingers

Open injuries to the bones of the hand and fingers

Open injuries of the elbow joint

Open injuries of the foot

Open injuries of the foot

Frostbite

Poisoning with aconite

Aniline poisoning

Poisoning with antihistamines

Poisoning with antimuscarinic drugs

Acetaminophen poisoning

Acetone poisoning

Poisoning with benzene, toluene

Toadstool poisoning

Poisoning with a poisonous milestone (cicuta)

Poisoning by halogenated hydrocarbons

Glycol poisoning

Mushroom poisoning

Dichloroethane poisoning

Smoke poisoning

Iron poisoning

Isopropyl alcohol poisoning

Poisoning with insecticides

Iodine poisoning

Cadmium poisoning

Acid poisoning

Cocaine poisoning

Poisoning with belladonna, bleached, dope, cross, mandrake

Magnesium poisoning

Methanol poisoning

Methyl alcohol poisoning

Arsenic poisoning

Indian hemp drug poisoning

Poisoning with hellebore tincture

Nicotine poisoning

Carbon monoxide poisoning

Paraquat poisoning

Poisoning by vapors of concentrated acids and alkalis

Poisoning by oil distillation products

Poisoning with antidepressant drugs

Salicylate poisoning

Lead poisoning

Hydrogen sulfide poisoning

Carbon disulfide poisoning

Poisoning with hypnotics (barbiturates)

Poisoning with fluoride salts

Central nervous system stimulant poisoning

Strychnine poisoning

Poisoning by tobacco smoke

Thallium poisoning

Poisoning with tranquilizers

Acetic acid poisoning

Phenol poisoning

Poisoning with phenothiazines

Phosphorus poisoning

Poisoning with chlorine-containing insecticides

Poisoning with chlorine-containing insecticides

Cyanide poisoning

Ethylene glycol poisoning

Ethylene glycol ether poisoning

Poisoning with calcium ion antagonists

Poisoning with barbiturates

Beta-blocker poisoning

Poisoning with methemoglobin formers

Poisoning with opiates and narcotic analgesics

Poisoning with quinidine drugs

Pathological fractures

Upper jaw fracture

Distal radius fracture

Tooth fracture

Broken nose bones

Scaphoid fracture

Fracture of the radius in the lower third and dislocation of the distal radius-elbow joint (Galeazzi injury)

Fracture of the lower jaw

Fracture of the base of the skull

Fracture of the proximal femur

Fracture of the cranial vault

Jaw fracture

Fracture of the jaw in the area of \u200b\u200bthe alveolar bone

Skull fracture

Fracture dislocations in the Lisfranc joint

Fractures of the talus

Fractures dislocations of the cervical vertebrae

Fractures of the II-V metacarpal bones

Fractures of the hip in the area of \u200b\u200bthe knee joint

Femur fractures

Trochanteric fractures

Fractures of the coronoid process of the ulna

Acetabular fractures

Acetabular fractures

Radial head and neck fractures

Sternum fractures

Femoral shaft fractures

Fractures of the diaphysis of the humerus

Fractures of the diaphysis of both bones of the forearm

Fractures of the diaphysis of both bones of the forearm

Fractures of the distal end of the humerus

Clavicle fractures

Bone fractures

Fractures of the shin bones

Hindfoot fractures

Fractures of the bones of the hand

Forefoot fractures

Forearm fractures

Fractures of the bones of the middle part of the foot

Fractures of the bones of the middle part of the foot

Fractures of the bones of the foot and toes

Pelvic fractures

Bone fractures in children

Fractures of the olecranon of the ulna

Scapula fractures

Brachial condyle fractures

Patella fractures

Fractures of the base of the I metacarpal bone

Humerus fractures

Metatarsal fractures

Spine fractures

Fractures of the proximal end of the tibia

Is a wound resulting from the action of shells (bullets, shrapnel, buckshot, shrapnel, shot) fired from firearms. Distinctive features of gunshot wounds are a severe reaction of the body, massive tissue damage, a significant duration of healing, a large number of infectious complications and deaths. Pathology is diagnosed on the basis of anamnesis, examination data and X-ray examination. Treatment includes anti-shock measures, replenishment of blood loss, PHO with suturing or removal of damaged organs, dressings and antibiotic therapy.

ICD-10

W34 X95

General information

A gunshot wound is a set of injuries resulting from the action of a projectile fired from a firearm. In character and course it differs from other types of wounds. It is accompanied by the formation of a large array of non-viable tissues and a severe general reaction of the body. There is a tendency to prolonged healing and frequent complications.

With gunshot wounds, all types of damage to organs and tissues can be observed: violation of the integrity of nerves, muscles and blood vessels, fractures of the bones of the trunk and limbs, damage to the chest, as well as damage to any hollow and / or parenchymal organs (larynx, liver, etc.). Injuries with damage to internal organs pose a great danger to life and are often fatal. Orthopedic traumatologists, thoracic surgeons, vascular surgeons, abdominal surgeons, neurosurgeons and other specialists can treat gunshot wounds, depending on the damage to certain organs and tissues.

The reasons

The gunshot wound is the main type of injury in the conduct of hostilities. It is relatively rare in peacetime and can be the result of criminal incidents or hunting accidents.

Pathogenesis

For gunshot wounds, certain features are characteristic that distinguish them from other types of wounds. A zone of dead tissue (primary necrosis) is formed around the wound channel. The wound channel has an uneven direction and length. With through wounds, an exit hole of significant diameter occurs. In the wound, foreign particles are found drawn there due to the high speed of the projectile. After a while, new areas of dead tissue (foci of secondary necrosis) are formed around the gunshot wound.

The destructive effect of the projectile is due to two components: a direct impact, that is, a direct impact on the tissue and a lateral impact, that is, the action of a shock wave, which instantly forms a high-pressure zone, throwing the tissue to the side. Subsequently, the resulting cavity "collapses" abruptly, a negative pressure wave appears, and the tissues are destroyed due to the huge difference between negative and positive pressure.

Taking into account the peculiarities of the traumatic effect in any gunshot wound, three zones are distinguished: a wound canal or a wound defect (a zone of direct impact of a projectile), a contusion area (in this zone, primary necrosis is formed) and an area of \u200b\u200bconcussion (a secondary necrosis is formed in this zone). The wound defect can be true or false. A true defect is formed when a piece of tissue is pulled out ("minus" tissue), a false one - when the disconnected tissues contract (for example, when damaged muscles contract).

Classification

Treatment of a gunshot wound

The first step is to stop the bleeding. With slight or moderate bleeding, the wound is closed with a pressure bandage; with abundant bleeding, a tourniquet is applied above the injury site. The victim is given pain relievers, if possible, an intramuscular injection of analgesics is performed. The patient is placed in a horizontal position (with the exception of wounds in the chest, in which, to facilitate breathing, the patient should be given a sitting or semi-sitting position), immobilization is performed using special tires or improvised means.

If the delivery of the victim to honey. the institution is difficult or postponed, at the primary health care point, anti-shock measures are carried out and prevention of wound infection is carried out by injecting antibiotics intramuscularly, washing the wound canal with antibiotic solutions, and also performing injecting the wound area.

The volume and sequence of medical measures in a specialized institution are determined taking into account the patient's condition. They replenish the BCC, carry out anti-shock measures, perform surgical treatment of wounds. In the course of surgery, contaminated and non-viable tissues are excised, if possible, the wound is washed and drained. Damaged vessels are ligated, damaged organs are partially excised and sutured or completely removed, small fragments of bones are removed, large fragments are compared. Usually, skeletal traction is applied at the initial stage for complex and unstable fractures.

With a wound channel of a small diameter, sutures are not applied to the gunshot wound; with a large defect, the edges of the wound are matched using rare single sutures. Contraindication to surgical intervention is agonal state and traumatic shock. Shallow tangential wounds, multiple shrapnel and small superficial "stuffed" gunshot wounds are not subject to surgical treatment.

In the postoperative period, antibiotics are prescribed, the correction of hypovolemia is continued, and dressings are performed. Subsequently, it is possible to impose delayed primary sutures (after 5-6 days), early secondary sutures (after 10-12 days) and late secondary sutures (after 3 weeks). Since gunshot wounds, as a rule, heal through suppuration, in the long-term period with such injuries, reconstructive interventions are often required: skin grafting, tendon plastics, nerve repair, intra- and extrafocal osteosynthesis, etc.

In today's turbulent world, you need to be prepared for any situation. And sometimes you just need to know a few simple rules that can save a person's life. This article should talk about what a gunshot wound is and what kind of assistance can be provided to a wounded person before the arrival of an ambulance.

About terminology

At the very beginning, you need to understand the concepts that will be actively used in the article. So, a wound is damage to organs and tissues, which is accompanied by a violation of the integrity of the skin. Wounds are accompanied by pain, bleeding, dehiscence of the edges of the damaged areas and, of course, often disruption of the normal functioning of the damaged part of the body. A gunshot wound is damage sustained with a firearm.

About the types of wounds

It should also be said that the gunshot wound can be different. The first classification - depending on the presence of the inlet and outlet:

1. Blind wound. In this case, the injured object becomes stuck in the human body.
2. Through wound. In this case, the object that injures the body passes through the tissue.

Second classification, depending on the subject of injury:

1. Injury of soft tissues - skin, muscles, nerve endings, tendons, blood vessels.
2. Bone damage.

The following classification is based on the penetration of the injuring object:

1. Wound penetrating the body cavity. In this case, the bullet penetrates into the abdominal, cranial, articular and other cavities of a person.
2. Wound that does not penetrate into the body cavity.

And the last classification is by the mechanism of wounding. In this case, a distinction is made between cut, stabbed, chopped, bitten, scalped, crushed, bruised, lacerated and, of course, gunshot wounds.

First aid

Properly provided first aid for a gunshot wound is very important. Indeed, sometimes it happens that before the ambulance arrives, a person may die, simply without waiting for the simplest actions from strangers. And everything happens due to the fact that people most often simply do not know how to act correctly and what needs to be done to save a person from death. How can you help a victim if he has a gunshot wound?

1. At the very beginning, the wound must be freed from clothing. This is necessary in order to evaluate it and understand how serious the bleeding is.
2. Further, it is imperative to stop the bleeding, even if it is insignificant at first glance. If the blood leaves a little, you can simply raise the wound site so that it cannot flow out (if the limbs are injured). Otherwise, the place of bleeding should be pinched with a finger (by squeezing the blood artery). Next, you need to try to apply a tourniquet slightly above the wound itself. If nothing suitable is at hand, you need to tear off a strip of fabric from your clothes and squeeze the place above the wound tightly.
3. Wound treatment. Only if the bleeding has stopped, you should try to rinse and disinfect the wound. It is good to use alcohol or hydrogen peroxide for this. Further, the area around can be treated with iodine to avoid contamination. And only after that, the wound can be bandaged with a sterile bandage. All of these medicines should be in any car medicine cabinet. So if there was a gunshot wound, you need to try to stop any car and ask the driver for a first aid kit.
4. If the bullet hit the bone (it is very difficult to determine this "by eye"), the wound site must be properly fixed. So, you will need to apply a splint. For this, any materials at hand can be useful.
5. It is important to remember that a person with a gunshot wound cannot always be moved or transported independently. Sometimes a bullet damages internal organs so that the slightest unskilled movement can greatly harm a person. So it’s best not to touch the wounded until the ambulance arrives. The only thing is to try to protect it from hypothermia, overheating or rain.

Limb injury

Separately, it is also necessary to talk about the dangers of gunshot wounds to the limbs. So, these are the most common wounds. In addition, they are very dangerous, because they are fraught with severe blood loss. Therefore, in the case of a gunshot, a person's limbs at the very beginning need to find the wound itself and do everything to stop the blood. By the way, by its color you can determine whether it is venous or arterial. Venous blood is dark in color. Arterial, however, is most often scarlet, it also comes out of the body of the wounded with a fountain. If the bleeding is venous, it is better to apply not a tourniquet, but a pressure bandage. In any case, it is worth remembering that all these auxiliary items can be applied to the body for no more than two hours (most often, during this period of time, the wounded person is already transferred to the hands of ambulance doctors). You also need to determine whether the integrity of the bones in a person is not violated. If the bone is broken, it must be fixed in an immovable position. It is also worth remembering that if a person has a gunshot wound, it can happen. In this case, you need to give If there are no such at hand, do not panic. After a while, consciousness will return to the wounded. It is not necessary to hit on the cheeks, bringing a person to his senses.

Head wound

The most dangerous is probably a gunshot wound to the head. After all, the survival rate in such cases is not very high - about 16%. But it is also necessary to provide assistance to the victim with such a wound. It should be said here that when a person is injured, a person will have a lot of blood, since this is where multiple vessels are located. Loss of consciousness by a person does not mean his death, it is worth remembering about it. Procedure for head injury:

1. The wound should be covered with a sterile tissue. If it bleeds a lot, you can try to stop the bleeding with a cotton swab.
2. It is best if the human body is horizontal.
3. It is not worth transporting the wounded on your own, it is better to wait for the arrival of an ambulance.
4. If a person has cardiac arrest, artificial respiration and heart massage should be done.

Neck and spine

It is not difficult to figure out what gunshot wounds look like, the photos in this case are the first clues. So, in case of injury to the neck or spine, you need to remember that a person can absolutely not be transported. The only thing is to put it on a hard surface. If the neck is bleeding, you need to try very quickly to stop the bleeding. After all, if pierced from blood loss, you can die in 15 seconds. So, you need to put a bandage on your neck. If it does not help, the artery should be pinched with a finger and kept in this position until the ambulance arrives.

Wounds in the chest, abdomen

Separately, it is also necessary to consider a gunshot wound to the abdomen and chest. So, at the very beginning, it must be said here that the human body is divided into three main zones: pleural, abdominal and pelvic organs. If a person's injury is internal, blood begins to accumulate in these areas. In this case, it is impossible to stop bleeding on your own. Complications of internal injuries:

1. Pneumothorax. This is the ingress of air into the pleural cavity through the place of the firearm.
2. Hemothorax. This is the ingress of blood into the pleural cavity.
3. Pneumohemothorax. This is the ingress of air and blood into the pleural cavity together.

You can only try to prevent air from entering. So, for this, the wound must be covered with a dense material or squeezed with a hand.

Bullet extraction

As mentioned above, gunshot wounds are very dangerous for human life (photos of the wounded are the first confirmation of this). However, in some cases, if there is absolutely no way to get qualified medical care, you can try to remove the bullet yourself. But this must be done very carefully and only if the arrival of doctors is impossible for certain reasons. Algorithm of actions:

1. First, the one who will carry out all the actions is prepared. Hands need to be treated with an antiseptic.
2. The skin around the wound is treated with an antiseptic.
3. If possible, an anesthetic should be given to the injured person. It can be the drug "Spazmalgon" or an ampoule of the drug "Novocain". If this is not the case, a hard object should be given to the person's teeth.
4. Use a knife to slightly increase the size of the bullet hole. Next, treat everything with an antiseptic again.
5. With the help of treated tweezers, you need to try to get the bullet. It is necessary to try not to touch the large blood arteries, as a person can die due to, i.e., loss of blood.
6. After the operation, the wound needs to be treated again and a bandage applied.

Expertise

If a person is injured, it is necessary to call not only an ambulance (although it is in the first place), but also police officers. Thus, forensic medical examination of gunshot wounds will also be mandatory. It is designed to answer the following questions:

1. The nature of the injury.
2. Direction of the wound channel, shot.
3. The distance that was between the offender and the victim.
4. The type of weapon used.
5. Number of bullet wounds.
6. The sequence of inflicting bullet wounds (in the event that there was more than one).
7. Whose hand was the damage: by his own or by the hand of another person.

It is worth saying that the forensic medical examination of gunshot wounds gives the investigation multiple important answers to questions, thanks to which it can move several steps forward.

Arrival of doctors

It is very important precisely with a gunshot wound. So, only specialists can provide that help to a person that can save his life. However, the importance should not be diminished in the least. After all, this can also save the life of the victim.

Before performing any actions, you need to assess the severity of the damage by three factors: the type and location of the injury, the condition of the victim. It is important to remember that the damage from firearms is deep, the bullet remains inside the body or goes through.

First aid for a gunshot wound to the head

Most headshots result in instant death. If the victim is alive, he must be carefully placed on a flat surface and ensure complete rest. If bleeding is severe, cover your head with a sterile tissue.

Under no circumstances should the victim be disturbed and transported to the hospital. This can lead to cardiac and respiratory arrest.

Gunshot wounds to arms and legs: what to do before the ambulance arrives?

With gunshot injuries to the extremities, the main danger is profuse bleeding if an artery is affected. The death of an injured person can occur within minutes after being wounded, so you need to act quickly. A tourniquet is needed to reduce blood loss.

After stopping bleeding, bandage the wound with a sterile bandage and immobilize the injured arm or leg. The condition can be alleviated with anti-shock and pain relievers.

How to deal with a gunshot wound to the chest and abdomen?

If the abdomen or chest is injured, then first you need to determine the extent of the damage. The internal organs that have fallen out do not need to be repositioned. Provide the victim with complete rest: lay on his back and bend his knees.

To prevent infection, the area around the wound should be treated with a disinfectant and a sterile dressing should be applied. Severe bleeding is difficult to stop, often the victim's condition worsens due to internal bleeding.

If the heart is damaged, then the condition of the wounded changes quickly, loss of consciousness is possible, the complexion becomes sallow. A gunshot wound can cause acute heart failure, filling the pericardium with blood, and other deadly organ problems. With such injuries, it is necessary to provide the victim with complete rest; only a specialist can provide first aid.

To save the life of a person with a gunshot wound, you need to determine the extent of the damage as soon as possible and provide first aid before the ambulance arrives. If you do not know how to help the victim, you can consult with the specialist who takes the call by phone.