2. DEFINITION
• A gunshot wound (GSW) is a penetrating injury caused by a
projectile (e.g. a bullet) from a gun.
• Damages may include bleeding, bone fractures, organ
damage, wound infection, loss of the ability to move part of
the body and, in more severe cases, death.
• Damage depends on the part of the body hit, the path the
bullet follows through the body, and the type and speed of
the bullet.
• Long-term complications can include lead poisoning and post-
traumatic stress disorder (PTSD).
3. •Gunshot wounds are among the most common causes
of death and injury in industrialized countries.
•The analysis and interpretation of gunshot wounds is
critical, and the forensic pathologist must have a
thorough knowledge of the features of theses
injuries.
4. CLASSIFICATION
Gunshot wounds are classified according to the speed
of the projectile using the Gustilo open fracture
classification:
• Low-velocity: Less than 1,100 ft/s (340 m/s)
Low velocity wounds are typical of small caliber
handguns and display wound patterns like Gustilo
Anderson Type 1 or 2 wounds
5. • Medium-velocity: Between 1,200 ft/s (340 m/s) and 2,000
ft/s (610 m/s)
These are more typical of shotgun blasts or higher caliber
handguns like magnums. The risk of infection from these types
of wounds can vary depending on the type and pattern of bullets
fired as well as the distance from the firearm.
• High-velocity: Between 2,000 ft/s (610 m/s) and 3,500 ft/s
(1,100 m/s)
Usually caused by powerful assault or hunting rifles and usually
display wound pattern similar to Gustilo Anderson Type 3
wounds. The risk of infection is especially high due to the large
area of injury and destroyed tissue.
6.
7. FEATURES OF MODERN COMBAT INJURY
• In modern warfare, the combat injury pattern is complicated
and always combines several injuries, including extensive
burns, multiple trauma, bone fracture, hemorrhage, infection,
sepsis, and organ damage, each of which can activate the
immune response.
• In a severe and combined injury, immune response disturbance
occurs, and finally, immunosuppression leads to sepsis and
multiple organ dysfunction syndrome (MODS).
• In the wake of revealing a possible mechanism concerning
immune dissonance, we have understood that immune
modulation is vital and indispensable in the treatment of sepsis
and MODS, which should not be limited in exploring cytokines
and molecules directly regulating immune cells.
8. • Other factors involved in immunomodulation must also be
considered; for instance, cellular biological processes are
markedly changed in acute insults and contribute to the
responsiveness of immune cells, including metabolism, apoptosis,
necroptosis, autophagy, and intercell communications.
• Taken together, the reviews and research in the current
thematic series shed light on the exploration of novel
interventional strategies for better therapy for combat injury.
Although there remains a gap between the bench and the
bedside or battlefield, it is our belief that a comprehensive
consideration must lead to the significant development of clinical
therapies in the future.
9. ESSENTIAL FEATURES
• Determining the range of fire is one of the most critical parts of the
forensic pathologist activity; secondary effects of the discharge
surrounding the entrance wound (muzzle imprint, soot deposition, stippling or
blackening of the skin edges) can help estimate the firing range
• Entrance wounds can be round, oval or irregular (atypical); an abrasion ring is
almost always present
• Exit wounds are usually irregular and there is no abrasion ring in the vast
majority of cases; there are no secondary effects of the discharge
• Wound mechanism and injury severity are mostly related to the kinetic
energy transferred by the bullet to the tissues with the development of 2
cavities within the body: the permanent and temporary cavities
• At autopsy, it is essential to provide proper documentation (by photographs
and body diagrams) of the gunshot wound's features
10.
11. BALLISTICS
• Ballistics is the science of mechanics that deals with the
flight, behaviour and effects of weapons and bullets.
INTERNAL BALLISTICS
TERMINAL BALLISTICS
(WOUND BALLISTICS)
EXTERNAL BALLISTICS
12. • Internal ballistics: The study of motion of projectile inside
the barrel of the gun. Ballistic experts deal with internal
ballistics.
• External ballistics: The study of motion of the projectile after it
leaves the barrel and before it hits the target. This too comes in
purview of the ballistic experts.
• Terminal ballistics: also called wound ballistics is the study
of projectile’s impact on the tissues. This comes in domain of
the doctor treating a patient with a firearm injury or in case of
death, a forensic expert. As a doctor is the first person to
evaluate the wounds of a person injured by a firearm, it is his
responsibility to record the wound precisely so as to help the law
enforcing personnel in investigating the crime.
13.
14. FIREARMS
Firearms of forensic interest can be generally classified as:
• Handguns (pistols and revolvers)
• Long guns (shotguns and rifles)
• Rifled: the barrel contains spiral lands and grooves into the
inside of the barrel that grips the bullet as it exits the
firearm, providing spin and stabilization along its path
• Smoothbore: the barrel is not rifled; typically found in
shotguns
16. BULLETS
During its travel, the bullet is subject to rotational forces
causing:
• Yawing: oscillation of the bullet along its longitudinal axis
• Tumbling: bullet loses its gyroscopic stability, presenting a
continually changing surface to the direction of motion
• Precession: rotation of the bullet around the center of mass
• Nutation: circular movement of the tip of the bullet
18. PREVENTION
• Medical organizations in the United States recommend a
criminal background check being held before a person buys a
gun and that a person who has convictions for crimes of
violence should not be permitted to buy a gun.
• Safe storage of firearms is recommended, as well as better
mental health care and removal of guns from those at risk
of suicide.
• In an effort to prevent mass shootings greater regulations
on guns that can rapidly fire many bullets is recommended.
19. MANAGEMENTS
Initial assessment for a gunshot wound is approached in the same way as other
acute trauma using the advanced trauma life support (ATLS) protocol. These
include:
• A) Airway - Assess and protect airway and potentially the cervical spine
• B) Breathing - Maintain adequate ventilation and oxygenation
• C) Circulation - Assess for and control bleeding to maintain organ perfusion
including focused assessment with sonography for trauma (FAST)
• D) Disability - Perform basic neurological exam including Glasgow Coma Scale
(GCS)
• E) Exposure - Expose entire body and search for any missed injuries, entry
points, and exit points while maintaining body temperature
Depending on the extent of injury, management can range from urgent surgical
intervention to observation. As such, any history from the scene such as gun
type, shots fired, shot direction and distance, blood loss on scene, and pre-
hospital vitals signs can be very helpful in directing management.
20.
21. PRE HOSPITAL CARE
• Prehospital management of gunshot wounds varies
somewhat based on the location of the injury, but almost
all ballistic injury patients require immediate transport to
a trauma center.
•Emergency medical services (EMS) providers should
follow common ATLS® prehospital guidelines to control
the airway, provide oxygen as needed, and control
bleeding with direct pressure as well as obtain vital signs
and intravenous (IV) access as soon as possible.
22.
23. HOSPITAL TREATMENT
• Treatment depends on the severity and location of the wound
and other individual health factors.
• Treatment for a gunshot wound might include:
• 1)surgery to remove the bullet and fix damaged internal
structures
• 2)an IV to administer antibiotics, fluids, and other medications
• 3)blood transfusion to replace lost blood
• 4)sedation or painkillers
24.
25. WOUND CARE
• If the wound was severe, you may have had surgery to:
Stop bleeding
Clean the wound
Find and remove bullet pieces
Find and remove pieces of broken or shattered bone
Place drains or tubes for body fluids
Remove portions of, or whole, organs
26. AFTER EFFECTS
• Being shot by a gun is traumatic. Patient may feel shock, fear
for your safety, depression, or anger as a result. These are
completely normal feelings for someone who has been through
a traumatic event. These feelings are not signs of weakness.
Other symptoms may be
• Anxiety
• Nightmares or trouble sleeping
• Thinking about the event over and over
• Irritability or being easily upset
• Not having much energy or appetite
27.
28. QUESTIONS
1. What are the damages caused by gunshots?
2. Name the three types of ballistics.
3. Was the presentation interesting?
4. On a scale of 1 to 10 what would you rate the presentation.
29. ANSWERS
1. Damages may include bleeding, bone fractures, organ
damage, wound infection, loss of the ability to move part
of the body and, in more severe cases, death.
2. Internal, external and terminal (wound) ballistics.
3. Yes it was great.
4. 100
