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GUNSHOT WOUNDS

  • Severity of gunshot wound related to bullet size, shape, velocity
  • Low velocity injuries: minor wounds
  • High velocity injuries: extensive soft tissue, bone damage
  • Treat associated fractures with plaster, traction or external fixation

Low velocity injuries

  • Debride wounds superficially; usually done in outpatient department
  • Lavage wound with large amounts of fluid
    • Do not close skin
    • Administer intravenous antibiotics for 1–3 day
    • Give tetanus prophylaxis
  • Treat fractures by closed means with cast, traction or external fixation
  • If bullet fragments remain in joint cavity, arrange to have them removed within a few weeks

High velocity injuries

  • Debride wounds in operating theatre, using adequate anaesthesia
  • Lavage each wound after removing all dead tissue, foreign material
  • Lavage between entrance and exit wounds, passing gauze through tract if necessary
  • Do not close wound; re-debride in 2–5 days
  • Administer antibiotics, tetanus prophylaxis
  • Treat fractures with cast or, preferably, external fixation or traction

WAR-RELATED TRAUMA: Landmines

  • Injury patterns related to type of landmine encountered
  • Blast injuries occur from pressure sensitive mines; trip-wire mines produce injury from multiple flying fragments
  • Evaluate entire patient for injury to multiple systems
  • Treat extremity injuries with debridement, skin coverage
  • Amputation often necessary
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