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