View Full Version : Pathology behind GSW's
Hey all, Im doing a presentation RE: Pathology Behind Gunshot Injuries.
To fill you in Im currently a Paramedic in Canada and as part of our CME some of us have been asked to make a presentation as a means of educating other medics.
Anyway Im curious to know what you all know about Death as a result of GSW's. Here's what I am battling with. I want to know what is more important in the final cause of death does it have to do with calibre such as bigger hole, more damage OR is it related to velocity of the round. Here's why I am going with velocity. Many of us know energy is represented as joules. So by having greater joules would that result in greater damage to hollow organs? Im on this track becasue much like large explosions tho some people will be killed from shrapnel others may die from the shock wave caused by the explosion due to damage on hollow organs...SO, can the same be said for GSW's?
I would really like to hear all points in this, don't be shy. If you disagree, awsome but please have something to back it up (it makes it easier to believe)
This has also been posted on the PD forum as well.
You can make a case for any of your points ie. the size of the round, the velocity or the fact of more damage. My viewpoint still boils down to the same issue that you face when using a weapon for self defense: shot placement. Of course a bigger projectile will cause more damage than a smaller, but if the shot is to a vital organ it doesn't matter. Additionally, you need to consider the type of round: hollow point, FMJ, etc. A .45 will tear up more muscle than a 9mm assuming the same type of round. A 9mm hollow point will tear up more muscle than a .45 FMJ. Will either cause death? Not necessarily. Another viewpoint: A 9mm to the head may lodge inside the skull, not bounce around much and not necessarily cause death, however, a round from a .22 will probably make like a pinball, scoot around throughout the brain and kill an individual.
I don't have any concrete evidence to my ramblings, these are just some personal thoughts on the issue. I work in an area that doesn't see many shootings so I am not speaking from a whole lot of experience in dealing with them. The GSW's I mainly see are 12 guages to the head and we all know what that does.
Velocity will play a major factor in damage. Cavitation is what does most of the damage. Sometimes a .22 will do more damage than a .45.
My wife (RN) went to a fascinating presentation put on by an assistant medical examiner about gunshot wounds and cause of death. He went mostly by personal experience, adding in others' research and experience. We long ago lost the paperwork that she brought home from that unfortunately.
He only discussed rifle and pistol, not shotguns. Shotguns have such a wide variety of ammo available that it is a whole other study.
What he basically said is it is almost entirely shot placement, depending on the caliber / velocity. He mostly compared slow and big (45acp) and small and fast (223). He had some fascinating examples, although some might consider them a bit gruesome. This was with mostly solid / round nose bullets.
Two of the main examples he used were the heart and liver.
With the liver, he showed how a 45acp can pass right by the liver and the person could survive. While a 223 bullet, passing the liver but not hitting it, would cause death due to the cavitation causing such trama to the liver that the person would not survive it.
With the heart, a 45acp passing through a heart would essentially destroy it. It would cause such a large hole ripping its way through that heart would not be able to function. With the 223, he had an example of someone who survived the bullet passing through the heart (the person survived for a short while, he died later from shock and other injuries). The size of the hole the 223 made was small enough that the heart could still function, it almost closed up. Also, as to cavitation damage, since the heart is basically a bunch of muscles, they were able to survive the cavitation and "close back up" to allow the heart to continue to function.
These were just a couple examples he gave during his presentation. He talked about how different bullet types can change what happens. He stressed that anyone getting shot in the heart or the gut (liver) would have a small chance of surviving, he was just using the cases to illustrate his discussion.
I wish I had been able to go to that discussion, and hadn't lost the paperwork for it. My wife said it was one of the best work-related presentations she's been to (she's been an RN for ~20 years).
Crack open a PHTLS book. There will be mucho info for your presentation. If I ever get some sleep on this shift, I may be able to formulate a coherent thought or two of my own about this....
I'll agree with the above postings. Shot placement has been the biggest factor in the GSWs where I've responded.
OK. I think I have got enough sleep to think a little.
1. I agree that shot placement is the biggest factor.
2. As far as kinematics is concerned, velocity is definately a more signifigant factor than mass. KE= (v)squared x 1/2 mass.
3. Damage to hollow organs cause complications that surgeons need to fix. Damage to solid organs makes people DRT. Solid organs are more vascular, therefore bleed more. The anaolgy between blast wave and GSW damage is partially right. Blast waves cause temporary cavities, and may result in shear damage. GSWs cause temporary cavities/ shearing forces too, but they also result in perminant cavities- AKA holes.
The situation is related directly to exactly what body parts or organs are disrupted by the GSW and proportional to the velocity at which a projectile strikes each area by the size, shape and mass of this projectile as it impacts that body part or organ.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
Projectile Speed is relevant to each of these<o:p></o:p>
Smaller-less impacted area<o:p></o:p>
Larger-bigger impacted area<o:p></o:p>
Lighter-impacts shallower, less push<o:p></o:p>
Heavier-impacts deeper, more push<o:p></o:p>
Incapacitation can occur without immediate death.<o:p></o:p>
Death occurs with blood loss and or lack of Oxygen in 4 to 6 minutes
Total nervous system disruption, brain or spinal cord injury, keeps signals form being transmitted for body function.
I hope this helps, I not trying to preach to the choir!
Don't have much to add. I just wanted to post a comment so I would get updates to this thread.
I have never treated a GSW, nor have I ever had the opportunity to shoot anyone.
Based on experience of shooting animals I would have to agree that shot placement is el numero uno. Second, I would have to say is velocity and third bullet type and fourth caliber. I know that I have instantly killed more deer with smaller hyper-fast rounds than I have will larger slower bullets. Larger slower bullets will kill but not as fast. Seems as though not only is there a hole and cavitation with a smaller bullet but simply the shock of that amount of energy stopping in a body.
My 2 cents. Probably not worth a whole lot but if you do a google search for Gun Shot Wounds Case Studies you can come up with a lot more better info.
Of the shootings I personally treated/ reviewed, the most important criteria as to survival - in order:
1. Shot placement - where did the bullet(s) strike?
2. Quality of care on scene - including first responder skill and ACLS units
3. Time to nearest Level 1 Trauma center....
All other variables as to caliber, type of bullet, moon phase, etc,etc were secondary:rofl:
I saw people who should not have survived , live. Others with "minor" wounds who did not.....somethings defy science and medicine...
CDNGLOCK, how did you make out with your presentation? Interested?
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