Gunshot wounds I have tended

[doc Russia]

While talking to CC one night, recalling some of the more interesting gunshot wounds I have come across, he suggested that I start a thread on that subject. I do happen to be in a unique position to talk about such things. So, for tonight, let me present the inaugural case:

26 year old male shot at close range (so known because of the stippling near the entrance wound). The round struck the left chest between the middle and distal third of the clavicle. He presented alert and awake, and in pain. There was no exit wound. The entrance wound was a little under 9mm across at its narrowest, so it was probably a nine millimeter. The bullet had struck the clavicle, shattering both. The bullet broke into two large fragments with several small ones. One large fragment stopped near the clavicle. The second one appears to have tracked more or less straight back in a line, missing the lung by millimeters, and ending on the underside of the scapula without noticeably damaging it.
He was neurologically intact, and there was no sign of vascular compromise.
He was quite lucky since not only the lung was unscathed, the neurovascular bundle under the clavicle appears to have survived intact. Had this been compromised, especially had the subclavian artery been transected, it would have been a major vessel bleed in a location which is not compressible. So, bleeding would have been about impossible to control. This is one of those times when a tampon might be useful in the field. The patient, in that case, would have needed definitive surgical care quite rapidly to survive.

Any questions or comments are welcome!

[308Mike]

Due to the lack of penetration, could it have been a .380 instead of a 9mm? Any indication if it was a soft-point or other such round? I seriously doubt a full-house .357 would have presented with so little penetration, but you never know.

[TheArmsman]

When would a tampon be contraindicated for a GSW?

[rightisright]

When would a tampon be contraindicated for a GSW?

Good question. To add to that, is there any advantage using a tampon over a QuikClot bandage and/or Izzy bandage (I keep both in my FAKs)?

[doc Russia]

Due to the lack of penetration, could it have been a .380 instead of a 9mm? Any indication if it was a soft-point or other such round? I seriously doubt a full-house .357 would have presented with so little penetration, but you never know.

I don't know that having about half of the bullet weight traveling through the torso, and stopping when it hits the inside of the scapula counts as underpenetration.
Yes, it could have been a .380. It could also have been a .38 or a .357.
Imaging studies were an x-ray and computerized tomography (CT or "cat" scan). The metal in the slug caused a lot of artifact in the CT scan, so I could not glean a whole lot of information from the study. The x-ray was in some ways more useful, but the deformity and destruction of the bullet made it impossible to guess the caliber of the bullet from the image.

[doc Russia]

When would a tampon be contraindicated for a GSW?

neck injuries where an expanding bandage could cause airway compromise.

[doc Russia]

When would a tampon be contraindicated for a GSW?

Good question. To add to that, is there any advantage using a tampon over a QuikClot bandage and/or Izzy bandage (I keep both in my FAKs)?

The advantage would be the ability to drive it deeper into the wound than impregnated gauze.

[rightisright]

The advantage would be the ability to drive it deeper into the wound than impregnated gauze.

Good to know. I'll be adding some tampons to my FAK.

[308Mike]

The advantage would be the ability to drive it deeper into the wound than impregnated gauze.

Good to know. I'll be adding some tampons to my FAK.

Is there one size that works better over the others? I would imagine the SUPER ones would absorb the most, but they might not fit many entry wounds, and exit wounds might be better dressed with a maxipad or ABD pad.

Do you have an opinion on the best compromise size to include in FAK/TRAUMA Kits?

[doc Russia]

The advantage would be the ability to drive it deeper into the wound than impregnated gauze.

Good to know. I'll be adding some tampons to my FAK.

Is there one size that works better over the others? I would imagine the SUPER ones would absorb the most, but they might not fit many entry wounds, and exit wounds might be better dressed with a maxipad or ABD pad.

Do you have an opinion on the best compromise size to include in FAK/TRAUMA Kits?

I have no recommendation on size. Exit wounds depend on how they present. some WILL be amenable to tampon insertion, some will not.