Education regarding ballistic injuries in the emergency department is sparse and may rarely be encountered if not training or practicing in a trauma center or a military wartime setting.
Our recent issue An Evidence-Based Approach to Managing Gunshot Wounds in the Emergency Department provides a comprehensive review on the management of ballistic injuries in the emergency department, including how to assess and manage gunshot wounds, how to recognize when further imaging or evaluation is needed, and how to recognize when transfer to another facility is required.
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Here are a few key points:
- Firearm projectiles injure tissues by (1) permanent cavitation (crush injury) and (2) temporary cavitation (tissue stretching). (See Figure 2 in the issue.)
- There is a growing body of literature to support the “scoop and run” (immediate transport) method for prehospital providers.
- The use of tourniquets to manage hemorrhage increases the survival of GSW patients.
- The time the tourniquet was placed must be recorded and reported.
- For patients with penetrating trauma, spinal immobilization is not recommended.21,22
- The patient must be fully exposed during examination, as wounds may be hidden.
- Cross-sectional CT imaging can allow for evaluation of the path of injury, which may be different from the expected path.