Tangential Gunshot Wounds Research Articles

Gunshot wounds to animals

Gunshot injuries are quite common in various animal species. In 40.0% of cases, this type of damage was detected on the corpses of roe deer, in 26.67% of cases, damage was noted on the corpses of Manchurian elk, 13.33% of cases were registered in horses and cattle. In 6.67% of cases, injuries were found on the dog’s corpse. In 40.0% of the cases, the injuries corresponded to blind gunshot wounds and were represented by an entrance gunshot wound and a wound channel. There was no exit wound. In 33.33% of the injuries corresponded to perforating gunshot and were represented by an entrance and exit wound opening and wound canal. 20% of the identified injuries are represented by tangential gunshot wounds, characterized by the presence of an open wound canal. In 6.67% of cases, injuries were attributed to bruised gunshot.

Tangential gunshot wound to the head

Introduction. Tangential gunshot wounds (TGSW) to the head is the high-velocity bullet that does not penetrate the cranium but passes through the tissue adjoining the cranial cavity, creating a “gutter” wound and indirectly causing cerebral injury. This article presents a reporting case of TGSW to the head, discusses the mechanism underlying this traumatic injury and the possible complications resulting from it, and reviews of literature. Case description. A thirteen-year-old schoolboy was admitted to the emergency department (ER) of the neurosurgery teaching hospital in Baghdad, Iraq, with a tangential gunshot to the head of an unknown source during civilian protests in Baghdad. In addition to a seizure attack in the ER, his Glasgow coma (GCS) scale was 13 initially. The computed tomography showed multiple bilateral brain contusions, interhemispheric haemorrhage, partially depressed fracture of the frontal bone midline, and a Paramedian to the left with a significantly depressed skull fracture. Then, an urgent decompressive craniectomy was performed. The postoperative course was uneventful, with rapid improvement in GCS of 15 one hour after surgery. On the six-month follow-up, the patient reported no further attacks of seizure. Conclusion. TGSWs are associated with good GCS and favourable prognosis in most cases unless the patient has been deteriorating or has an associated ICH. Moreover, in our case, the history taking, mechanism of the injury, rapid evolution, and radiological imaging have an essential effect on the outcome.

Tangential cranial gunshot wound in an infant in historical context: illustrative case.

BACKGROUNDMilitary neurosurgeons have long known that tangential cranial gunshot wounds can be associated with intracranial complications out of proportion to the external appearance of the injury. This phenomenon seems not to have been described in infancy.OBSERVATIONSAn infant suffered a massive, acute subdural hemorrhage from a contralateral tangential gunshot wound that did not facture the skull.LESSONSSimilar to adults, infants are subject to catastrophic intracranial injury from gunshots that do not penetrate the skull. The nature of the injury in this case reflected distinctive aspects of the tissue characteristics and proportions of the infant head.

Air embolism: an unusual cause of delayed death following gunshot wound to the chest

A 29-year-old man was shot in the chest twice sustaining extensive contusion of the right lung. He was, however, clinically stable with no major vessel injury or significant blood loss. Unexpected cardiac arrest occurred hours after hospital admission due to left coronary artery air embolism. Lung parenchymal damage from the passage of two projectiles within the chest wall close to the pleural cavity had occurred, with disruption of the capillary-alveolar interface and passage of air into the pulmonary venous circulation. While tangential gunshot wounds to the chest wall may rarely cause air embolism, symptoms are usually immediate. The present case demonstrates, however, that death may occur unexpectedly some time after the initial trauma in an individual who is considered clinically stable.

A Tangential Gunshot Wound to the Head: Case Report and Review of the Literature

Background: Patients with tangential gunshot wounds (TGSWs) commonly present with a good Glasgow Coma Scale score and without a history of loss of consciousness. Typically, the bullet does not breach the skull, however, there is a considerable force directed into the brain, and these patients are best treated as sustaining a moderate-to-severe blunt head injury. These patients require observation and repeat imaging. Physicians should be aware of this entity as these patients can deteriorate in a delayed fashion. Objectives: The authors present a case of a TGSW to the head in a neurologically intact patient. The initial post-injury computed tomography (CT) scan showed a very small subdural hematoma (SDH) with no overlying fracture of the skull. A delayed CT scan performed 4 h after arrival to the Emergency Department and 6 h after injury demonstrated an increase in size of the SDH, new traumatic subarachnoid hemorrhage, and bilateral cerebral contusions. Clinically, the patient showed worsening of her neurological examination. She underwent aggressive non-surgical treatment for increased intracranial pressure with almost complete recovery. Conclusion: Although patients with TGSWs are typically in good condition upon presentation, these injuries are not always trivial, and these patients should have, at minimum, a non-contrast brain CT scan to evaluate underlying damage to the brain and skull. In addition, a delayed CT scan and close observation on a neurosurgical service are indicated.

Tangential Gunshot Wound to the Chest Causing Venous Air Embolism: A Case Report and Review

This is a case report of a 53-year-old woman who presented to the Emergency Department after sustaining a tangential gunshot wound to the left anterior chest wall. On arrival, the patient was somnolent, hypotensive, hypoxic, and had impaired speech. The patient's cardiopulmonary status stabilized quickly after fluid resuscitation and supplemental oxygen. Because the initial chest radiograph revealed only mild vascular congestion without traumatic injuries, a computed tomography angiogram of the chest was subsequently obtained, which showed air within the right ventricle and pulmonary arteries. Significant bilateral pulmonary infiltrates were also noted without evidence of pneumothorax, penetrating lung, or vascular injuries. There are numerous case reports of venous air embolism (VAE) after penetrating neck, chest, and abdominal injuries, surgical procedures, or secondary to unintentional air injection through venous catheters. Due to the wide range of neurological and cardiopulmonary clinical presentations, the non-specific signs and symptoms of VAE may frequently be attributed to other causes, especially in the setting of trauma. An overview of the pathophysiology, clinical presentation, diagnosis, and treatment of VAE is presented, with emphasis on diagnostic imaging modalities.

Small Bowel Injury From a Tangential Gunshot Wound Without Peritoneal Penetration: A Case Report

Gunshot wounds with transperitoneal trajectories are associated with a 98% incidence of significant intraabdominal injuries and mandate exploratory laparotomy. However, protocols using triple-contrast computed tomography (CT) scanning or diagnostic laparoscopy are increasingly being used to evaluate bullet trajectories to determine the need for laparotomy based on peritoneal penetration. Patients can be treated nonoperatively as long as peritoneal penetration has been ruled out. The studies recommending this approach have all been conducted within civilian trauma systems. Handguns cause the majority of gunshot wounds in this setting. Modern military rifles, however, have different wound ballistics than handguns. Civilian-based practice protocols for tangential gunshot wounds may not apply in the military setting.

Tangential gunshot wound with MagSafe ammunition.

MagSafe ammunition is a type of unconventional prefragmented ammunition. A fatal tangential gunshot wound involving MagSafe ammunition is presented. The ammunition and wound characteristics are discussed.

Videolaparoscopia no trauma abdominal

Despite the use of laparoscopy in abdominal trauma for several decades, it was only after the advent of video chip camera that an explosion of interest ocurred, giving rise to possibilities and perspectives not only in diagnosis but also in therapeutics. In trauma, its use has been gradually defined and experience has shown the benefits of the method in early diagnosis of visceral injuries as well as avoiding unnecessary laparotomies. Trauma laparoscopy is a safe method, can reduce negative and nontherapeutic laparotomies. The worrisome failure of laparoscopy to detect gastrintestinal injuries, specially small lesions can be avoided with a mandatory and apropriated run bowel exploration. We believe that in hemodinamically stable patients, video laparoscopy is safely indicated in some situations in trauma, such as evaluation of diaphragmatic injuries in thoraco abdominal stab wounds and tangential gunshot wounds of anterior abdominal wall.

Neurobehavioural outcomes of penetrating and tangential gunshot wounds to the head

Objective : The objective of this study was to compare penetrating and tangential gunshot wounds to the head with regards to demographic, neurobehavioural and clinical outcome measures. Methods : Twenty-nine patients with penetrating gunshot wounds (P-GSW) and 11 patients with tangenital gunshot wound (T-GSW) to the head admitted to an acute neurotrauma service were compared using standardized neurobehavioural and clinical outcome measures. Results : The mean GCS was 10.5+/-0.79 for the P-GSW group and 13.4+/-0.72 for the T-GSW group. The mean AIS-CNS for the P-GSW group was 5.00+/-0 and for the T-GSW group was 3.7+/-0.27. Significance was found on Digit Span (p < 0.05) and Block Design ( p < 0.009) subtests. Outcomes between the two groups were similar, except for significant differences were found for acute length of stay (LOS) (P-GSW was 47.72+/-13.2 and T-GSW group was 13.0+/- 1.3, p = 0.005) and for acute care charges (P-GSW group was $150533+/-23834 and T-GSW group was $70712+/-16587, p = 0.05). Conclusions : Initially, a penetrating gunshot wound is a more severe and costly injury than a tangential gunshort wound to the head, however T-GSW possess significant deficits and, if the patient survives past the acute phase of recovery, the two groups have similar functional outcomes. Future prospective trials should be conducted utilizing standard classification, neuropsychological, and clinical outcome measures.

Neurobehavioral outcomes of penetrating and tangential gunshot wounds to the head

Neurobehavioral outcomes of penetrating and tangential gunshot wounds to the head

Neurobehavioral outcomes of penetrating and tangential gunshot wounds to the head

Neurobehavioral outcomes of penetrating and tangential gunshot wounds to the head

Characteristics of Gunshot Wounds in the Skull

The analysis of trauma to the skeleton is an important aspect of forensic case work, but most pathology references devote limited attention to this topic. This paper describes various aspects of gunshot wounds, including entrance and exit patterns, angle and path, range of fire and velocity, and caliber of the bullet, based on observations of a series of known cases. Skeletal remains of 21 victims of gunshot wounds were studied. In most cases, there was documentation of the investigation, autopsy, and victim's identity. Each case was analyzed in terms of wound location, shape, size and exit/entry surface area ratio, beveling, and direction of shooting Skull entry wounds were most often round or oval. Unusual shapes were observed in bones like the mandible and mastoid process, but were also found to be triangular, nearly rectangular or irregular. Tunneling was observed in the mastoid process. The expected internal beveling was obvious in all but one skull. External beveling of an entry wound was only observed in one case (parietal bone). Exit wounds were roughly round, oval, square, and rectangular and were always more irregular than entry wounds. External beveling of exit wounds was observed in most vault bones, but there was none in the orbit, maxilla, greater wing of the sphenoid, temporal, or left occipital bone. Tangential gunshot wounds were seen in a mastoid process, zygomatic process, mandibular ramus and condyle, and occipital condyle. Most of the exit to entry surface area ratios (cm2) varied from 1.4 to 2.0. In four cases the ratio indicated that entrances were larger than exists. In conclusion, understanding of gunshot wound characteristics is an important matter to interpret distance, velocity, direction and sometimes caliber size. Assessment of this nature of gunshot wounds helps reconstruct events surrounding the death.

Patients with Tangential Gunshot Wounds to the Head Need Head CT

As many as 40% of initially nonfatal gunshot wounds to the head are tangential (TGSW), that is they do not penetrate the inner table of the skull. This

Intracranial Hemorrhage Associated with Tangential Gunshot Wounds to the Head

Tangential gunshot wounds (TGSWs) to the head are gunshot wounds in which the bullet or bullet fragments do not penetrate the inner table of the skull. To determine the occurrence of intracranial hemorrhage (ICH) associated with TGSW to the head and to assess the ability of selected clinical criteria to predict ICH in this patient population. A retrospective chart review of patients diagnosed as having TGSWs to the head presenting to the ED of Los Angeles County + University of Southern California Medical Center from October 1, 1993, to May 31, 1996. Four hundred twenty patients with gunshot wounds to the head presented to the ED. CT confirmed the diagnosis of TGSWs in 154 patients (36.7%). Head CT of patients with TGSWs revealed 25 (16.2%) skull fractures and 37 (24.0%) ICHs. Fourteen (56.0%) skull fractures were depressed. Of patients with a CT-documented TGSW to the head, 23 (16.1%) had a history of a loss of consciousness (LOC), 129 (84.3%) had a normal neurologic examination in the ED, 17 (11.1%) had a Glasgow Coma Scale score (GCS) < 15, and 75 (48.7%) had retained extracranial bullets or bullet fragments. Of all patients with TGSWs to the head, 113 had a GCS of 15 with no LOC and a normal neurologic examination, with 17 of these 113 patients (15.0%) having ICH. One patient died while hospitalized. Fifty-six (36.6%) patients were released home directly from the ED. Five clinical criteria (history of LOC, GCS < 15 on ED presentation, skull fracture, location of TGSW on the skull, and presence of extracranial bullet fragments) were examined to determine their ability to predict ICH. None of these criteria either alone or in combination were adequately predictive of ICH. In this series, 1 in 4 patients with a TGSW to the head had an ICH. All patients with TGSWs to the head should undergo head CT to rule out depressed skull fractures and ICH.

Civilian cases of tangential gunshot wounds to the head: Stone JL, Lichter T, Fitzgerald LF, et al. J Trauma. 1996:57–60

Civilian cases of tangential gunshot wounds to the head: Stone JL, Lichter T, Fitzgerald LF, et al. J Trauma. 1996:57–60

LAPAROSCOPY IN TRAUMA

Laparoscopy is a nearly century-old technique that has experienced a resurgence of interest from surgeons since the development of technology that has broadened its applications. Although laparoscopy has been used to evaluate patients with possible abdominal trauma, its use for this purpose is limited by the availability of other diagnostic procedures that may be more suitable for particular circumstances and are more accurate for certain injuries. Laparoscopy is contraindicated in patients who are hypovolemic or hemodynamically unstable and should not be performed in patients with clear indications for celiotomy. It may not be appropriate for patients with cardiac dysfunction, nor for those with significant head injuries who are at risk for intracranial hypertension. Its best applications may be in stable patients with stab wounds or those with tangential gunshot wounds of the abdomen. The likelihood of missing hollow visceral injuries depends upon the indications for conversion to celiotomy. If peritoneal violation or the presence of a small amount of blood in the peritoneal cavity is used as an indication for celiotomy, then the missed injury rate will be low but the unnecessary celiotomy rate will be diminished only slightly compared with a policy of mandatory celiotomy. Excessive enthusiasm for laparoscopy in trauma might result in its use when other diagnostic measures or simple observation are more appropriate. The desire to perform a procedure can be compelling, especially in circumstances in which the general surgeon would not operate upon a patient but simply provide postoperative care after other surgeons have operated. The use of laparoscopy for these purposes can only be condemned, as it increases the costs and risks of care without improving the outcome. The role of laparoscopy in trauma is evolving, and further research into its diagnostic role and therapeutic applications is clearly needed.

Civilian Cases of Tangential Gunshot Wounds to the Head

A series of 168 civilian cases of tangential gunshot wounds to the head is presented. Neurologic deficits on presentation were generally minimal. Computed tomographic (CT) scans were performed in 51% of patients, and abnormal CT findings were noted in 35% (18% of all patients). Major operative procedures were required in 9% of the patients. Serious sequelae of tangential injuries are described even with patients who initially have no neurologic abnormality. We suggest that a CT scan is warranted in all cases of tangential gunshot wounds to the head.

Hematoma in the posterior fossa secondary to a tangential gunshot wound of the occiput

The case of 16-year-old boy who incurred a subdural hematoma in the posterior fossa an intracerebellar hematoma after a tangential civilian gunshot wound is reported. The skull was not fractured, and yet surgically significant clots required removal. The patient recovered. The discussion centers on the mechanism of injury and seriousness of tangential gunshot wounds and traumatic hematomas in the posterior fossa.

Hematoma in the Posterior Fossa Secondary to a Tangential Gunshot Wound of the Occiput: Case Report and Discussion

Abstract The case of 16-year-old boy who incurred a subdural hematoma in the posterior fossa and an intracerebellar hematoma after a tangential civilian gunshot wound is reported. The skull was not fractured, and yet surgically significant clots required removal. The patient recovered. The discussion centers on the mechanism of injury and seriousness of tangential gunshot wounds and traumatic hematomas in the posterior fossa.