Gunshot wound

from Wikipedia, the free encyclopedia
Scrap defect of the roof of the skull with a funnel-shaped extension to the outside and relief fracture lines in the right parietal bone
Classification according to ICD-10
T14.1- Open wound on an unspecified part of the body
X93 / X94 / X95 Assault:

with handgun / with rifle, shotgun or heavier firearm [firearm] / with other or unspecified firearm [firearm]

W32 / W33 / W34 Accident:

by handgun / by rifle, shotgun and heavier firearm [firearm] / by other and unspecified firearms [firearms]

X 72 / X 73 / X74 Intentional self-harm:

by handgun / by rifle, shotgun and heavier firearm [firearm] / by other and unspecified firearms [firearms]

Y35.0 Legal measure involving the use of firearms [firearms]
Y36.4 War injuries caused by firearms [firearms] and other forms of conventional warfare
Y22 / Y23 / Y24 Circumstances uncertain:

Shot from handgun / shot from rifle, shotgun or heavier firearm [firearm] / shot from other or unspecified firearm [firearm]

ICD-10 online (WHO version 2019)

A gunshot wound ( lat. , Plural vulnera sclopeteria ) or gunshot wound is an injury caused by a projectile ( arrow or projectile is caused); this can get stuck in the wound or it penetrates the body. Forensically and militarily, the gunshot wound is examined in more detail in wound ballistics .

species

Depending on the path and fate of the projectile, one distinguishes between penetration , Steckschuss (the projectile, here plug projectile called, remains in the body), ricochet and graze.

The grazing shot runs tangentially to the body surface , so that the bullet tears open a trench-shaped wound, but without tunneling into the body. A Tangentialschuss with channel-shaped wound as a trough pan in lying under the skin to as hair rope shot designated.

A bounce shot is triggered by matt bullets ( rubber bullets , such as those used by law enforcement officers at demonstrations ). It does not penetrate the skin, so it does not cause an external wound, but a bruise , the traces of which are often overlooked on the tough, elastic skin. Underneath, however, there can be significant injuries, even broken bones, torn muscles and intestines (the latter are internal wounds).

The effect of a shot depends on the organ or body area affected and also on the type of bullet and the physical constitution of the person hit. Contrary to all myths, it is unpredictable. The old musket balls were easily deflected by resistances, such as B. Bones. They then moved the body part concerned, e.g. B. in a rib shot, the chest (ring / contour shot). The conical bullets of the cans usually penetrate the body in a straight direction. All lead bullets can flatten on the body, provided they are matt. Full-jacketed bullets with small calibers have a high penetration power and usually retain their shape. Shotgun wounds are of minor importance as the shot usually cannot penetrate deeply. When cannon fire on wooden sailing ships , wounds were often observed from flying splinters of wood, which either ricocheted off the bones and only penetrated under the skin, but, depending on the angle and force, sometimes also inside the body. According to today's strict definition, these injuries are not gunshot wounds, and medically they are more similar to injuries from explosions.

Shot fracture of the femur. X-ray from the side

Medical aspects

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In the gunshot wound, a distinction the bullet from the Committee . Gunshot wounds without committee is called Steckschuss . The reject wound is usually significantly larger as a result of the irregular tumbling motion and shock wave of the projectile. Gunshot wounds have particular effects due to the fact that not only tissue loss in the gunshot channel itself, but also tissue destruction in a zone of molecular vibration around the gunshot channel as a result of the high kinetic energy of the bullet . In the case of gunshot wounds, a so-called temporary wound channel is created through the projectile, which is caused by penetrating gases and the displacement effect of the projectile. However, due to the elasticity of the tissue, it becomes smaller again and the permanent wound canal is formed.

If bones are affected by the bullet , an extensive splintering ( bullet fracture) usually occurs.

There are always two groups of consequential damage to be feared at different intervals:

  1. direct, mostly acute:
    1. internal bleeding from vascular or heart lesions , from damage to parenchymal organs such as the spleen and liver
    2. Difficulty breathing due to opening of the chest , injury to the lungs
    3. Functional failure of the central nervous system, for example when shot in the head
    4. Infection or inflammation of the peritoneum from hollow organ perforations
  2. delayed: infection

Untreated gunshot wounds to the skin, soft tissue, chest or abdominal cavity lead to inflammation or blood poisoning ( sepsis ) and usually require antibiotic therapy. Regularly shaped metal bullets can heal into the body as long as the metal is not tissue toxic or causes gas formation ( beryllium ). Penetrated pieces of clothing or wood or so-called secondary projectiles (e.g. splinters from coverings), but also dead (avital) bone splinters, often cause significant suppuration . In the case of gunshot wounds, the stressful psychological effects (panic, depression and demotivation) must also be examined.

history

Surgical removal of a bullet on the right iliac crest (right, Fig. 1), bullet impression on the outside of the right iliac bone (top left, Fig. 2) and on the front of the left tibia (bottom left, Fig. 3). Color lithograph by Nicolas Henri Jacob , 1840

Since the middle of the 15th century (1460 with Heinrich von Pfalzpaint , 1497 with Hieronymus Brunschwig , 1517 with Hans von Gersdorff ) the treatment of gunshot wounds caused by firearms has been documented in German texts. Various competing treatments were common; for example, pouring hot oil into the firing channel to treat the presumed poisoning by gunpowder . For this reason, Giovanni da Vigo also recommended in 1514 that boiling elderflower oil (oleum sambuci) be put into the gunshot wound. In France, Ambroise Paré , who discovered in 1536 that the use of a far milder mixture of egg yolk, rose oil and turpentine (which did not cause burns itself) allowed the wound to heal better , dealt more intensively with gunshot wounds in the 16th century.

The surgeon Gustav Simon published a book on gunshot wounds in 1851 in which he contradicted outdated notions, such as the idea that a gunshot wound was like a burn because bullets heated tissue. In 1849 he had treated and observed 148 patients injured by gunshot wounds over a long period of time, with 143 soldiers injured by shotgun pellets. Of the 148 wounded, 5 died, the rest were released cured. Simon took the view that many gunshot wounds were tubular cuts with loss of substance.

Up until the late 19th century, gunshot wounds were treated extensively, especially in the context of armed conflicts. As a rule, the surgeon examined the firing channel in the field hospital with his bare fingers, tried at all costs to remove the stuck projectile, thus increasing the wound and the risk of sepsis . In the case of injuries to the extremities, this usually resulted in an amputation , also due to the fact that until the end of the 19th century the projectile was made of lead, and it wasn't until the 20th century that full-jacketed cartridges became mandatory in war use. At the end of the 19th century, the pendulum turned into the opposite: it meant leaving gunshot wounds alone, thoroughly disinfecting the outside and waiting. Two developments gave rise to this: In 1872 Richard von Volkmann introduced the antiseptic treatment of wounds with carbol (according to Lister ), and the calibers of modern infantry rifles were increasingly smaller and full-jacket bullets were used, so the firing channels were much narrower. In his article on gunshot wounds from the modern infantry rifle , published in January 1905 in the magazine Die Woche , the surgeon Ernst von Bergmann, who specializes in war injuries, sums up the resulting situation as follows:

"So off with the ball search and ball pulling! The number of examples of projectiles healing in all organs and tissues is increasing. As early as 1895 I was able to report on 24 5 mm revolver bullets that had penetrated the brain during suicide attempts. Nineteen of them healed without further disturbances, without the patients suffering later either.

[During the war ] in 1877/78 the wounds came from two and four times larger projectiles than the modern jacketed projectile of our infantry. The clean and smooth wound canals of close-up and long-range shots in the soft tissues, the small entry and exit openings in the bone fractures, when they come about from a distance of more than 800 meters, give much more hope today than back then. […] In this regard, we are excited to see the results of the Russo-Japanese war , in which very capable war surgeons are active on both sides and the gunshot wounds come from rifles with the smallest caliber used up to now. "

- Ernst von Bergmann : The Week, 1905

See also

literature

  • Bernd Brinkmann, Burkhard Madea (Hrsg.): Manual forensic medicine. Volume 1, Springer, Berlin 2004, ISBN 3-540-00259-6 .
  • Silke MC Brodbeck: Postmortem computed tomography of gunshot wounds compared to autopsy findings. Verlag für Polizeiwissenschaft, Frankfurt am Main 2008, ISBN 978-3-86676-039-4 (also: Frankfurt am Main, Univ., Diss., 2005).
  • Vincent J. M. DiMaio: Gunshot Wounds. Practical Aspects of Firearms, Ballistics, and Forensic Techniques. 2nd edition, CRC, Boca Raton 1999, ISBN 0-8493-8163-0 .
  • Beat Kneubuehl (eds.), Robin Coupland, Markus Rothschild, Michael Thali: Wundballistik. Basics and Applications. 3rd edition, Springer, Heidelberg 2008, ISBN 978-3-540-79008-2 .
  • Ralf Vollmuth: “From the shot wounds”. The treatment of gunshot wounds in German-language surgical works of the 15th century. In: Orvostörténeti közlemények. Communicationes des historia artis medicinae 145-146 , Volume 40, 1994, No. 1 f., Pp. 5-28.
  • Otto Karl Schjerning et al .: The gunshot wounds. [Advances in the field of X-rays. Supplementary Volume 7]. Hamburg, Gräfe & Sillem, 1913, 2nd edition.
  • Georg Hirth : Self-confessions of a seriously wounded man . In: The Gazebo . Issue 43, 1866, pp. 672-674 ( full text [ Wikisource ]).

Web links

Commons : Gunshot Wound  - Collection of images, videos and audio files

Individual evidence

  1. ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 157.
  2. ↑ Franz Bäumer, Angelika Schaller, Hermann A. Henrich: On the history of the surgery of gunshot injuries. In: Würzburg medical history reports. Volume 14, 1996, pp. 449-458; here: pp. 449–451.
  3. ↑ Ralf Vollmuth : Notes on the treatment of gunshot wounds from firearms in German-language surgical works of the 15th century: Three supplements. In: Würzburg medical history reports. Volume 17, 1998, pp. 205-214.
  4. ↑ Cf. also Felix Croes: Schotwonden in de 16 e eewu. Medical dissertation Amsterdam 1940.
  5. ^ Gundolf Keil: Hans the French. In: Burghart Wachinger u. a. (Ed.): The German literature of the Middle Ages. Author Lexicon . 2nd, completely revised edition, volume 3. De Gruyter, Berlin / New York 1981, ISBN 3-11-007264-5 , column 450 f.
  6. ↑ Ralf Vollmuth: Traumatology and field surgery at the turn of the Middle Ages to the modern age. Steiner, 2001, ISBN 3-515-07742-1 , p. 101.
  7. ↑ Munich medical weekly. Volume 67, Issue 3, 1920, p. 1071.
  8. ↑ Axel W. Bauer : Therapeutics, Therapy Methods. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 1388-1393; here: p. 1389.
  9. ↑ Franz Bäumer, Angelika Schaller, Hermann A. Henrich: On the history of the surgery of gunshot injuries. In: Würzburg medical history reports. Vol. 14, 1996, pp. 449-458; here: p. 453 f.
  10. ^ A b c Gustav Simon (Grand Ducal Hessian military doctor): About gunshot wounds . combined with a report on the in Grossh. Military Lazareth in Darmstadt treated the wounded from the summer of 1849. Ernst Heinemann, Heyer`s Universitäts-Buchhandlung, Giessen 1851, OCLC 916967625 ( limited preview in the Google book search - information on the number of wounded on page 2, comparison with burns on page 6 below, gunshot wound corresponds to a cut on page 10).
  11. ^ Die Woche , No. 2, 1905, p. 61.