Bullet wounds

Description:

Bullet wound (Latin vulnus sclopetarium) — result of influence of the striking firearms factors (splinters, a case-shot, a shrapnel, bullets, fraction). It significantly differs from all other types of wounds on structure, the nature of local and general changes, the course of processes of healing.

Before identification of a shell bullet and missile wounds are equally designated as gunshot wounds.

Characteristic differences of a bullet wound are defined by ballistic properties of a shell, a form and a design of a bullet, and also structure of the damaged fabrics.

Ballistic properties of a hurting shell are characterized by the initial speed, weight, stability degree in flight and at hit in fabric.

Symptoms of Bullet wounds:

Direct action of a hurting shell is resulted by the wound channel representing irregular shape the getting crack filled with a wound detritis, blood clots, foreign bodys, bone splinters at injury of bones, and also the shell at the bottom of this crack if wound was not through. Primary necrosis of sites of fabric, adjacent to a zone of wound defect is a consequence of all factors of shock influence. These fabrics lose viability at once and have to be completely exsected and removed during primary surgical treatment. The fabrics which got molecular concussion because of effect of cavitation are included into the potential area of a secondary necrosis. These are fabrics with numerous microhemorrhages and intracellular deformations. Extensiveness of this area depends on many factors. In particular, from amount of the energy of side blow of a shell transferred to fabrics, and from character of the temporary pulsing cavity in fabrics owing to effect of cavitation. The area of such runway is more at not through wound a bullet of small caliber with effect of somersaults. A secondary necrosis of fabrics — the process which is dynamically developing in time which scales depend on surgical treatment of a wound and treatment.

Differences.

The bullet wound differs from other types of wounds (chipped, cut, chopped) in the following features:

    * existence of a zone of dead fabrics around the wound channel (primary necrosis);
    * uneven extent and direction of the wound channel. Big outlet opening at its existence;
    * existence in a wound of the foreign debris involved inside by the high speed of a hurting shell;
    * education in the next hours and days after wound, the new centers of the dying-off fabrics, in the field of much bigger area of the wound channel (a secondary necrosis).

Reasons of Bullet wounds:

In the mechanism of formation of a bullet wound four key factors play a role:

  1. Influence of a shock wave. At the time of contact of a bullet with the struck tissues of a body there is a consolidation of the environment caused by a shock wave which extends ahead of a bullet (with a sound speed in fabrics — 1465 m/s). Further, as a result of transfer of a motive energy of a hurting shell to fabrics, there are long damped oscillations which do the greatest harm because of effect of cavitation and make the third factor of formation of a bullet wound;
  2. Influence of a hurting shell. The striking effect of a shell directly depends on its initial speed. Low-speed shells (a splinter, a shrapnel, low-power pistol bullets, or bullets spent) — to 400 m/s. High-speed — over 760 m/s. The striking effect increases with increase in a corner of nutation of a shell in fabrics and reaches a maximum when the bullet overturns and somersaults. For example, the bullet of the boss of caliber 7,62×39 in mm from the AKM assault rifle has big stability in flight and gives to fabrics about 20% of the motive energy. The bullet of the boss of small caliber 5,45×39 mm, released from AK74, possesses a smaller impulse, but because it is longer and easier than a caliber bullet 7,62×39 for mm, flies on the verge of stable flight and at an entrance to fabrics begins to somersault, putting much bigger damages and giving to fabrics up to 60% of a motive energy. The boss's bullet 5,56×45 mm of the countries of NATO for M16 rifles also belongs to the same type. Americans the first applied this type of the boss in the war in Vietnam, having estimated bigger quantity of not through severe wounds;
  3. Influence of energy of side blow. When passing a hurting shell through fabrics after it the temporary pulsing cavity (TPC) which sizes, depending on the motive energy transferred to fabrics exceed diameter of a shell by 10 — 25 times is formed. Duration of existence of the runway exceeds time of passing of a shell through fabrics by 1000 — 2000 times. The cavity reaches the largest sizes in points of the maximum braking of a shell, that is when roving and somersaults. Therefore this factor has the greatest impact on formation of bullet wounds from the high-speed somersaulting bullets with the displaced center of gravity. The similar bullets inclined to a rikoshetirovaniye from firm surfaces, enter fabrics already at an angle therefore the maximum sizes of the runway are formed already at the beginning of the wound channel;
  4. Influence of a vortex flow. It is the third stage of action of the air stream accompanying flight of a shell. It tightens to the wound canal dust, particles of the earth, fabric, microbes of air and surrounding skin.

Treatment of Bullet wounds:

Bleeding needs to be stopped, applying a compressing bandage or a plait. Venous bleeding stops below a wound, and arterial (scarlet blood, the bleeding pulsing) — above it. It is not recommended to impose a plait more than for two hours. This time has to be enough for delivery of the victim in medical institution.