I hate .22 !!!!!!

[swatsurgeon]

I just finished a 3 1/2 hr operation in the human body of a post christmas depressed patient that tried to end it all with a self inflicted GSW with his .22 LR to the chest (1st pic). Entrance just under the breast bone and exit left kidney area (2nd pic, butt to the left, head to the right...he's tilted on his side).
On its merry journey, it hit the left lobe of liver, the stuff that holds the large intestine (just missing the colon by 1/2 inch), lacerating the duodenum (beginning of the small intestine where it then becomes the jejunum.... where it's a bitch to repair, missed the aorta by 2-3 mm, bounces of the spine, goes left up through the end of the pancreas, through the spleen, bounces again off of a rib, goes down next to the kidney, lacerating it and finally out the back!!

It just goes to show, it's not the caliber of the bullet but : SHOT PLACEMENT EVERY TIME....and bouncy little bullets that hit more things and keep trauma surgeons in the OR longer!! Atleast big bullets travel in straighter lines and in more predictable ways..... This is why I love ballistics.......

[swatsurgeon]

I redirected this so we could discuss "seemingly" small wounds.....think of this as a shrapnal wound. Take NO wound for granted. This guy didn't get to the OR for 4 hrs after his injury. The biggest problems he would face if his delay was 'in theater' in being evac'ed would have been with the small bowel injury, the slow but steady bleeding from the spleen and also the pancratic injury. All of these wounds are repairable but left untreated...the small bowel injury for greater than 8 hrs increases mortality significantly, eventually the spleen bleed would cause shock if it continued, and the pancreas would likely put him into big trouble 1-2 days later if not drained/repaired.
Small external wounds can have major internal injuries....let none of your teammates/commrades in arms not seek medical attention as soon as feasible....I imagine some one every once and awhile says they feel fine post injury...as did this patient the entire 3.5 hrs, it wasn't until after this that his belly started to bother him, his pulse and blood pressure and respiratory rate were all normal...

[Tuukka]

After seeing a GSW to the abdomen from a .22LR, it changed some of my views on terminal ballistics.

[52bravo]

in denmark we dont see that menny GSW, I have only see 2 in dec. ta my stay at a traumacenter neuro icu, one from a bee bee gun(i think u calll them). it got all way past the cranium. not fatal and no sequale.

[52bravo]

what lang time care?
ABC, no IVF if no shock, but a line for antibiotica and pain med..

but what to do now??

if he get low BP?
temp. up?

[DoctorDoom]

x

[swatsurgeon]

DocDoom,
the family actually alerted us to the exit wound...we missed it, it was under someones hand when we rolled him to examine his back. The operation was mostly an exploration of the retroperitoneal area and repair of the duodenum, I looked at the aorta, renal vesels, kidney....just following the track of the bullet.

[DoctorDoom]

x

[swatsurgeon]

spleen was repaired with the modern technique of removal!!!
pancreas was just drained after one suture to stop bleeding.

[DoctorDoom]

x

[swatsurgeon]

absolutely......in fact if there was a hole through the tail of the pancreas rather than the 'crease' across the bottom edge of it I would have resected the tail...using the spleen as a handle it makes for an easy case.

[DoctorDoom]

x