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frostfire
06-15-2017, 09:11
http://www.theaustralian.com.au/business/media/abc-reporter-adam-harvey-hit-by-bullet-in-philippines-city-of-marawi/news-story/81576fc7280cc7930eaab28a5550fd06

I have my share of seeing neck GSW in resuscitation room, OR, and ICU.
99% the patient did not make it. The ER resuscitation room also convinces me of the veracity of the adage "pistol round wounds, rifle round kills."

For our medical (and forensic ammo) folks, how many scenarios have you seen with such positive outcome i.e. walking, talking, mild distress immediately after?

Also what can render such otherwise lethal round ineffective?
- Stray round at extended distance and the bullet is < 2000 fps by then?
- A ricochet/skip or near vertical impact? He reported he was bending over getting stuff from his car when struck
- FMJ design with old ammo?
- 5.56 and not 7.62, 22 caliber and not .30?
- Simply miraculous occurrence? (I have seen xray of bullet lodged in the middle of baby's head and the baby was completely age appropriate and fighting IV and NG....but I put that under soft fontanel so the skull can afford the swelling brain without herniation)

Have you seen such cases, 35NCO?

Thank you for the education.

35NCO
06-15-2017, 20:31
Cant read the article due to a log on needed.

Unfortunately anything I have ever been involved with has been from fatal incidents.

18Ds and MDs may have more thoughts on the trauma care and survivability.

I think you covered all the points. Projectile variables, size and location of wound, time to care, luck...

I am not a medic or have any substantial medical training. All I could say is miraculous recoveries from the seemingly medically impossible do happen. Why, we just do not always have an explanation. I suspect sometimes its just the powerful will to live.

frostfire
06-15-2017, 21:42
Cant read the article due to a log on needed.


Here's a working one
https://www.theguardian.com/media/2017/jun/15/abc-journalist-adam-harvey-hit-in-neck-by-stray-bullet-while-reporting-in-philippines

35NCO
06-16-2017, 00:00
Looks like luck to me.

Would be nice to see front or rear facing of the xray. I suspect it was very low velocity with minimal penetration. Really no deformation of the projectile at all. The discoloration of the tip of the projectile is interesting. Appears to be 7.62x39 lead ball. Because of the short distance of the tip to the meplat of the lead core, I beleive it is Russian, quite possibly Ulyanovsk FMJ.

miclo18d
06-16-2017, 06:35
The only "neck" injury that I have seen came from high to low, transacted the pharynx/larynx the went inferior and probably hit the aorta or heart. Needless to say an American soldier lost his life that night.

The picture of an undeformed rifle round in the neck leaves me a little suspicious of how it got here. Rifle rounds traveling at 2000-3000fps don't stop in structures such as the neck and wound cavities should generally damage a lot of tissue in an object with a diameter of about 5-6in. Major vessels such as: carotid artery, IJ, and EJ. Structures like spine and larynx and of course all of the musculature to keep your head from flopping over.

If it had been a supersonic round he's likely going to be reporting from the grave. I would guess that something slowed it down or it was fired in the air and came down and entered the skin under gravity and not propulsion.


All that to say, I've seen crazy things happen, so who knows.

Odd Job
06-17-2017, 01:28
The discoloration of the tip of the projectile is interesting. Appears to be 7.62x39 lead ball. Because of the short distance of the tip to the meplat of the lead core, I beleive it is Russian, quite possibly Ulyanovsk FMJ.

The tip is not "discolored," it appears darker on the radiograph because of the effect of composite density. In this case the high density or radiographically opaque metal of the bullet is superimposed on the low density or lucent oropharynx. If you follow the lucency of the airway you see it is responsible for that radiographic change in density:

Odd Job
06-17-2017, 01:35
I agree with you about the likelihood that this projectile had slowed down before it hit the journalist. I have a radiograph from a similar case where a young woman took a round from a 7.62 x 39 cartridge in the chest but survived, partly because of the posterior trajectory and partly because of distance. If I can find that radiograph I will post it here.

Odd Job
06-17-2017, 02:22
See attached my example:

1) Supine chest radiograph with skin breach marked on the upper left side of the chest (the right side on your screen). That diffuse opacity of the left lung is a haemothorax which doesn't have an obvious fluid level because the image was taken supine.

2) Erect view of the same case. Note how the bullet now sits more inferiorly. This indicates it is in a tissue plane where it has some movement (both because of gravity and because of freedom to move in that tissue). You could argue there is a fluid level at the left lung base (right side of your screen) but that's diaphragm area also, so it is hard to visualise. This image is taken before the insertion of the chest drain. Note the subcutaneous emphysema and lung contusion.

3) Lateral view, very important to localise where this projectile is. Here we see it is posterior. Trajectory is left postero-lateral chest moving through the left lung on a posterior course to a position outside of the thoracic cavity behind the right lung. That thick coiled tube is a chest drain.

You can read more about skin breach markers here:

https://www.linkedin.com/today/posts/brandon-bertolli-b6500522

miclo18d
06-17-2017, 06:01
Thanks for that great write up odd job. It always helps when someone actually has the training to back up what they say. My radiology experience is very limited.

Odd Job
06-17-2017, 14:55
You're welcome!

35NCO
06-18-2017, 21:17
The tip is not "discolored," it appears darker on the radiograph because of the effect of composite density. In this case the high density or radiographically opaque metal of the bullet is superimposed on the low density or lucent oropharynx. If you follow the lucency of the airway you see it is responsible for that radiographic change in density:

Thank you for your professionalism. That all makes so much sense.

I thought it was the hollow void of the projectile jacket before the meplat of the lead core showing on the scan. That is how I got to the conclusion it was lead ball fmj, and a mfg, because some have very specfic distances of tip to meplat. If there is no seperation of the metal types, then no way to really tell with a solid. Besides determine caliber with the right tools if enough remains.

http://i2.photobucket.com/albums/y3/briansmithwins/762x39cutawaycartridges.jpg

Odd Job
06-19-2017, 12:33
I think if the tip was hollow, the radiographic density within that triangle would be a lot less dense than what it appears to be on the image (although we are now getting into a small area of a radiograph which should ideally be viewed in its original DICOM format).

I don't know if I have any spitzer projectiles with a hollow tip in my small collection, but if I find one I will X-ray it in various ways and post the images here, if that is of interest.

35NCO
06-21-2017, 07:41
Oddjob,

I would be interested to see for an interest of understanding that.

Is there a good resource that references weapons projectiles specifically in xrays and scans? Or something that discusses the response signature of metallic objects being scanning while in the body?

Thank you.

Brush Okie
06-21-2017, 11:27
I know I am a little late in on this one, but from the GSW's I have seen the only thing predictable about a wound is they are unpredictable. I have seen bullets take weird turns. First person I treated that was shot was with a small 22 long rife out of a 2 in barrel across the room. It went in to the left thorax just below the nipple, bounced around and wound up next to the spine about where that one is. For all we know that round could have entered through the leg or other part of the body and ended there. I doubt it but it is possible.

miclo18d
06-22-2017, 06:33
I know I am a little late in on this one, but from the GSW's I have seen the only thing predictable about a wound is they are unpredictable. I have seen bullets take weird turns. First person I treated that was shot was with a small 22 long rife out of a 2 in barrel across the room. It went in to the left thorax just below the nipple, bounced around and wound up next to the spine about where that one is. For all we know that round could have entered through the leg or other part of the body and ended there. I doubt it but it is possible.

He posted this pic on twitter and stated the bullet was still in his neck. I made the assumption that the bandaged area was point of entry.

But I do agree that bullets do crazy things!

Odd Job
06-22-2017, 16:20
Oddjob,

I would be interested to see for an interest of understanding that.

Is there a good resource that references weapons projectiles specifically in xrays and scans? Or something that discusses the response signature of metallic objects being scanning while in the body?

Thank you.

There's no public reference database I know of.
I have a selection of cases available for anyone to read, where some projectiles have been X-rayed in situ and then recovered. These are from handgun cases mainly. You can see some of those cases in the link below:

https://www.linkedin.com/today/posts/brandon-bertolli-b6500522

I have a bunch of handgun projectiles which were X-rayed and photographed in the same position. I have posted some of those on other boards, mainly when a specific question came up about some aspect of that projectile. For example one question was about the difference between jacket materials as seen radiographically.
I have two Winchester Silvertip rounds which I fired into dry paper wads intentionally, in order to get the jackets to peel away from the core. The first round was a .32ACP which had an aluminium jacket and was not visible under normal medical X-ray exposures. The second one was a 9mm bullet with a nickel plated copper jacket which was visible on X-ray.
Here are the two bullets and the explanation alongside. I shot those rounds in South Africa many moons ago...

Edit: I should add that not all .32 Silvertips had an aluminium jacket. I have another one in my collection which is nickel plated like the 9mm one above.

Odd Job
06-22-2017, 16:24
I know I am a little late in on this one, but from the GSW's I have seen the only thing predictable about a wound is they are unpredictable. I have seen bullets take weird turns. First person I treated that was shot was with a small 22 long rife out of a 2 in barrel across the room. It went in to the left thorax just below the nipple, bounced around and wound up next to the spine about where that one is. For all we know that round could have entered through the leg or other part of the body and ended there. I doubt it but it is possible.

The best one I saw was a gunshot face that ended up damaging the liver. It is Case number 5 in the link above.