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3.14.5 - Ballistic Injuries
from Section 3.14 - Environmental Injuries
- By Tim Hartley
Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
Book:

Intensive Care Medicine

Published online:

27 July 2023

Print publication:

01 December 2021, pp 428-432
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Summary

Key Learning Points
1. Blast injuries may be split into primary, secondary, tertiary and quaternary injuries.
2. There are two major mechanisms of injury that occur via a gunshot wound: crushing tissue destruction by the path of the projectile, and stretching and shock by the formation of a temporary cavity.
3. The path of a bullet is very unpredictable and, as such, must be extensively investigated radiologically to see the full path and extent of the damage.
4. Treatment of patients with ballistic injuries can be simplified into three main steps: resuscitation and primary surgery, restoration of normal physiology in the ICU and return to theatre.
5. A thorough repeat full external examination should always be considered on admission to the ICU, especially if the patient becomes unstable and no identifiable cause is identified.