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from Section 3.14 - Environmental Injuries
Published online by Cambridge University Press: 27 July 2023
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.
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