Gunshot injuries

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Sangoma
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Gunshot injuries

Post by Sangoma » Sat Aug 18, 2018 8:54 am

It's been bothering me for quite a while, and now I am watching this comedy where the guy is shot in the arm. So, he tells his wife: "Honey, you have to remove the bullet..." I don't know how and when it started. But in the laymens' minds removing the bullet is the most important thing when someone is shot. In some movies the person shot is nearly dying, then someone decides, what the hell, he is going to die otherwise, there is some graphic digging around with tweezers/kitchen knife/scissors/other tool and voila, the victim opens his eyes/coughs/wheezes for couple of breaths and gets back to whatever action he was supposed to be in.

For fuck's sake, removing the bullet is THE LAST THING on surgeon's mind when dealing with gunshot victims. For illustration, imagine your car being shot through the radiator. What's your priority? Right, to plug the water leak, and if the bullet is nowhere to be seen you are not going to even bother looking for it, as long as the car is driveable. It's the same with the human body: damage control is why we take the victim to the operating room. Fixing damaged blood vessels, organ injury, stopping the bleeding, repairing the holes in the bowel - that's what we do. Most of the time we cannot see the bullet and don't care.

One can start bothering with it later if it causes trouble. For example, it is lodged in the vertebra close to the nerve root and causes pain. Sure, then the guy is taken back to theatre to remove the damn thing.

I just wanted to clarify this. There are quite a few other medical things they get wrong in the movies. For example, heating a knife on the flame and burning the wound, but this is so obviously stupid that I assume everyone understands that.

Thank you for listening to my little lecture. I am going back to the movie.
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Re: Gunshot injuries

Post by JimZipCode » Sat Aug 18, 2018 3:14 pm

Sangoma wrote:
Sat Aug 18, 2018 8:54 am
For example, heating a knife on the flame and burning the wound, but this is so obviously stupid that I assume everyone understands that.
Wait. Cauterization isn't a thing?
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Re: Gunshot injuries

Post by Gene » Sat Aug 18, 2018 4:14 pm

Lecture by an anesthesiologist about treating gunshot wounds.

https://www.youtube.com/watch?v=wXwPtP-KDNk&t=1067s
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Re: Gunshot injuries

Post by nafod » Sat Aug 18, 2018 8:14 pm

JimZipCode wrote:
Sat Aug 18, 2018 3:14 pm
Sangoma wrote:
Sat Aug 18, 2018 8:54 am
For example, heating a knife on the flame and burning the wound, but this is so obviously stupid that I assume everyone understands that.
Wait. Cauterization isn't a thing?
Leeches, obviously. Right in the wound.
Don’t believe everything you think.

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Re: Gunshot injuries

Post by JimZipCode » Sat Aug 18, 2018 9:51 pm

nafod wrote:
Sat Aug 18, 2018 8:14 pm
Leeches, obviously. Right in the wound.
No, maggots. They debride the wound, protect from gangrene.
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nafod
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Re: Gunshot injuries

Post by nafod » Sat Aug 18, 2018 10:10 pm

Maggots gnawing on your dead flesh to clean out a wound is hard core.

Sangoma, how do you feel about sugar on wounds and infections? We used it on a recurring MRSA infection to great effect.
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Sangoma
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Re: Gunshot injuries

Post by Sangoma » Sun Aug 19, 2018 2:01 am

I have no field experience with gunshot wounds, only the management in the operating room. A lot of it, from my years in South Africa. So I wouldn't comment on sugar and maggots.

As far as cauterization is concerned, doing it with the red hot knife (the way they do it in the movies) will add a third degree burn to already serious injury.
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Re: Gunshot injuries

Post by Turdacious » Tue Aug 21, 2018 1:20 pm

Sangoma wrote:
Sun Aug 19, 2018 2:01 am
I have no field experience with gunshot wounds, only the management in the operating room. A lot of it, from my years in South Africa. So I wouldn't comment on sugar and maggots.

As far as cauterization is concerned, doing it with the red hot knife (the way they do it in the movies) will add a third degree burn to already serious injury.
So you've got more experience dealing with injuries from burned tires than gunshot wounds?
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Sangoma
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Re: Gunshot injuries

Post by Sangoma » Tue Aug 21, 2018 11:07 pm

In South African hospitals the number of gunshot wounds any critical care worker deals with gets to tripple digits within a year. Burned tyre injury - when they put a tyre around someone's neck and set it alight - most of them don't make it to the hospital. When they do airway burns are a nightmare to deal with. So no, I have treated way more patients hit by bullets. I left SA fourteen years ago, but as far as I know stats haven't changed much. Weird thing, this is the primary reason why I left that country, but from the professional point of view I really miss it.
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