Penetrating trauma (PT) is of such magnitude in this country that it is nearly impossible to do it justice in short form. This is primarily a medical blog, and as such I’ll defer addressing the politics of it all. The fact remains that gunshot and stab wounds take an astounding toll on human life in the U.S, with over 16,000 homicides annually (approximately 45 deaths every day). The ramifications of these wounds encompass much more than medical considerations, but I’ll devote this space to discussing basics of penetrating trauma.
By design, intentional stab and gunshot wound aim to kill. Just as I noted in discussing the blunt trauma seen in motor vehicle crashes, any area of the body can be shot or stabbed. Unintentional injuries are also a source of common emergency room presentations. Major ERs and Trauma Centers are known within the industry as the ‘knife and gun clubs’.
Penetrating injuries to virtually all areas (brain, neck, chest, back, abdomen, groin, extremities) can be fatal. Gunshots wounds have several ways of injuring you, including the direct damage to tissue, indirect damage from the shock waves and direct damage from fragments (of the bullet or bone).
- PT that reaches blood vessels can cause fatal bleeding. In the abdomen, the liver is the most commonly injured organ because of its large size and can bleed enough to cause shock and death.
- PT that reaches the spinal cord can cause paralysis and death.
- PT to the brain can cause all manners of dysfunction, including loss of speech, motion, sensation, bodily functions, paralysis and death.
- PT to the chest can cause puncture, rupture and/or loss of lung and heart function, leading to a pretty rapid death.
Be reminded that although both gunshot wounds and stab wounds involve penetration and may puncture your internal organs, gunshots are more prone to deeper penetration with higher energy and may create exit wounds, causing damage throughout its course.
What You Can Do
Here are the things you must consider after becoming a victim of penetrating trauma.
- Get to safety. Perpetrators of penetrating trauma meant to hurt you and often mean for you to be dead. They may be looking to finish the job. I’ve been involved in many scenarios where individuals came to the ER to do just that.
- Once you’re safe, immediately call 911 regardless of how you feel. You may be in shock and your body will fight feverishly to normalize how you feel – right up until you crash. In other words, you can’t trust how you feel. Another vital consideration about getting medical attention rapidly is what we call ‘The Golden Hour’. The opportunity to address many of the truly life threatening considerations in penetrating trauma is best done within the first 60 minutes of the injury.
- Once you’re safe, apply pressure (clean towels) to any bleeding sites. Cover yourself with blankets as needed to preserve heat.
- Avoid movement. Gunshot wounds are associated with spinal cord injuries, so movement could be dangerous.
What You Should Expect
Treatment of penetrating trauma is very dramatic and necessarily regimented due to the early lack of knowledge of the depth and location of injuries. As such, assessment and treatment protocols generally are in place for the region of the body penetrated. The first consideration is always ensuring that the patient’s Airway is intact, Breathing is still ongoing, and Circulation (blood flow) is sufficient (The ‘ABCs’ of Trauma management). After that, use of x-rays, CT scans and other radiologic modalities to identify the location and extent of injuries will be employed based on the stability of the patient. Sometimes immediate surgical intervention is needed.
This is another situation where prevention is the best course of action. Avoiding injuries when possible should go without saying but often does not. Gun safety for gun owners is crucial to avoid unintentional injuries. Attention to detail is very important when handling guns and knives. Unintentional injuries tend to occur when handlers of these weapons get too comfortable. Unfortunately, once penetrating trauma has occurred, it seems like a game of chance. For every person who is told “If that bullet was one more inch to the right, you’d be paralyzed (or dead)”, another family has to be told to make arrangements. Unfortunately, my father was the victim of a random fatal gunshot wound when I was six years old, so I know that story all too well.
If you remember anything from this blog post, remember time is of the essence. Get your loved one to us inside of ‘The Golden Hour’ to give the best chance of a good outcome.