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A ballistics expert examines the effects of bullets on tissues. He defines a "penetrating missile" as one that delivers an entrance wound but no exit wound, and a "perforating missile" as one that possesses both entrance and exit wounds. He also defines bullet "yaw" as the tumble of a bullet or its tendency to turn sideways in flight. A diagram of bullet yaw is seen in Figure A. Which of the following scenarios leads to the greatest transfer of kinetic energy to tissues?
Penetrating missile with mass "2m", velocity "v", yaw of 90 degrees at the point of impact
Perforating missile with mass "m", velocity "2v", yaw of 0 degrees at the point of impact
Penetrating missile with mass "m", velocity "2v", yaw of 90 degrees at the point of impact
Perforating missile with mass "m", velocity "2v", yaw of 90 degrees at the point of impact
Penetrating missile with mass "2m", velocity "v", yaw of 0 degrees at the point of impact
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A 24-year-old male presents after being shot in the lower back. Radiographs and advanced imaging show that the bullet traversed the paraspinal musculature, entered the pelvis below the pelvic brim, and is currently lodged in the ilium. No intra-articular involvement was noted, and the bony injury is stable. No occult blood is noted on the rectal examination. The police report indicates that the bullet was fired from a low-velocity weapon. Which of the following is the most important treatment for this patient assuming he is hemodynamically stable?
Immediate exploratory laparotomy and bullet removal
Bullet removal followed by surgical stabilization of the ilium
Immediate surgical debridement of the bullet tract and delayed closure of the soft tissue wound
Empiric antibiotic therapy and observation
A 21-year-old male presents to the emergency department after sustaining a gun shot wound to his abdomen. Subsequent radiographs reveal a bullet in the L2 vertebral body. Physical exam shows no neurologic deficits. He undergoes emergent laparotomy and is found to have a small bowel laceration. What would be the preferred treatment following his exploratory laparotomy and small bowel repair?
Intravenous antibiotic coverage for Gram negative bacteria for 7 days
Surgical decompression and bullet fragment removal
Broad-spectrum oral antibiotic coverage for 7 days
Broad-spectrum intravenous antibiotic coverage for 7 days
What is the most appropriate treatment for a 17-year-old boy who sustained a gunshot wound to his forearm from a handgun with a muzzle-velocity of 1000 feet/second if he is neurovascularly intact and radiographs reveal no fracture?
Irrigation and local wound care in the emergency department
Emergent irrigation and debridement in the operating room with vacuum-assisted wound closure
Emergent irrigation and debridement in the operating room with 7 days of intravenous antibiotics
Wound closure in the emergency department with follow-up wound check in 1 week
Exploration and removal of all bullet fragments in the emergency department and 10 day course of oral antibiotics
A 24-year-old man who sustained a gunshot wound to the abdomen ten hours earlier was brought to the emergency department. On physical examination he was found to have 4 of 5 weakness in his bilateral lower extremities. Radiographs are shown in Figure A. Computed tomography of the lumbar spine showed retained missile in the vertebral body and paraspinal soft tissues, but not within the spinal canal. His FAST was positive and he underwent an emergent exploratory laparotomy where an injury to the cecum was identified and treated. Management should now include which of the following?
Bullet fragment removal from a transabdominal approach
Bullet fragment removal from a retroperitoneal approach
Broad-spectrum oral antibiotics for 3-5 days
Broad-spectrum intravenous antibiotics for 7-14 days
IV methylprednisolone at 5.4mg/kg/h for 48 hours