Gunshot wound

A gunshot wound (GSW) is physical trauma due to a bullet from a firearm. Damage may include bleeding, broken bones, organ damage, infection of the wound, or loss of the ability to move part of the body. Damage dependents on the part of the body hit, the path the bullet follows through the body, and the type and speed of the bullet. Long term complications can include lead poisoning and post traumatic stress disorder (PTSD). Factors that determine rates of firearm violence vary by country. These factors may include the illegal drug trade, access to firearms, substance misuse including alcohol, mental health problems, firearm laws, and social and economic differences. Before hospital management begins by verifying the area is safe. This is followed by stopping major bleeding, than assessing and supporting the airway, breathing, and circulation. Firearm laws, particularly background checks and permit to purchase, decrease the risk of death from firearms. Safer firearm storage may decrease the risk of firearm related deaths in children. In 2015 about a million gunshot wounds occurred from interpersonal violence. Firearms, globally in 2016, resulted in 251,000 deaths up from 209,000 in 1990. Of these deaths 161,000 (64%) were the result of assault, 67,500 (27%) were the result of suicide, and 23,000 were accidents. In the United States guns result in about 40,000 deaths in 2017. Firearm related deaths are most common in males between the ages of 20 to 24 years. Economic costs due to gunshot wounds have been estimated at $US 140 billion a year in the United States. Trauma from a gunshot wound varies widely based on the bullet, velocity, entry point, trajectory, and affected anatomy. Gunshot wounds can be particularly devastating compared to other penetrating injuries because the trajectory and fragmentation of bullets can be unpredictable after entry. Additionally, gunshot wounds typically involve a large degree of nearby tissue disruption and destruction due to the physical effects of the projectile correlated with the bullet velocity classification. The immediate damaging effect of a gunshot wound is typically severe bleeding, and with it the potential for hypovolemic shock, a condition characterized by inadequate delivery of oxygen to vital organs. In the case of traumatic hypovolemic shock, this failure of adequate oxygen delivery is due to blood loss, as blood is the means of delivering oxygen to the body's constituent parts. Devastating effects can result when a bullet strikes a vital organ such as the heart, lungs or liver, or damages a component of the central nervous system such as the spinal cord or brain. Common causes of death following gunshot injury include bleeding, low oxygen caused by pneumothorax, catastrophic injury to the heart and major blood vessels, and damage to the brain or central nervous system. Non-fatal gunshot wounds frequently have mild to severe long-lasting effects, typically some form of major disfigurement such as amputation due to a severe bone fracture, and may cause permanent disability. The degree of tissue disruption caused by a projectile is related to the cavitation the projectile creates as it passes through tissue. A bullet with sufficient energy will have a cavitation effect in addition to the penetrating track injury. As the bullet passes through the tissue, initially crushing then lacerating, the space left forms a cavity; this is called the permanent cavity. Higher-velocity bullets create a pressure wave that forces the tissues away, creating not only a permanent cavity the size of the caliber of the bullet but also a temporary cavity or secondary cavity, which is often many times larger than the bullet itself. The temporary cavity is the radial stretching of tissue around the bullet's wound track, which momentarily leaves an empty space caused by high pressures surrounding the projectile that accelerate material away from its path. The extent of cavitation, in turn, is related to the following characteristics of the projectile: