Gunshot wound
A penetrating injury from a firearm projectile with variable severity.
A gunshot wound is a type of penetrating injury caused by a projectile—most often a bullet—fired from a gun. The immediate harm can include bleeding, broken bones, damage to internal organs, infection of the wound, and partial or total loss of movement. Whether the wound is fatal depends on which part of the body is struck, the bullet’s path through the body, and the bullet’s type and speed. Over the long term, complications may include bowel obstruction, failure to thrive, paralysis and neurogenic bladder, repeated breathing problems and pneumothorax, brain damage from lack of oxygen that can lead to early dementia, amputations, chronic pain and extreme sensitivity to light touch (hyperalgesia), deep vein thrombosis leading to pulmonary embolism, limb swelling and weakness, and lead poisoning.
The factors that influence rates of gun violence differ from country to country. These can include the illegal drug trade, easy access to firearms, misuse of alcohol and other substances, mental health issues, firearm laws, social attitudes, economic inequality, and jobs such as police work that carry higher risk. In places where guns are more common, arguments are more likely to end in death, but firearm laws—especially background checks and permits to purchase—can lower that risk. Safer storage of firearms may reduce the number of firearm-related deaths among children.
Before treating a gunshot wound, responders must first make sure the area is safe. Then they stop major bleeding, followed by checking and supporting the airway, breathing, and circulation.
In 2015, roughly one million gunshot wounds worldwide resulted from interpersonal violence. In 2016, firearms caused about 251,000 deaths globally, up from 209,000 in 1990. Of those deaths, 161,000 (64%) were from assault, 67,500 (27%) were suicides, and 23,000 (9%) were accidents. In the United States, guns caused about 40,000 deaths in 2017. Firearm-related deaths are most common among males aged 20 to 24. The economic cost of gunshot wounds in the United States has been estimated at $140 billion per year.
The severity of a gunshot wound varies widely depending on the bullet’s velocity, mass, entry point, trajectory, the anatomy it hits, and whether it exits the body.
- Field
- Medical trauma
- Classification
- Penetrating injury
- Common causes
- Interpersonal violence, suicide, accidents
- Global deaths 2016
- 251000
- Us deaths 2017
- 40000
- Us economic cost
- $140 billion per year
Lore & Background
Gunshot wounds vary widely based on bullet velocity, mass, entry point, trajectory, affected anatomy, and exit point. The immediate damaging effect is typically severe bleeding with potential for hypovolemic shock. Devastating effects occur when a bullet strikes a vital organ such as the heart, lungs, or liver, or damages the central nervous system. Common causes of death include bleeding, pneumothorax, catastrophic injury to the heart and major blood vessels, and damage to the brain or central nervous system.
The degree of tissue disruption is related to cavitation. Higher-velocity bullets create a temporary cavity many times larger than the bullet itself. The kinetic energy of a projectile is proportional to mass and the square of its velocity, making velocity a more important determinant of injury. Bullets may fragment upon impact, but it is not universally established that fragmentation of shattered bone is a more common complication than bullet fragmentation—both can occur depending on the specific circumstances of the wound.
The Kronlein shot, a distinctive pattern of cranial injury, is typically associated with high-velocity projectiles such as rifle bullets, shotgun slugs, and other similarly fast-moving projectiles, though it is not exclusively caused by these types.
Reader's Guide
Gunshot wounds represent a significant global health burden, with about a million wounds from interpersonal violence in 2015 and 251,000 deaths in 2016. Deaths are most common in males aged 20-24 years. Factors determining rates of gun violence vary by country and include the illegal drug trade, easy access to firearms, substance misuse, mental health problems, firearm laws, social attitudes, economic differences, and occupations such as police officer. Where guns are more common, altercations more often end in death, but firearm laws, particularly background checks and permit to purchase, can decrease this risk. Safer firearm storage may decrease risk in children.
Management begins with verifying the area is safe, then stopping major bleeding, and assessing airway, breathing, and circulation. The pathophysiology involves cavitation, with temporary cavities from high-velocity rounds causing extensive tissue disruption. The Gustilo open fracture classification categorizes wounds by velocity, with high-velocity wounds typically causing Type 3 wounds and higher infection risk. The Kronlein shot demonstrates the extreme hydrodynamic effects possible with high-velocity projectiles. Economic costs in the United States have been estimated at $140 billion per year.
Did You Know?
- In 2016, firearms resulted in 251,000 deaths globally, with 64% from assault, 27% from suicide, and 9% from accidents.
- The Kronlein shot is a headshot wound where the intact brain is ejected from the skull, caused only by high-velocity rifle bullets or shotgun slugs.
- The velocity of a bullet is a more important determinant of tissue injury than its mass, as kinetic energy is proportional to the square of velocity.
- Firearm-related deaths are most common in males between the ages of 20 and 24 years.
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