Gunshot Wounds - Preclinical Diagnostics and Therapy

In spite of the gunshot rampages in Germany in the recent years, gunshot wounds are rare in Germany and cannot be compared to the high number of nonfatal gunshot wounds in the United States of America. To understand the injury caused by bullets hitting a human body some facts about wound ballistics have to be known. The grade of injury depends on the bullet properties as well as the properties of the hidden tissue. The higher the amount of energy the bullet is transferring to the body, the higher is the damage caused in the human tissue. All gunshot wounds are contaminated. But even though this is a well-known fact, there is no consensus about the surgical treatment in literature. While most authors recommend a debridement and an antibiotic therapy, in some areas of the world uncomplicated gunshot wounds are treated with sterile wound dressing and a single shot of antibiotics. In a preclinical setting the main goal to go for with gunshot wounds is to stop the bleeding. In recent years the tourniquet became a routine tool in the preclinical stage to achieve this. New haemostyptic wound dressings show promising results in the treatment of bleeding wounds as well, even though there are still some unanswered questions. Beside that the preclinical treatment should follow the military-modified PHTLS algorithm. © Georg Thieme Verlag KG Stuttgart, New York.