GUNSHOT WOUND

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Gunshot wounds are unpredictable puncture wounds that cause major tissue damage. Three factors work together to determine the severity of a gunshot wound.
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The most commonly injured organs and tissues are the:

intestines liver vascular structures spleen intra thoracic structures.

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NURSING MANAGEMEN T
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The initial evaluation is always focused on assessing the airway, breathing, circulation, disability (neurological status), and exposure (completely undressing the patient), which are done simultaneously by the
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The secondarysurveyis a head-to-toe assessment, including vital signs.

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Examine the patients entire skin surface carefully for abrasions, open wounds, powder burns, and hematomas, paying special attention to skin folds, groin, and axillae.

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Assess the patients abdomen, back, and extremities for lacerations, wounds, abrasions, and deformities. Some highvelocity weapons may cause extensive tissue destruction and fractures.

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Inspect the patient for both entrance and exit wounds.

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Additional:

Stay Safe. If you are not the victim, practice universaland wear personal protective equipment if available. Any situation that involves a gun is potentially dangerous, and rescuers are no help to a 7/22/12 victim if they get hurt.

Call for helpas soon as it is clear a gun is involved. Surviving a gunshot wound depends greatly on how quickly a victim gets to a hospital. Ideally, a gunshot wound victim should be on the way to a hospital in an ambulance within 10 minutes 7/22/12 of being shot.

Do not move the victim unless his or her safety is in danger. Followbasic first aid. If the victim isunconsciousbut breathing, keep the airway open and clear. If the victim is not breathing,begin CPR. Control any bleeding.

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Seal gunshot wounds to the chest with some type of plastic to keep air from being sucked into the wound. This helps prevent the development of a collapsed lung. If the victim begins complaining of worsening shortness of breath, remove the seal. Let conscious victims sit or lie in a position most comfortable for them. Unconscious victims should be placed in therecovery position.
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Do notelevate legs to treat forshockif the gunshot wound is above the waist (unless the gunshot wound is in the arm). Gunshot wounds to the abdomen and chest will bleed more quickly once the legs are elevated, making it harder for the victim to breathe. 7/22/12

Expose the Injured Area

All clothing should be removed to ensure that no injury is missed and to allow you to estimate the trajectory (path) of the bullet.

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Do not probe the wound blindly. Blind probing of the gunshot wound can be dangerous. It may dislodge the clot in an injured blood vessel that has stopped bleeding, thus leading to significant blood loss.

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Neurovascular Exam

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Check the circumference of the injured area. Is it becoming larger (an indication of on-going bleeding), or is it essentially staying the same size? Check for pulses in the vicinity of and distal to the bullet wounds.

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Palpate nearby pulses for a thrill (vibration), and listen with a stethoscope for a bruit. Thrills and bruits may be signs of arterial injury, even if a pulse is palpable.

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Adequate assessment of motor function is often difficult because of pain related to the traumatic injury, but always makes the effort. Sensation should not be affected by pain. Test sensation in the extremity distal to the wound to 7/22/12 evaluate for nerve injury.

Presented by CABALLES, RUBIE ROSE C.

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