The importance of assessment before automatically treating.

[Aidey]

The back story is that the patient was the driver of a slow speed MVC in which the passenger ran off. It was a .45 caliber gun.

The victim was transported to the hospital where staff was initially confounded by the large amount of bleeding. They eventually removed a cervical collar and found a bullet wound behind the victim's ear.

Oops.

 

[abckidsmom]

The back story is that the patient was the driver of a slow speed MVC in which the passenger ran off. It was a .45 caliber gun.



Oops.

Dolt.

How do you miss a pool of blood under the patient's head?

 

[Aidey]

No idea. I can't figure out how significant bleeding in a slow speed MVC didn't raise some serious suspicions from the get go. I mean, in order to c-spine the patient, their hands had to be right there where the wound was.

 

[mycrofft]

Bullet entrance can be hard to find in thick bloody hair.

Where did this .45 slug stop? In the head? Surprised secondary signs and symptoms weren't seen, like bleeding from eyes/nose/ears, CSF, fist- sized hole in opposite end where slug exited.
Having said that, I've seen .32's slide and stop between scalp and skull once. Short barrel revolver at fifty feet from the front. One was low enough to penetrate, and pt died.

 

[ffemt8978]

Link to the original story:

http://spokane.myfoxlinks.com/news/...an-in-critical-condition-one-suspect-arrested

 

[CAOX3]

Yeah something isnt adding up here. Im no firearms expert but in my experience you dont have to look too hard especially an exit wound in close range, large caliber GSW to the head.

 

[looker]

Sounds like they didn't do any assessment at all. Maybe just grab and go and let hospital figure out where all the blood is coming from.

 

[usafmedic45]

Speaking as a former deputy coroner, it's not uncommon for even "large caliber" rounds not to exit the skull (especially if they are hollow points or "wadcutter" rounds, mostly due to the decreased mass of the round and increased tendency to mushroom). It's not until you get into the magnum rounds where you're pretty much guaranteed an exit wound. I've seen several suicides with .45 rounds to the head where the slug was just sitting in skull or under the skin.

Of course, the press could have gotten the size of weapon wrong or the police seized a weapon that wasn't the one that inflicted the wound.

 

[CAOX3]

Speaking as a former deputy coroner, it's not uncommon for even "large caliber" rounds not to exit the skull (especially if they are hollow points or "wadcutter" rounds, mostly due to the decreased mass of the round and increased tendency to mushroom). It's not until you get into the magnum rounds where you're pretty much guaranteed an exit wound. I've seen several suicides with .45 rounds to the head where the slug was just sitting in skull or under the skin.

Of course, the press could have gotten the size of weapon wrong or the police seized a weapon that wasn't the one that inflicted the wound.

Interesting, my only experience with large caliber GSWs to the head were complete internal and external devestation. I will admit I am completely uninformed about ammunition.

Good information.

Thanks you sir.

 

[lightsandsirens5]

Wow, that is getting pretty close to home for me. Spokane is my nearest big city. I know several Spokane and Spokane Valley medics and also fire guys. I'll have to ask if they have heard any more.

I'll let you know if I do.

 

[Aidey]

Speaking as a former deputy coroner, it's not uncommon for even "large caliber" rounds not to exit the skull (especially if they are hollow points or "wadcutter" rounds, mostly due to the decreased mass of the round and increased tendency to mushroom). It's not until you get into the magnum rounds where you're pretty much guaranteed an exit wound. I've seen several suicides with .45 rounds to the head where the slug was just sitting in skull or under the skin.

Of course, the press could have gotten the size of weapon wrong or the police seized a weapon that wasn't the one that inflicted the wound.

I had one where the guy shot himself with a .45 and there was no entry wound, it was an under the chin shot. However, when I grabbed his head the back of his head was literally mushy. I have no idea what specific type of .45 it was.

Even if there was no exit wound, it seems a little crazy that the entry wound was totally missed. I get that if someone has thick matted hair that can complicate it. But I would like to think that the responders found it strange a guy was bleeding all over and unconscious from a low speed MVC.

 

[mycrofft]

Thanks USAF, real first hand knowledge!

That's what EMTLIFE needs to be more about!!

 

[Afflixion]

considering the story does not give much information on the wound I can only speculate. They only speak of one wound which from very basic physics would imply it was an entrance wound. Entrance wounds from a .45 can be no larger than 1/4 of an inch especially in the head where it can be easily lost in hair is mycrofft stated, but bullet wounds do not always hemorrhage severely, I've seen a 7.62 entrance wound that just barely trickled blood, also in the head. Granted this may or may not be the case here but it is a very likely scenario.

 

[mycrofft]

Don't bleed much if they're dead.

7.62 ought to acheive that pretty well.

 

[usafmedic45]

Entrance wounds from a .45 can be no larger than 1/4 of an inch especially in the head

You do realize that a .45 caliber round is .45 inches across right?

 

[abckidsmom]

You do realize that a .45 caliber round is .45 inches across right?

Always with the technical details, lol.

Is that the actual projectile or the measurement of the bullet in the casing? Just curiosity.

 

[usalsfyre]

Always with the technical details, lol.

Is that the actual projectile or the measurement of the bullet in the casing? Just curiosity.

Actual projectile size is 0.451".

 

[lightsandsirens5]

considering the story does not give much information on the wound I can only speculate. They only speak of one wound which from very basic physics would imply it was an entrance wound. Entrance wounds from a .45 can be no larger than 1/4 of an inch especially in the head where it can be easily lost in hair is mycrofft stated, but bullet wounds do not always hemorrhage severely, I've seen a 7.62 entrance wound that just barely trickled blood, also in the head. Granted this may or may not be the case here but it is a very likely scenario.

Yea....entrance wound from a (roughly) .30 cal round to the head prolly won't bleed much. As mycrofft already said, dead people really don't bleed too bad. Now on the other side where the round exited, (assuming it did) there will be probably quite a bit of blood and/or brain matter.

Now, if your pt takes a 7.62 to the body and assuming they don't have their heart or great vessels perforated, the will probably bleed like a stuck pig. (At least all the ones I have seen did that.

 

[usafmedic45]

Always with the technical details, lol.

Is that the actual projectile or the measurement of the bullet in the casing? Just curiosity.

Caliber is a measure of the size of the projectile as it leaves the barrel.

 

[usafmedic45]

As mycrofft already said, dead people really don't bleed too bad

Take a look at the inside of a body bag after a trauma and tell me that. LOL