The Influence of the Opioid Epidemic on Firearm Violence in Kentucky Counties.

BACKGROUND: The opioid crisis is a major public health emergency. Current data likely underestimate the full impact on mortality due to limitations in reporting and toxicology screening. We explored the relationship between opioid overdose and firearm-associated emergency department visits (ODED & FAED, respectively). METHODS: For the years 2010 to 2017, we analyzed county-level ODED and FAED visits in Kentucky using Office of Health Policy and US Census Bureau data. Firearm death certificate data were analyzed along with high-dose prescriptions from the Kentucky All Schedule Prescription Electronic Reporting records. Socioeconomic variables analyzed included health insurance coverage, race, median household earnings, unemployment rate, and high-school graduation rate. RESULTS: ODED and FAED visits were correlated (Rho = 0.29, P< 0.01) and both increased over the study period, remarkably so after 2013 (P < 0.001). FAED visits were higher in rural compared to metro counties (P < 0.001), while ODED visits were not. In multivariable analysis, FAED visits were associated with ODED visits (Std. B = 0.24, P= 0.001), high-dose prescriptions (0.21, P = 0.008), rural status (0.19, P = 0.012), percentage white race (-0.28, P = 0.012), and percentage high school graduates (-0.68, P < 0.001). Unemployment and earnings were bivariate correlates with FAED visits (Rho = 0.42, P < 0.001 and -0.32, P < 0.001, respectively) but were not significant in the multivariable model. CONCLUSIONS: In addition to recognized nonfatal consequences of the opioid crisis, firearm violence appears to be a corollary impact, particularly in rural counties. Firearm injury prevention efforts should consider the contribution of opioid use and abuse.

[The possibilities for the expert diagnostics of the influence of the glance of a bullet on the character of the injuries inflicted by shooting a hunting weapon]. / Vozmozhnosti ékspertnoi otsenki vliianiia rikosheta pul' na kharakter povrezhdenii ot vystrelov iz okhotnich'ego oruzhiia.

The objective of the present work was to study and analyze the available data concerning the influence of the glance of a bullet on the character of the injuries inflicted by shooting certain types of hunting weapons. This review gives evidence of the possibility of the objective diagnostics of the injuries inflicted by gunshots using the rifle-bore weapons. However, we have failed to find information about the diagnostic criteria for the evaluation of the wounds inflicted by the bullets shot from smooth-bore hunting rifles after their glance from various surfaces in the available special literature publications. Such situation creates the prerequisites for the erroneous conclusions from the results of forensic medical expertise of the after-penetration blunt wounds.

A strange bullet which caused chylomediastinum and chyloptysis.

Chyloptysis and chylomediastinum are uncommon complications of various kinds of thoracic operations, malign and nonmalign diseases. In the English language medical literature, there were no cases of both chylomediastinum and chyloptysis following trauma. We discuss a case of chylomediastinum and chyloptysis after penetrating trauma. The patient sustained a bullet wound that caused chylomediastinum and chyloptysis without damaging major structures apart from the thoracic duct in the mediastinum. Following surgical intervention, the patient has remained problem-free for 5 months.

Successful management of a severe combat penetrating brain injury.

We report the case of successful management of a transcranial penetrating high-energy transfer injury in a 20-year-old soldier. The bullet traversed both cerebral hemispheres and lacerated the superior sagittal sinus rendering him unconscious. We detail the care received at all stages following injury from 'Buddy Aid' on the battlefield, resuscitation by a forward medical team through to prompt neurosurgery within 2 h of injury. Subsequent aeromedical evacuation and continuing aggressive critical care has allowed the patient to survive with acceptable neurological impairment after what is generally considered an unsurvivable injury.

Endovascular repair of a left common carotid pseudoaneurysm associated with a jugular-carotid fistula after gunshot wound to the neck.

The management of traumatic injury of the common carotid artery has traditionally required a conventional surgical intervention, which is associated with a high mortality rate. Endovascular procedures might offer a less invasive alternative to treat these injuries, with a lower rate of mortality and morbidity. We report the case of a 30-year-old man who presented after penetrating injury due to a low-velocity gunshot wound to the neck. Angiography demonstrated a high-flow arteriovenous fistula and large false aneurysm of the common carotid artery. A self-expanding covered stent was placed across the injured portion of the artery, resulting in thrombosis of the aneurysm and preservation of the parent artery, without any significant complication. Covered stent placement is an alternative approach to treating carotid artery pseudoaneurysms associated with a jugular-carotid fistula.

Varied presentations of missile emboli in military combat.

Fragment embolization is a rare phenomenon in trauma patients. Although surgical and endovascular management of vascular injuries have evolved significantly, the detection and management of fragment emboli remain a formidable challenge. We reviewed our experience with this entity from December 2001 to March 2008. During this time period, four (1.1%) of 346 US soldiers evacuated to Walter Reed with arterial or venous injuries were discovered to have suffered missile emboli. Venous emboli were treated with anticoagulation and arterial emboli were treated with standard embolectomy techniques with good result. The presentation, diagnosis, and surgical management of these cases are described.

[Laryngeal lead shot injury: therapy and follow-up]. / Laryngeale Schrotschussverletzung : Therapie und Verlauf.

Laryngeal shot injuries are rare. The case of a 65-year-old man who suffered from an injury with lead pellets is reported. After exploration with removal of the pellet from the lateral cricoarytenoid muscle, an immobility of the vocal fold developed, accompanied by impaired vocal function. Despite persisting immobility of the vocal fold, after 12 weeks voice compensation was achieved by voice therapy.

Late presentation of axillary arterial ischemia following a gunshot wound: Case report.

Penetrating injuries of axillary artery are uncommon and associated with high mortality and morbidity rate. Clinical presentation of these injuries may vary; therefore, a high index of suspicion is essential. We are reporting a case of late presentation of axillary arterial ischemia, 10 days after a gunshot wound, which occurred to a 20-year-old male. The patient was treated successfully with open surgical intervention.

Firearm suicide: pathways to risk and methods of prevention.

Firearms are utilized in approximately half of all US suicides, making them a serious public health concern and a target of suicide prevention efforts. Practical capability influences the transition from suicidal ideation to action and is particularly relevant to firearm suicide. Firearm ownership, experience using firearms, unsafe firearm storage, and high cultural acceptability of firearms increase risk for death by firearm suicide. Means safety strategies, which emphasize the reduction of practical capability for suicide through the limitation of access to and safe storage of firearms, are effective in preventing suicide and include interventions such as lethal means counseling, firearm legislation, and promoting safe storage practices. Public health interventions aimed at reducing firearm suicide are critical topics for continued research.

Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review.

PURPOSE: The present study aims to describe three cases of patients inflicted by rubber bullets with severe facial fractures. METHODS: In addition, a review of English-language literature involving facial fractures by rubber bullets from 1975 to 2016 was performed. RESULTS: This current study demonstrated that the use of the LLRBW is unsafety even when applied by police enforcements exclusively. CONCLUSIONS: Management of facial fractures caused by LLRBW is done in a usual manner with closed or open reduction associated with bone mini-plates or reconstruction plates when indicated. Special initial wound care should be done to avoid secondary infection and additional procedures.

Novel Approach to a Giant External Iliac Vein Aneurysm Secondary to Posttraumatic Femoral Arteriovenous Fistula.

We describe a case of a 55-year-old male with a remote history of a gunshot wound to the left thigh who presented with a 1-year history of worsening high-output congestive heart failure, left lower extremity edema, and left lower abdominal discomfort. Diagnostic evaluation included a computed tomographic angiography (CTA) that demonstrated a fistulous communication between the left superficial femoral artery (SFA) and vein (SFV) as well as a 7.2-cm external iliac vein aneurysm. Given his symptomatology, an endovascular repair of his AVF was recommended, followed by antithrombotic therapy for his aneurysm. Three-month postoperative CTA confirmed AVF exclusion as well as a significant decrease in maximal diameter of the left external iliac vein aneurysm now measuring 24 mm. This case is the first reported successful mid-term repair of a iliac venous aneurysm in the setting of a traumatic arteriovenous fistula using an endovascular approach.

New Year's Eve injuries caused by celebratory gunfire--Puerto Rico, 2003.

Bullets fired into the air during celebrations fall with sufficient force to cause injury and death. However, few data exist regarding the epidemiology of injuries related to celebratory gunfire. In Puerto Rico, where such celebratory actions are common, news media reports have indicated that approximately two persons die and an estimated 25 more are injured each year from celebratory gunfire on New Year's Eve. The Puerto Rico Department of Health (PRDOH) invited CDC and local law enforcement agencies to assist in the investigation of injuries resulting from celebratory gunfire that occurred during December 31, 2003-January 1, 2004. This report summarizes the findings of that investigation, which determined that 1) bullets from probable celebratory gunfire caused 19 injuries, including one death and 2) such injuries affected a higher percentage of women and children aged <15 years than injuries from noncelebratory gunfire, with the majority occurring in certain public housing areas in densely populated, metropolitan San Juan. Education and enforcement of existing laws are needed to prevent these injuries.

The perspectives of violent street gang injuries.

Street gang violence has become a major public health problem in the United States, especially in the inner city. To prevent gang violence, one must understand the many facets of violent street gang activity and the psychological effects of gang violence on individuals as well as on the community. Further, one must have an understanding of the root causes of violent street gang formation, the relationship of firearms to gang violence, and the medical cost of these types of injuries. Prevention should begin with alleviating the root causes of violent street gang formation and include breaking the bonds of violent street gang membership. Adults acknowledge a societal obligation to protect and guide children and adolescents as an investment in the future. Because both children and adolescents lack judgment and experience, they cannot be expected to avoid injury and violence on their own. Although the financial cost of preventing gang violence would not be insignificant, the savings in terms of lives and medical expenditure would be immense. Unless steps are taken to end the physical and psychological trauma, regions of the United States, such as Los Angeles County, will not be safe from the effects of gang violence.

Vascular injury secondary to gunshot wound: wanna be, gonna be, never was.

This case report is unusual not because of the history of gunshot wound but because the patient lied about the injury. The patient stated that he was wounded in combat while serving in Vietnam. When records were verified, it was discovered that the patient was not a veteran and, therefore, could not have been injured in combat. The fact that this patient claimed to be a combat veteran but never served in the military brings to mind the words from the well-known Airborne cadence "Wanna Be, Gonna Be." However, in this case the patient never was.

[Wounds from modern small arms and international humanitarian law]. / Raneniia sovremennym strelkovym oruzhiem i mezhdunarodnoe gumanitarnoe pravo.

The article cites the concept, basic standards and principles of international humane law concerning the banning or restriction of some types of conventional weapons. The authors describe international methods for appreciation of destructive effects of wounding missiles. On the basis of literature and their own experiments the authors make a conclusion that actually it would be impossible to formulate a straight definition between "human" and "inhumane" bullets, as well as to establish a criterion which could determine the admissible or inadmissible limits for gunshot injuries.