[Distribution features of gunshot residue from hunting Steyr Mannlicher AUG-Z3 carbine on targets]. / Osobennosti raspredeleniya na mishenyakh produktov vystrela iz okhotnich'ego karabina Steyr Mannlicher AUG-Z3.

OBJECTIVE: To study the morphology of distribution of shot factors on white targets made of coarse calico at different distances. MATERIAL AND METHODS: The study was conducted on 57 experimental damages of targets made of cotton fabric, caused by shots from hunting self-loading Steyr Mannlicher AUG-Z3 carbine of.223 Rem caliber. The number of experimental firings equal 19 was done by 3 shots at the distance from close range to 250 cm. The examination of shot targets was carried out using the visual, metric, stereoscopic (Leica 125M microscope) methods, in ultraviolet rays (LUMATEC SUPERLITE M Series light). RESULTS: The nature and morphology of distribution of gunshot residue on targets' surfaces made it possible to establish close range firing zones. The nature in which soot is deposited during shot under the conditions of point-blank range and in the first zone of close range (up to 8 cm) allows to establish the position of weapon's transverse plane relative to the target basing on a specific blowout of a gas-powder jet from special design of flame arrestor. The performed experimental shooting from hunting self-loading Steyr Mannlicher AUG-Z3 carbine made it possible to determine the metric and morphological characteristics of the close range firing zones: 1 zone is equal a distance up to 8 cm; 2 zone - up to 30 cm; 3 zone - up to 100 cm from muzzle of weapon. The design features of Steyr Mannlicher AUG-Z3 carbine's flame arrestor allow to identify the type of weapon according to the morphological pattern of target's damage. The complex of obtained data makes it possible to determine the firing distance with high accuracy.

The Pearls and Pitfalls of a Migrating Bullet Embolus.

Venous bullet embolism is an exceedingly rare trauma diagnosis that presents diagnostic and therapeutic challenges. We present the case of a 32-year-old man who sustained multiple gunshot wounds with a venous bullet embolism to the right pulmonary artery. Imaging at first demonstrated a bullet lodged within the right lower lobe. The patient underwent multiple bronchoscopies and ultimately was found to have a bullet embolus in the right pulmonary artery. Repeat endovascular attempts failed at removal, and during a right thoracotomy, the bullet migrated to the left pulmonary artery. Coil embolization of the left lower lobe pulmonary artery was performed, and the patient was found to be asymptomatic at the 1-year follow-up. To our knowledge, this is the first case to demonstrate coil embolization of the pulmonary artery as a method of endovascular treatment for a venous bullet embolus. We present this case report to emphasize the difficulty in diagnosis, localization, and management of a migratory bullet within the pulmonary circulation.

Injury Patterns and Treatment Strategies in Civilian and Military Isolated Abdominal Gunshot Wounds.

BACKGROUND: Combat-related gunshot wounds (GSW) may differ from those found in civilian trauma centers. Missile velocity, resources, logistics, and body armor may affect injury patterns and management strategies. This study compares injury patterns, management, and outcomes in isolated abdominal GSW between military (MIL) and civilian (CIV) populations. METHODS: The Department of Defense Trauma Registry (DoDTR) and TQIP databases were queried for patients with isolated abdominal GSW from 2013 to 2016. MIL patients were propensity score matched 1:3 based on age, sex, and extraabdominal AIS. Injury patterns and in-hospital outcomes were compared. Initial operative management strategies, including selective nonoperative management (SNOM) for isolated solid organ injuries, were also compared. RESULTS: Of the 6435 patients with isolated abdominal GSW, 183 (3%) MIL were identified and matched with 549 CIV patients. The MIL group had more hollow viscus injuries (84% vs. 66%) while the CIV group had more vascular injuries (10% vs. 21%) (p < .05 for both). Operative strategy differed, with more MIL patients undergoing exploratory laparotomy (95% vs. 82%) and colectomy (72% vs. 52%) (p < .05 for both). However, no difference in ostomy creation was appreciated. More SNOM for isolated solid organ injuries was performed in the CIV group (34.1% vs. 12.5%; p < 0.05). In-hospital outcomes, including mortality, were similar between groups. CONCLUSIONS: MIL abdominal GSW lead to higher rates of hollow viscus injuries compared to CIV GSW. MIL GSW are more frequently treated with resection but with similar ostomy creation compared to civilian GSW. SNOM of solid organ injuries is infrequently performed following MIL GSW.

An unplanned complex suicide with 6 mm Flobert revolver and train crash: a case report.

A complex suicide defines a combination of multiple suicidal methods the victim successively or concurrently carries out. We present a case of a 72-year old man found dead on the railtrack, seemingly committing simple train-related suicide. Flobert revolver - a small caliber handgun was found nearby. Herein, we emphasize the significance of a thorough external examination, stress the fact that victim can act after low-energy projectile trauma and match our case to a similar complex suicide.

Burden of unintentional pediatric firearm injury: An examination of the Nationwide Readmission Database.

BACKGROUND: Significant increases in firearm-related mortality in the US pediatric population drive an urgent need to study these injuries to drive prevention policies. The purpose of this study was (1) to characterize those with and without readmissions, (2) to identify risk factors for 90-day unplanned readmission, and (3) to examine reasons for hospital readmission. METHODS: The 2016-2019 Nationwide Readmission Database of the Healthcare Cost and Utilization Project was used to identify hospital admissions with unintentional firearm injury in patients younger than 18 years. Ninety-day unplanned readmission characteristics were assessed and detailed. Multivariable regression analysis was used to assess factors associated with unplanned 90-day readmission. RESULTS: Over 4 years, 1,264 unintentional firearm injury admissions resulted in 113 subsequent readmissions (8.9%). There were no significant differences in age or payor, but more women (14.7% vs. 23%) and older children (13-17 years [80.5%]) had readmissions. The mortality rate during primary hospitalization was 5.1%. Survivors of initial firearm injury were more frequently readmitted if they had a mental health diagnosis (22.1% vs. 13.8%; p = 0.017). Readmission diagnosis included complications (15%), mental health or drug/alcohol (9.7%), trauma (33.6%), a combination of the prior three (28.3%), and chronic disease (13.3%). More than a third (38.9%) of the trauma readmissions were for new traumatic injury. Female children, those with longer lengths of stay, and those with more severe injuries were more likely to have unplanned 90-day readmissions. Mental health and drug/alcohol abuse diagnoses were not an independent predictor for readmission. CONCLUSION: This study provides insight into the characteristics of and risk factors for unplanned readmission in the pediatric unintentional firearm injury population. In addition to using prevention strategies, the utilization of trauma-informed care must be integrated into all aspects of care for this population to help minimize the long-term psychological impact of surviving firearm injury. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.

[Impact of projectile incidence angle with obstacle during ricochet on the damage characteristics formed in smoothbore weapon shot]. / Vliyanie ugla vstrechi puli s pregradoi pri rikoshete na kharakteristiku povrezhdenii, obrazuyushchikhsya pri vystrele iz gladkostvol'nogo oruzhiya.

The aim of this study was to establish the degree of projectile incidence angle with obstacle on forensic medical characteristic of gunshot injuries arising from smoothbore weapon fire and bullet ricochet. Based on the comprehensive forensic study results of experimental entry gunshot injuries, statistically significant differences in the following morphological signs were found for two ranges of incidence angle values (10-20° and 30-50°): «Number of MD¼, «Length 1 MD¼, «Length 2 MD¼, «Width 1 MD¼, «Orientation of AD to the conventional clock face relative to MD 1 or to the group of largest MD (max. value)¼. The medians and limits of 99% confidence intervals of these features values were observed depending on the range of incidence angle values. The revealed patterns can be used in expert practice during forensic medical examination of gunshot injuries formed as a result of a projectile ricochet after smoothbore weapon fire, as well as to develop a methodology for conducting a forensic study of this gunshot injury type.

Two Endovascular Stent Graft Repairs Needed for an Extrathoracic Aortic Graft: Distant Complications After an Original Open Repair for a Gunshot Wound to the Chest.

Although the management of traumatic injuries to the thoracic aorta has shifted toward endovascular management, the historical standard of care is open reconstruction. Choosing to reoperate when faced with a complication from a prior open repair can be challenging; endovascular management can be a reasonable option in this situation. This report describes a 54-year-old man with a remote history of open surgery for a traumatic injury to the descending thoracic aorta who underwent endovascular aortic stent graft placement for coverage of extrathoracic graft extension with pseudoaneurysm formation and distal embolization. He returned a year later with a type IIIb endoleak with rupture into the posterolateral chest wall. A sec ond endovascular approach was used to successfully reline the graft and exclude the rupture.

Contemporary management and outcomes of penetrating colon injuries: Validation of the 2020 AAST Colon Organ Injury Scale.

INTRODUCTION: The American Association for the Surgery of Trauma Colon Organ Injury Scale (OIS) was updated in 2020 to include a separate OIS for penetrating colon injuries and included imaging criteria. In this multicenter study, we describe the contemporary management and outcomes of penetrating colon injuries and hypothesize that the 2020 OIS system correlates with operative management, complications, and outcomes. METHODS: This was a retrospective study of patients presenting to 12 Level 1 trauma centers between 2016 and 2020 with penetrating colon injuries and Abbreviated Injury Scale score of <3 in other body regions. We assessed the association of the new OIS with surgical management and clinical outcomes and the association of OIS imaging criteria with operative criteria. Bivariate analysis was done with χ 2 , analysis of variance, and Kruskal-Wallis, where appropriate. Multivariable models were constructed in a stepwise selection fashion. RESULTS: We identified 573 patients with penetrating colon injuries. Patients were young and predominantly male; 79% suffered a gunshot injury, 11% had a grade V destructive injury, 19% required ≥6 U of transfusion, 24% had an Injury Severity Score of >15, and 42% had moderate-to-large contamination. Higher OIS was independently associated with a lower likelihood of primary repair, higher likelihood of resection with anastomosis and/or diversion, need for damage-control laparotomy, and higher incidence of abscess, wound infection, extra-abdominal infections, acute kidney injury, and lung injury. Damage control was independently associated with diversion and intra-abdominal and extra-abdominal infections. Preoperative imaging in 152 (27%) cases had a low correlation with operative findings ( κ coefficient, 0.13). CONCLUSION: This is the largest study to date of penetrating colon injuries and the first multicenter validation of the new OIS specific to these injuries. While imaging criteria alone lacked strong predictive value, operative American Association for the Surgery of Trauma OIS colon grade strongly predicted type of interventions and outcomes, supporting use of this grading scale for research and clinical practice. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.

[Main milestones of forensic ballistics history in Russia]. / Osnovnye vekhi istorii sudebno-meditsinskoi ballistiki v Rossii.

The purpose of the scientific work is to outline the main stages of the development of forensic examination of gunshot injuries in Russia. The analysis of the special literature from 1865 to the present time has demonstrated that the issue of forensic examination of gunshot injuries has been analyzed quite deeply by Russian forensic specialists. Meanwhile, expert practice sets forth tasks that are associated with the emergence of new firearm samples and new methods of laboratory and instrumental diagnosis.

[Variability of input gunshot injuries of clothing fabrics]. / Variabel'nost' vkhodnykh ognestrel'nykh povrezhdenii tkanei odezhdy.

One of the main components of a gunshot injury is the entrance hole. Its characteristic features: round shape, size, the presence of a central tissue defect, abrasion collar (contamination, metallization), are differential diagnostic signs of an entrance gunshot injury. Under the conditions of the conducted experiments, the peculiarities of the variability of the described signs of the entrance holes on the clothing fabrics were studied, depending on the nature of the objects to be subjected and the contact velocity of the firearm projectile. The identified features must be taken into account when examining gunshot injuries, as well as planning and conducting experimental studies with firearms.

[Historical aspects, current state and problematic issues of forensic medical examination of a gunshot blunt trauma]. / Istoricheskie aspekty, sovremennoe sostoyanie i problemnye voprosy sudebno-meditsinskoi ekspertizy zapregradnoi ognestrel'noi travmy.

The data of the world literature characterizing the forensic aspects of blunt trauma are generalized and systematized. The issues related to the morphology of damage caused after overcoming an obstacle made of various materials by a bullet, the trajectory of a firearm projectile after overcoming an obstacle, the deformation of a bullet, the transfer of fragments of an obstacle by a bullet, the determination of the distance to the target located behind the damaged barrier, the study of the strength properties of individual human armor protection, the nature of the release of particles of an obstacle. The current state of forensic medical examination of blunt trauma is considered, problems and promising directions of their solution are identified. The importance of using knowledge in the field of theoretical mechanics of deformed solid bodies and high-speed impact interaction of solid bodies is noted.

[Treatment of victims with mine-explosive injuries]. / Rezul'taty lecheniya ranenykh s minno-vzryvnoi travmoi.

OBJECTIVE: To study the incidence and structure of combat gunshot surgical trauma received during the 2nd Karabakh War and to analyze the results of treatment of these victims. MATERIAL AND METHODS: We analyzed surgical treatment of 60 victims with combat gunshot surgical trauma received during the 2nd Karabakh war. In 25 (41.7%) victims, injury occurred as a result of mine-explosive trauma. These victims were divided into 3 groups depending on mechanism of mine-explosive injury. The 1st group included 7 (28%) patients who received mine-explosive injury due to indirect (propelling) effect of blast wave. The 2nd group included 14 (56%) victims in whom mine-explosive injury was caused by non-contact (distant) impact of mine fragments. The 3rd group consisted of 4 (16%) patients whose mine-explosive injuries were caused by direct impact of explosion factors on various anatomical areas. Patients were also ranked into 3 groups depending on the nature and severity of mine-explosive injury: wounded with isolated injuries (n=16, 64%), wounded with concomitant injuries (n=2.8%), wounded with combined and multiple injuries (n=7, 28%). RESULTS: Most patients underwent organ-sparing procedures. Resections were performed only in 4 cases (splenectomy - 3, nephrectomy - 1). Postoperative complications developed in 23 (38.3%) wounded (suppuration of postoperative wounds - 13, post-traumatic pleuritis - 5, clotted hemothorax - 2, subphrenic abscess - 1, phlegmon of perineum and perianal region - 2). Mortality rate was 1.7%. CONCLUSION: Timely sorting and evacuation of victims, early qualified surgical care and correct postoperative management with monitoring of vital functions can improve the results of treatment of victims with mine-explosive trauma. Autologous skin grafting for extensive defects and closure of colostomy with restoration of colon continuity were essential in rehabilitation of these patients.

Heridas atípicas producidas por proyectil de arma de fuego Reporte de caso / Atypical wounds caused by firearm projectile Case report

Resumen Las heridas por proyectil de arma de fuego se definen como los efectos que producen sobre el organismo los disparos realizados con armas cargadas de proyectiles o diversos tipos de pólvora u otros explosivos. La valoración médico legal en estos casos, en personas vivas, se realiza en la Sección Clínica Médico Forense del Departamento de Medicina Legal del Organismo de Investigación Judicial, esta incluye la historia médico legal, el examen físico, el análisis de documentos médicos aportados, pericias conexas efectuadas y revisión de bibliografía, esto para tener todos los elementos de juicio que permitan realizar un análisis objetivo y basado en la evidencia científica, y así poder responder a las interrogantes de la Autoridad Judicial. El presente artículo abarca algunos de los aspectos principales a tomar en cuenta ante hallazgos atípicos de los orificios de entrada y salida de los proyectiles, mediante la presentación y abordaje de un caso clínico.

Abstract Firearm projectile injuries are defined as the effects produced on the body by shots fired with weapons loaded with projectiles or various types of gunpowder or other explosives. The legal medical assessment in these cases, in living persons, is carried out in the Forensic Medical Clinical Section of the Department of Legal Medicine of the Organismo de Investigación Judicial, this includes the legal medical history, physical examination, analysis of medical documents provided, expert carried out and bibliography review, this to have all the elements of judgment that allow an objective analysis based on scientific evidence, and thus be able to answer the questions of the Judicial Authority. This article covers some of the main aspects to be considered when faced with atypical findings of the entry and exit holes of the projectiles, through the presentation and approach of a clinical case. Ver bases de datos

[Diagnostic difficulties in a patient with a combined gunshot injury involving non-penetrating abdominal wound and injury of superficial femoral artery]. / Sochetannaya ognestrel'naya travma bedrennoi arterii i nepronikayushchego raneniya zhivota.

Non-penetrating gunshot abdominal wounds are rare in peacetime and mainly caused by firearm traumatic weapons. The main therapeutic measure in this case is primary surgical debridement with adequate drainage. At the same time, such injuries may be accompanied by damage to internal organs. Timely diagnosis of these lesions may be difficult, and surgical treatment may be necessary. We report a patient with combined gunshot injury, damage to superficial femoral artery and non-penetrating abdominal wound followed by contusion and necrosis of small bowel. When providing medical care in patients with non-penetrating gunshot abdominal wounds, one should remember possible damage to internal organs due to high kinetic energy of the wounding projectile resulting contusion-induced necrosis.

Evaluation of firearm injuries by trauma scoring systems in a secondary health care institution.

BACKGROUND: Scoring systems are widely used in trauma patients and are very important in the care of trauma patients. The objective of this study was to investigate the effectiveness of scoring systems in evaluating the patients who were brought to a hospital without a trauma center due to firearm injuries (FIs) using scoring systems, and the efficacy of these systems in identifying patients who should be treated in a trauma center. METHODS: Patients brought to Hakkari Yüksekova State Hospital due to FIs between January 2010 and December 2019 were retrospectively investigated. Patients aged 16 and over were included in the study. Patients who were brought to the hospital while deceased and those who did not respond to cardiopulmonary resuscitation in the hospital were excluded from the study. In addition, patients who underwent simple outpatient medical intervention were not included in the patient group. Patients were evaluated demographically. The mortality predictions of trauma scoring systems, which are widely used in the evaluation of trauma patients, were examined. In addition, the effectiveness of scoring systems in identifying patients who should be treated in trauma centers was investigated. RESULTS: In the study, 331 patients, 96.9% of whom were male, were evaluated. The patient group consisted of young patients and the median age was 27 (IQR, 24-29) years. A total of 74 (22.4%) patients were referred to trauma referral hospitals for diagnosis and treatment. Mortality occurred in 46 (13.9%) patients. Glasgow coma scale, injury severity score (ISS), revised trauma score, new trauma score, and trauma revised ISS were found effective for predicting mortality in patients, and scoring systems were correlated with each other. However, scoring systems were not found effective in distinguishing patients who should be treated in a trauma center. CONCLUSION: Scoring systems are significant in predicting mortality of patients with gunshot wounds. However, trauma scoring systems have not been found to be effective in distinguishing patients who require referral to a trauma center.

Pediatric firearm injuries to the extremity: management in the emergency department.

Firearm injuries are a leading cause of pediatric mortality in the United States. The frequency of pediatric extremity firearm injuries and the high repeat incidence in high-risk patients make it important for emergency clinicians to understand how to manage these injuries. This issue focuses on the acute management of firearm injuries to the extremities of pediatric patients, drawing from the pediatric literature or extrapolated from adult literature where pediatric evidence is scarce. Current trends, novel management, and controversies are also discussed.

[Possibility of determining «Paradox¼ and «Lancaster¼ barrel boring type by human body gunshot wounds morphology and clothing defects]. / O vozmozhnosti sudebno-meditsinskoi diagnostiki tipa sverlovki kanala stvola «Paradox¼ i «Lancaster¼ po morfologii ognestrel'nykh ranenii tela cheloveka i povrezhdenii odezhdy.

In the specialized forensic medical literature there is no data that allow to reliably and objectively confirm application «Paradox¼ or «Lancaster¼ boring firearms to cause injury. This study analyzes the literature in order to determine the possibility of diagnosing these types of weapon's barrel boring by the morphology of injury. The results of the analysis demonstrate a high probability of barrel boring type distinctive features existing. In addition, has been found the opportunity to determine the type of bullet in the cartridge used to damage. Concluded that it is necessary to do an additional experimental research of the specified conditions for causing firearm injuries.

Forensic diagnostics of the range of rifled firearm calculated by back spatter over clothing.

BACKGROUND: Numerous studies have been conducted by using sophisticated methodologies for the deduction of range in cases of firearm injuries. However, the stark dearth of literature for similar purpose by just simple analysis of blood traces on items of clothing is astonishing. PURPOSE: This study was done to determine the relationship between range of a rifled firearm and blood traces on the clothing of victims in firearm injuries. METHODOLOGY: Simulation experiments were performed by firing test shots in closed shooting range by using a Glock 17 pistol (9 mm luger) into pieces of clothing soaked with sheep blood. A total of 132 shots were fired. The morphologies and amount of blood spatter formed over a range varying from 5 cm to 100 cm (shooting angle-90°) were studied. RESULTS: An inverse relationship was found to exist between morphology of blood traces produced on the target and the distance of the shot fired. The misting and micro-blood spatters were recorded at a range of 5-60 cm. The distance from which shots were fired carried significant impact on the appearance and density of the spray and the blood spatter. CONCLUSIONS: The results provide a scientifically determined, statistically valid and simple equation formula in the most cost effective and easy manner for the deduction of range by mere examination of clothing in cases of firearm injuries. The requirements of the sacrifice of animals, and/or extrapolation of the results to humans by conducting experiments using hypothetical targets were also obviated in this study.