Gunshot Wound Management

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Vol.18, No. 12 December 1996 HEINZ SYMPOSIUM 1996

Continuing Education Article

FOCAL POINT

KEY FACTS

s The mass, velocity, design,

and composition of projectiles

influence their destructive

properties.

s Even low-velocity projectiles can

inflict serious and sometimes

fatal injuries.

s High-velocity projectiles can

cause massive tissue destruction

because of their tremendous

kinetic energy and the shock

waves they send through

adjacent tissue.

s Failure to follow correct

procedures for documenting

and handling forensic evidence

can adversely affect the outcomeof litigation.

5A basic understanding of

ballistics helps the veterinarian

select the most appropriate

treatment for gunshot wounds.

Gunshot WoundManagement

Tufts University

Michael M. Pavletic, DVM

Projectiles often cause injuries in humans and animals. A projectile is anobject that is propelled by external force and that continues in motionby inertia. In veterinary medicine, gunshot wounds are the most com-

mon projectile injuries. The likelihood of a veterinarian seeing such injuries,however, depends on the location of the practice. In 1985, I conducted an epi-zootiologic study of gunshot wounds (111 in dogs and 10 in cats) seen asemergencies at Boston’s Angell Memorial Animal Hospital from 1972 to 1983.Most of the injuries took place in lower-income neighborhoods, which had agreater incidence of crime. Angell Memorial’s proximity to these areas and itsestablished 24-hour emergency service explains the comparatively large num-

ber of cases seen during this period.1

More animals were shot in the evening and early morning hours than at any other time of day. In most cases, the animals had been left outdoors unsuper-vised. A larger percentage of the shootings occurred over the weekend (Friday night through early Monday morning). Handguns were the most common

weapon documented (n = 95). Three animals that were shot with high-velocity rifle rounds were referred from rural areas. Six animals had shotgun wounds,and 17 had wounds from air-propelled BB or pellet guns. Incidental retainedprojectiles discovered on routine radiographs were not included in the study.1

Many of the injuries were misdiagnosed as vehicular trauma or bite wounds.1

Because the severity of gunshot wounds varies considerably, a basic under-standing of ballistics will allow clinicians to select the most appropriate forms

of treatment. This article reviews the ballistics, pathophysiology, and manage-ment of gunshot wounds.

BALLISTICSBallistics is the science of the motion of projectiles in flight—from the point

of initial propulsion to the final path through the target. Kinetic energy is ameans of quantifying the destructive capacity of projectiles. The physics formu-la for kinetic energy outlines the relationship between projectile mass and veloc-ity; this relationship explains, in part, the destructive capacity of projectiles:

Kinetic energy = mass × velocity 2

2

V



Doubling the mass doublesthe kinetic energy of a pro-

jectile, but doubling the ve-locity quadruples the kineticenergy. Other factors, how-

ever, influence the severity of trauma caused by projec-tiles.2,3

PROJECTILE VELOCITYLow-velocity projectiles

are classified as those thattravel less than 1000 feet/sec; medium-velocity pro-

jectiles travel between 1000and 2000 feet/sec; and high-velocity projectiles travel

faster than 2000 to 2500feet/sec. Most handguns areconsidered to be low-veloci-ty weapons. Rifles can gen-erate the higher velocitiesdesired for military andhunting purposes.2,3

PROJECTILE CALIBER,DESIGN, ANDCOMPOSITION

The term caliber refers to

the diameter of the projec-tile or bore (interior diame-ter) of a gun barrel. Caliberis measured in fractions of an inch or in millimeters.Larger caliber suggests greaterprojectile mass. Because of differing shapes and compo-sitions of projectiles, howev-er, the mass and velocity of projectiles of a given calibervary widely.2,3

A cartridge, or round, con-sists of the primer, case, pow-der, and bullet. When a

weapon’s firing pin strikesthe primer within the base of the casing, the powder chargeignites and propels the bulletforward. For most rifles andhandguns, spiral grooves

within the barrel (rifling) im-part rotation, or spin, on thebullet’s longitudinal axis to

stabilize its flight for greateraccuracy. Shotguns andmany air-powered weaponshave smooth bores designedfor the specific projectiles

fired.

2,3

Bullets can be designed tohelp maintain their shape, todeform in a controlled fash-ion, or to fragment on im-pact. Most bullets are com-posed of lead, with variableamounts of antimony addedas a hardener. A lead coremay be encased in a metal

jacket composed of copper,cupronickel, brass, or soft

steel to limit bullet deforma-tion from the heat, friction,and tremendous pressuresthat can be generated as thebullet passes through the bar-rel. A jacket also influencesbullet deformation when thebullet strikes and passesthrough a target. Heavier bul-lets have greater penetrationthan smaller high-velocity projectiles, which rapidly dis-

sipate their kinetic energy.

2,3

By international law, mili-tary projectiles must have afull-metal (full patch) jacketto limit the additional tissuedestruction associated withbullet deformation and frag-mentation. Civilians, howev-er, can purchase nonjacketedor partially jacketed bulletsto be used for hunting andself-defense.2,3 In partially

jacketed bullets, a portion of the lead core is exposed, which allows the nose to par-tially flatten, or mushroom,in a controlled fashion. Al-though penetration may notbe as deep as that seen withfully jacketed bullets, expan-sion of the exposed lead tipenhances the projectile’s im-pact, destructive capacity, andkilling potential (Figure 1).

Small Animal The Compendium December 1996

K I N E T I C E N E R G Y s P R O J E C T I L E C H A R A C T E R I S T I C S s J A C K E T S

Figure 1—Two .38-caliber rounds retrieved from the brainof an aggressive pit bull. The lead core has completely sep-arated from the partial jacket in one bullet. The secondbullet, minus the exposed lead tip, is substantially intactafter passing through the skull.

Figure 2A

Figure 2B

Figure 2—( A ) Lateral and (B) dorsoventral radiographicviews of a paralyzed cat. A BB entered the spinal canalthrough an intervertebral foramen. Despite its modest ve-locity and mass, this air-powered projectile can inflict seri-ous injury when fired from a weapon at close range.



Commercially availablehollow-point bullets and ex-ploding bullets, which areintended for security or self-defense purposes, are de-

signed to rapidly deformand fragment to enhanceabsorption of the projectile’skinetic energy. Some indi-viduals flatten the ends of bullets and score crossedgrooves on the surface (so-called dumdum bullets) forsimilar purposes.2,3

Exploding and “prefrag-mented” projectiles weremore recently introduced

for use against skyjackersand other criminals. Theprojectiles impart a “knock-down” effect on the personstruck by maximizing ab-sorption of kinetic energy.In addition, they reduce thedangers associated with theround exiting the body andstriking the plane’s fuselageor passengers inside thepressurized airplane cabin.

Depending on the composi-tion and design of the ex-ploding bullet, undetonatedrounds retained in the body can pose a hazard to the sur-geon removing the projec-tile. Body temperature or

jostling of the bullet can cause unstable bullets to ex-plode during removal. A projectile of unknown typeshould be handled gently during removal and storage.2,3

DESTRUCTIVE CAPACITY OF PROJECTILES

Tissue in the immediate path of a bullet is laceratedand crushed. The damage that the shock waves releasedby high-velocity projectiles cause to adjacent tissues canbe more difficult to conceptualize. Soft tissue and boneballoon outward from the path of the passing projec-tile, thus briefly creating a cavity. This phenomenon,termed cavitation , can produce a temporary cavity thatis up to 30 times the diameter of the bullet.

During cavitation, a vacuum forms. This vacuum candraw contaminants and surface debris from both the en-try and exit sites into the temporary cavity. The crushingand compression effect of cavitation results in extensive

trauma to tissue and the re-gional circulation. Fracturedbones, torn vessels, rupturedbowels, and massive contu-sions can occur without di-

rect contact with the projectile.Edema and vascular throm-bosis progress for hours afterinjury and can result in agreater volume of tissuenecrosis than was originally estimated at initial woundassessment.2–4 Traumatizedtissue, vascular compromise,foreign debris, and the inoc-ulation of bacteria into thedepths of the wound increase

the risk of infection.

2–4

The specific gravity of thetissues struck also influencesthe nature and severity of the wound. Rigid structures(e.g., cortical bone) canshatter on impact, whereassofter cancellous bone (e.g.,distal femur) is less prone tofragmentation. Low-velocity bullets can punch throughsoft cancellous bone. Frag-

ments of cortical bone orthe projectile can becomesecondary projectiles, en-hancing regional tissue in-

jury.2–4 Elastic tissues, suchas lung and muscle, canstretch to a variable degree,

thereby better maintaining their architectural integrity and reducing the amount of tissue destruction. In con-trast, the liver, with a specific gravity similar to muscle,is less cohesive and resilient. The liver fractures rathereasily on impact.2–4

PROJECTILE WEAPONSCompared with most handguns, rifles can accurate-

ly fire large, high-velocity projectiles. Although mosthandguns are considered to be low-velocity weapons,rounds from a more powerful handgun can exceed1000 feet/sec (medium-velocity range) and causeconsiderable tissue destruction. Lower-velocity

weapons, including air-powered weapons, can pro-duce serious and lethal wounds in humans and ani-mals, although they do not produce extensive tissuetrauma.

The Compendium December 1996 Small Animal

E X P L O D I N G P R O J E C T I L E S s T I S S U E D A M A G E s C A V I T A T I O N

Figure 3A

Figure 3B

Figure 3—Two examples of .177-caliber air-rifle pellets.The pointed pellet ( A ) is designed to deeply penetrate tis-sue, whereas the waisted pellet (B) is designed to flattenand rapidly decelerate on impact.



Air-Powered ProjectilesIn contrast to convention-

al handgun and rifle car-tridges, in which projectilesare propelled by gases re-

leased from exploding gun-powder, BB and pellet gunsprimarily rely on com-pressed air that is releasedfrom a chamber to propelthe lightweight BB or pellet.

Air rifles can achieve veloci-ties comparable to many handguns, but the roundsrapidly lose velocity overcomparatively shorter dis-tances because of their shape

and lighter weight.2–4

BBs (.175 caliber) andpellets (.177, .20, and .22calibers) are currently usedfor target practice and hunt-ing of small animals. Unlikethe round BB, pellets comein various shapes, whichmodify their performance(Figures 2 and 3).

Retained pellets and BBsare common incidental

findings on radiographs.They rapidly decelerate overrelatively short distances asa result of air resistance.They slow down further onimpact with the elastic skin.Thus, BB and pellet pene-tration often is limited tothe hypodermis and under-lying musculature.2–4 Whenfired at close range, howev-er, they can penetrate deep

into the body.

ShotgunsShotguns are smooth-

bore, long-barreled gunsdesigned to fire a groupingof spheres. These pellets(“shot”) vary in size andnumber, depending on thebore of the shotgun and thegame hunted. The pelletsemerge from the muzzle in a

tight cluster but disperse asthey move down range in a

widening, funnel-like pat-tern. The muzzles of shot-guns can be modified in

design (choke) to vary thepattern or dispersion of theshot over a given distance.2–4

Shotguns can also fireheavy lead projectiles calleddeer slugs . The hollow base of the slug expands to seal thebore of the shotgun on deto-nation of the charge. Becauseshotguns have smooth bores,angular grooves etched onthe outer surface of the deer

slug impart a spin on thisprojectile to stabilize itsflight.2,3 A variation, calledsabots , are solid projectilescased in plastic sleeves thatseal the barrel. The sleevesare shed during flight.

When a shotgun is firedat close range (within 15yards), the dense cluster of pellets, presented in a com-pressed surface area, results

in massive tissue destruc-tion. When the shotgunis fired at very close range,the cardboard or plastic

wadding that is used to sep-arate the pellets from thepowder charge in the shellcan also be driven into the

wound. When shotguns areused beyond their effectivehunting range (20 to 40yards), the pattern of pellets

is more widely dispersed,pellet velocity is greatly re-duced, and the capacity forthe pellet to inflict life-threa-tening injury diminishes.2,3

MANAGEMENT OFPROJECTILE WOUNDS

Management of gunshot wounds varies according tothe type of weapon, the ki-netic energy of the projec-


B B G U N S s P E L L E T G U N S s S H O T G U N S

Figure 4A

Figure 4B

Figure 4CFigure 4—( A ) High-velocity rifle round that entered the up-per right facial area of a dog that was referred from a ruralarea. (B) The mandible and maxilla were shattered into mul-tiple fragments. Extensive soft tissue destruction secondary tocavitation and fragmentation of the bone and portions of thebullet are evident. (C) There was a large, explosive exit

wound on the left side of the head. Radiographs demonstrat-ed a small trail of lead fragments, with the bulk of the high-velocity round exiting the body despite passage throughdense bone. These findings are characteristic of a high-veloci-ty rifle round, probably a partially jacketed hunting round.



tile, and the location of the wound(s). The nature of the wound can help determinethe weapon used. If a bul-let is retained in soft tissue

without striking bone, it canbe surmised that the round was low velocity. However, if the round struck and shat-tered dense bone of a large-breed dog and had sufficientenergy to exit the body, ahigh-velocity rifle round ormore powerful handgunshould be suspected4 (Figure4).

The size and shape of

entry and exit wounds canbe somewhat misleading. Although exit wounds aregenerally larger than entry

wounds because of the outward or explosive egress, exit wounds may be smaller thanentry wounds if velocity andprojectile mass are dimin-ished at the point of exitfrom a body region. A tum-bling projectile that present-

ed its long side at entry alsocan produce a comparatively large entry wound and en-hance tissue destruction

within its path. At very closerange, explosive gases re-leased at the muzzle can bal-loon the entry wound.3

Low-velocity projectilesthat have not entered a jointor struck an important body structure can create wounds

that can be treated by localcleansing and lavage of theentry and exit sites. Wounddebridement may be limitedto the skin and underlyingfascial tissues. A topical dressing is applied to the wounds.Systemic antibiotics may be advisable in selected cases(Figure 5). Easily accessible bullets can be removed, butattempts to explore for deeply retained projectiles simply to retrieve the round should be discouraged.4 Lead poi-soning (plumbism, saturnism) secondary to retained pro-

jectiles is rare in humans and animals. Only once did I see

a Labrador retriever with ele-vated lead blood levels andclinical signs compatible

with plumbism (without evi-dence or history of lead con-

sumption). This dog hadnumerous retained birdshotpellets in the thoracic area.

The exposed surface areaof a retained lead projectileand the location of the pro-

jectile in the body can in-fluence the degree of leadabsorption. Lead has greatersolubility when exposed tosynovial fluid. When suchexposure occurs over long

periods, lead poisoning hasoccurred in humans.5,6 Un-deformed, fully jacketedbullets expose little of thesurface area of the lead core,thus limiting the risk of plumbism. Therefore, con-cern over lead poisoningseldom justifies removal of lead projectiles.5,6

In wounds from high-velocity projectiles, the sig-

nificant tissue destruction(especially when bone hasbeen struck) usually re-quires wound explorationand debridement. Whentissue viability cannot bedetermined immediately,many of these wounds re-quire variable periods of open wound managementand staged debridement.2–4

The more powerful low-

velocity projectiles can alsoshatter bone, thus necessi-tating wound exploration,debridement, fracture stabi-lization, and drainage.

Gunshot wounds to the abdominal cavity should beexplored as early as feasible because of the significantrisk of peritonitis secondary to bowel perforation4 (Fig-ure 6). From an historical perspective, 90% of Civil

War patients with abdominal gunshot wounds died of peritonitis.7 During the Vietnam War, rapid evacuationof patients from the combat field to the surgical suite


E N T R Y W O U N D S s E X I T W O U N D S s W O U N D T H E R A P Y

Figure 5A

Figure 5BFigure 5—( A ) A .22-caliber gunshot wound to the head of a cat. The projectile passed through the nasal cavity andthe maxillary bone, destroying adjacent teeth. It thenpassed through the oral cavity and fractured the leftmandible before exiting the left lateral facial skin. Themetallic probe demonstrates the pathway of the bullet.Soft tissue trauma was exacerbated by bone fragmentation.(B) The wounds were opened, explored, and debrided.Free fragments of bone and broken teeth were removed.The maxillary defect was closed by apposition of viablemucosa bordering the surgical site. The mandibular

wound was handled similarly, and drainage was estab-

lished. Broad-spectrum systemic antibiotics were adminis-tered. The patient recovered completely.



reduced the mortality rate to9%.7 I have seen severe peri-tonitis in several animals in

which abdominal explo-ration was not performed.

Most of these patients ap-peared stable on presentationbut developed massive peri-tonitis from bowel perfora-tion a few days after injury.

Unlike penetrating ab-dominal wounds, many tho-racic gunshot wounds may not require exploration. Ex-ploration is required, how-ever, if hemorrhage is lifethreatening, air leaks are un-

responsive to thoracostomy tube insertion and continu-ous suction drainage, or theesophagus or other adjacentvital structures are impacted(Figures 7 and 8). Projectilescan pass through the chestand into the abdominal cav-ity, thus necessitating ab-dominal exploration.2–4

Pellets or BBs that enterthe eye can elicit a severe

foreign-body reaction. Inthese cases, the projectilemust be removed. Closure of the scleral or corneal perfo-ration may be complicatedby the ragged entry woundcreated by the pellet or BB.Occasionally, projectiles passthrough the eye and into theorbit. Extensive hemorrhagemay occur in the retrobulbarspace, or the optic nerve may be struck. More powerful

projectiles may enter the brain through the thin orbitalbone.8,9 Radiographs and computed tomography helpdefine the location of the projectile. Complete destruc-tion of the ocular architecture necessitates removal of the eye.

Gunshot wounds involving the maxillofacial areamay threaten the patient’s ability to breathe if extensivehemorrhage and swelling obstruct the upper airway.Suction of blood and saliva may provide temporary re-lief, but an emergency tracheostomy may be the best

way to ensure a patent airway. Bleeding may be con-trolled temporarily with moderate external pressure to

the area until ligation or re-pair can be performed. Inthe interim, judicious intra-venous fluid support shouldbe provided.

Gunshot wounds to thebrain are associated with ahigh mortality rate in hu-mans and animals. After acareful physical and neuro-logic examination, specificdiagnostic tests (includingcomputed tomography andmagnetic resonance imag-ing) can be selected. In hu-mans, carotid arteriography is commonly performed

to assess the integrity of theblood supply to the brain.10,11

Fortunately, dogs have ex-cellent collateral circulationto the brain, even whenboth carotid arteries are lig-ated.

Gunshot wounds to thehuman brain usually are ex-plored to remove possiblesources of infection (debris,contaminants, and bone

fragments). Although thisapproach may be justified attimes in small animals, dataregarding the managementof gunshot wounds to thebrain in animals are lacking.Retained projectiles may bedifficult or impossible toapproach without causingmore serious injury to thebrain. There are reports of

humans surviving and functioning satisfactorily with re-

tained projectiles in the brain. The same is true for smallanimals that have sustained low-velocity gunshot wounds.12,13 Careful evaluation of the injury and patientare required to determine the best approach to theemergency medical and surgical management of in-tracranial projectile trauma.

The neck is especially prone to serious injuries be-cause of the concentration of vital structures in thissmall anatomic region. The larynx, trachea, spinal cord,cranial nerves, carotid and jugular vessels, pharynx, andesophagus are among the vital structures susceptible toprojectile trauma. Major problems in the management


P E R I T O N I T I S s T H O R A C I C W O U N D S s E Y E W O U N D S

Figure 6A

Figure 6BFigure 6—( A ) Air-powered BB gun injury to the abdomenof a Siamese cat. At presentation, the cat was depressedand had abdominal pain. (B) Laparotomy revealed multi-ple perforations of the bowel wall. The probe illustratesone of the perforating wounds to the small intestine. Notethe small BB retrieved from the bowel site. (From PavleticMM: Atlas of Small Animal Reconstructive Surgery .Philadelphia, JB Lippincott Co, 1992. Reproduced withpermission.)



of cervical gunshot wounds are the difficulty in diag-nosing some deeper wounds and the possible resultantdelay in repair, which could result in serious complica-tions. Cervical gunshot wounds in humans are often

explored because of the risk of esophageal perforationand major vascular injury. In dogs, major esophagealperforation (which could result in cervical and anteriormediastinal infection) may be ruled out by esopha-goscopy and radiographic contrast examination.4,11–19

Cervical exploration is also warranted in the presence of profuse or persistent bleeding, expanding hematomas,

wounds to the larynx or trachea, serious spinal cord injuries, or unstable vertebral fractures11,14–19 (Figure 9).

Gunshot wounds to bones are treated by internal or ex-ternal stabilizing devices. Because management of exten-sive orthopedic injuries can be difficult and costly, limb

amputation may be advisable in some cases (Figure 10).Bullets can migrate through fascial planes or gravitate

in the thoracic and abdominal cavities. Projectiles canenter the vascular system and embolize to distantanatomic locations. Projectiles in humans also havebeen documented to enter a bronchus and then becoughed up or swallowed.2,3 A pellet that entered the


C E R V I C A L W O U N D S s B O N E W O U N D S s B U L L E T M I G R A T I O N

Figure 7A Figure 8A

Figure 7B

Figure 7—( A ) Pneumothorax secondary to shotgun pellets.(B) A thoracostomy tube was inserted and connected to achest drainage system. The patient recovered completely.

Figure 8B

Figure 8—( A ) Cardiac tamponade secondary to shotgun

pellets penetrating the pericardium. (B) Pericardiocentesis was followed by pericardiectomy. The patient recoveredcompletely.



LEGAL CONSIDERATIONSForensic evidence of a shooting may be requested by

owners, game wardens, and attorneys.20–23 Veterinarians

must be able to document such evidence or request as-sistance from an experienced pathologist. Basic proto-cols and responsibilities involved with handling foren-sic evidence must be followed, or legal cases will becontested easily. Detailed records should include notesof all conversations.

A complete set of quality radiographs and color pho-tographs of the entire animal should be taken to illus-trate the general position of the injuries. This will helporient those reviewing the case. Close photographs of individual injuries should include an area 15 cmaround the wounds. A metric ruler should be included


R E T A I N E D P R O J E C T I L E S s F O R E N S I C E V I D E N C E s D A T A C O L L E C T I O N

Figure 9BFigure 9— A dog that had been shot in the neck with ahandgun was presented with extensive subcutaneous em-physema and pneumomediastinum. ( A ) Manual compres-sion of the skin highlights the extensive air accumulation.(B) A hole in the trachea at the level of the thoracic inlet

was identified and sutured closed. The subcutaneous em-physema rapidly decreased within 72 hours after surgicalcorrection. The patient recovered completely.

Figure 9A

Figure 10BFigure 10—( A ) A gunshot wound to the right humerus andscapulohumeral joint of a cat. (B) Because of the extensivesoft tissue and orthopedic trauma, the limb was amputat-ed. The exact weapon was unknown, although a .22-caliber round was suspected.

Figure 10A

urinary bladder of a Labrador and later caused acute

urethral obstruction has been documented4

(Figure 11). When the pathway of projectile(s) cannot be clearly documented, multiple radiographs of the body shouldbe taken to determine the pathway and to rule out bul-let migration.

Retained projectiles from a previous shooting can cre-ate confusion in the diagnostic evaluation of trauma pa-tients. Clinicians may mistakenly conclude that an injury is a gunshot wound if a bullet is visible on the radiograph.The patient must be inspected carefully for entry woundsand whether the presenting wounds or clinical signs arecompatible with a gunshot wound2–4 (Figure 12).



in the photographs to indi-cate scale. The photographsare labeled with the date,case number, and examin-er’s initials. Projectiles

should be photographed insitu before their removal.20

Flexible plastic probes orcatheters can be used tohighlight the course of aprojectile. Metallic probesshould not be used becausethey can separate tissuesduring insertion and possi-bly scratch the surface of aretained projectile, thereby disturbing rifling marks on

its outer surface.

20

When feasible, an experi-enced, board-certified vet-erinary pathologist shouldperform the detailed post-mortem examination. Other preexisting medical orphysical conditions may have affected the circum-stances of the animal’s demise.

Tissue samples are takento confirm the presence of any suspected diseases, de-termine the age of a wound,

and help distinguish entry from exit wounds. Tissuesamples occasionally aretaken for more detailed test-ing and analysis by law-enforcement officials.

Information commonly requested in court relates tothe number and location of

wounds, features of the wounds and related tissueareas, course of the projec-

tiles, angle of fire, projectilesand foreign debris recov-ered, cause and time of death,and details pertaining to thehandling and disposition of specimens collected.20 Entry

wounds are closely inspect-ed to determine the proxim-ity of the weapon to theanimal. A 15-cm squarearound entrance woundsshould be removed, pinned

to a piece of rigid material,and then frozen for analysisto determine the presence of propellant and projectileresidue. This tissue specimen

should not be washed orplaced in formalin.20

Careful examination andcollection of tissues surround-ing the path of a projectileare useful in determining

whether game has been ille-gally killed by a gun duringrestricted bow-hunting sea-sons. Some hunters insert abroad-head arrow into a gun-shot wound to mask the na-

ture of the weapon. Fleshalong the path of the bulletcan be collected to recoverparticles of lead released by frangible projectiles. Lead

residue can be identified by atomic absorption spec-trophotometry in tissue surrounding the tract. Tissue sam-


R E Q U I R E D P H O T O G R A P H S s T I S S U E S A M P L E S s W O U N D D E S C R I P T I O N

Figure 11—Lateral radiograph of a Labrador retriever withacute urinary tract obstruction secondary to migration of a.20-caliber Sheridan pellet, which lodged at the os penis.The dog had been shot in the urinary bladder; a small scar

was noted in the skin where the projectile originally en-tered the abdominal cavity. A urethrotomy successfully re-moved this air-powered pellet.

Figure 12—( A and B) Two radiographic views of a fractured femur in a cat. This comminutedfracture was not caused by a gunshot wound, as the admitting clinician originally suspected.The retained BB was an incidental finding. No entry wound was present, and this air-pow-ered projectile was not capable of this degree of orthopedic trauma.

Figure 12A Figure 12B



ples taken from a separate, uninvolved body region of thecarcass serve as a control.20 Examination of gastric contentscan also help the pathologist determine the circumstancesof the incident.20–23

The lands (elevated borders) and grooves of a rifled

barrel embed marks on jacketed and nonjacketed bul-lets. Occasionally, the lead core separates from the out-er jacket. Retrieval of the jacket is of greater impor-tance because the rifling marks are scored on its outersurface. Bullets should be handled carefully becausescratching the surface can damage the rifling marksused to help identify the weapon. Forceps can bepadded with tape to avoid this problem. The bulletshould be washed with water and alcohol and then al-lowed to air dry. The washing removes blood and tis-sue fragments.20 The bullet can be marked on its base(bottom) to ensure that it can be identified later.

Close-up photographs of the bullet ensure its identifi-cation. All projectiles should be wrapped in facial tissues

and placed in vials or containers that can be sealed with tape. The body region from which each projectile was retrieved must be clearly identified, and each projectile must be placed in a separate, marked container.The container is identified with the date, time, casenumber, and owner’s name and it is initialed by those


H A N D L I N G P R O J E C T I L E S s L I T I G A T I O N

present at the necropsy. An indelible marker should beused on the container or on a nonremovable label. 20

The projectiles should be secured from tampering oraccess by other individuals. Projectiles are turned overonly to a qualified law-enforcement officer. Any per-

sons receiving the specimens must add the time anddate of the transfer and their initials to the container. 20

Owners often ask for the projectiles. Such requestsshould be denied because the projectile could be al-tered or lost, thus reducing the credibility of the evi-dence gathered.

Errors in collecting data and recording pertinent in-formation can adversely affect the outcome of a case,despite the best intentions of the veterinarian. There-fore, careful attention to the legal issues discussed inthis section will help clinicians avoid the embarrassingerrors and pitfalls associated with inappropriate case

preparation in a court of law.

About the AuthorDr. Pavletic, who is a Diplomate of the American College

of Veterinary Surgeons, is Professor and Head of the

Department of Small Animal Surgery, School of Veterinary

Medicine, Tufts University, North Grafton, Massachusetts.

REFERENCES1. Pavletic MM: A review of 121 gunshot wounds in the dog

and cat. Vet Surg 14:61–62, 1985.

2. Pavletic MM: Gunshot wounds in veterinary medicine: Pro- jectile ballistics—Part I. Compend Contin Educ Pract Vet 8(1):47–60, 1986.

3. Pavletic MM: Gunshot wounds in veterinary medicine: Pro- jectile ballistics—Part II. Compend Contin Educ Pract Vet 8(2):125–134, 1986.

4. Pavletic MM: Atlas of Small Animal Reconstructive Surgery .Philadelphia, JB Lippincott Co, 1992, pp 92-108.

5. Dillman RO, Crumb CK, Lidsky MJ: Lead poisoning froma gunshot wound. Am J Med 66:509–514, 1979.

6. Leonard MH: The solution of lead by synovial fluid. Clin Orthop 64:255–261, 1969.

7. Greisman HC: Wound management and medical organiza-tion in the Civil War. Surg Clin North Am 64:625–638, 1984.

8. Sevel D, Atkins AD: Pellet gun injuries of the eye. S Afr Med J 54:566–568, 1978.9. Slatter D: Fundamentals of Veterinary Ophthalmology , ed 2.

Philadelphia, WB Saunders Co, 1990, p 490.10. Podgorny G, Stanley L: Gunshot victims. Reg Nurs 45:

47–51, 110, 112, 1982.11. Swan KG, Swan RC: Gunshot Wounds . Littleton, MA, PSG

Publishing Co, 1980.12. Zimmer MA, Hoppe WE: Gunshot wound in a head of a

dog. VM SAC 74:814–815, 1979.13. Pavletic MM: Unpublished data, School of Veterinary

Medicine, Tufts University, North Grafton, MA, 1992.14. Small IA: Reconstructive prosthetic surgery of massive cran-

iofacial injury. J Oral Maxillofac Surg 41:609–612, 1983.

Interested in writing for

COMPENDIUM? For small animal articles, please contact

Dr. Douglass Macintire (email macindk@

vetmed.auburn.edu; phone 334-844-6032).

For exotics articles, please contact

Dr. Branson Ritchie (phone 706-542-6316;

email [email protected]).



15. Popovsky J: Perforations of the esophagus from gunshot wounds. J Trauma 24:337–339, 1984.

16. Ordog GJ, Albin D, Wasserberger J, et al: 110 Bullet wounds to the neck. J Trauma 25:238–246, 1985.

17. Massac E, Siram SM, Leffall LD: Penetrating neck wounds. Am J Surg 145:263–265, 1983.

18. Yap RG, Yap A, Obeid FN, Horan DP: Traumatic esopha-geal injuries: 12 Year experience at Henry Ford Hospital.

J Trauma 24:623– 625, 1984.19. Sulek M, Miller RH, Mattok KL: The management of gun-

shot and stab injuries of the trachea. Arch Otolaryngol Head

Neck Surg 109:56–59, 1983.20. Green PD: Protocol in mediolegal veterinary medicine. II.

Cases involving death due to gunshot and arrow wounds.Can Vet J 21:343–346, 1980.

21. Dillon JH: Firearms and toolmark identification. NationalCollege of District Attorneys, 1986.

22. Dillon JH: Ballistics and firearms. National College of Dis-trict Attorneys, 1986.

23. Peterson GF: Gunshot and shotgun wounds. National Col-lege of District Attorneys, 1986.


Documents

Gunshot Wound Management