Terminal Ballistics A Text And Atlas Of Gunshot Wounds Pdf

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Terminal Ballistics: A Text and Atlas of Gunshot Wounds

Background: The tissue factors important in wound ballistics provide a useful insight into the pathophysiology of organ injury in all traumas. Wound ballistics includes penetrating and blunt trauma mechanisms. Although the mechanism of a traumatic event may be pure blunt or penetrating trauma, the mechanism of tissue injury may be mixed. The aim of the present study was to review the literature about Blunt and Penetrating Trauma Mechanisms. Results: The varied ability of different types of tissue to tolerate the physical displacement of tissue stretch in gunshot wounds and the inability of any tissue to survive being crushed by a bullet is a model for the relative abilities of different tissues to tolerate blunt trauma and penetrating trauma of all types.

Center-fire rifle bullets crush tissue as they pass through it, as does any penetrating trauma agent. This crushed tissue does not survive. Center-fire rifle bullets also cause blunt trauma by tissue displacement temporary cavitation.

The ability of different tissues to survive this blunt trauma is related primarily to tissue elasticity and cohesiveness. Conclusions: The blunt and penetrating trauma aspects of wound ballistics can be used to explain the response of all tissue to blunt and penetrating trauma of all types, assisting in predicting and explaining the severity or lack of severity of tissue injury in trauma in general.

In all penetrating trauma, tissue is crushed by the penetrating object. That tissue does not survive. Similar to the effect of a bullet passing through tissue, if a penetrating object other than a bullet is large enough or moving fast enough, some blunt trauma, due to displacement of tissue adjacent to the path of the penetrating object, will occur.

This is identical to the type of blunt trauma occurring during temporary cavitation in certain gunshot wounds. The ability to survive temporary cavitation blunt trauma is very specific. More elastic, more cohesive tissue, such as skeletal muscle, lung, empty intestine, nerve, blood vessel and to some extent bone, can tolerate this quite well.

Less elastic, less cohesive organs, such as liver, brain and heart, do not tolerate temporary cavitation blunt trauma well [ 1 ]. In typical urban gunshot wounds, all of the tissue injuries are caused by tissue crushed by the bullet, its fragments or the secondary missiles it creates by breaking apart the structures through, which it passes. Significant temporary cavitation is very uncommon in urban gunshot wounds, because the most are caused by less potent handguns.

A center-fire rifle or large handgun is usually required to fire a bullet capable of causing significant temporary cavitation [ 2 ]. Blunt trauma can be local, such as from being struck with a hammer or the local blunt trauma of temporary cavitation associated with penetrating trauma.

Blunt trauma can be diffuse, such as that resulting from failing from a height or being an unrestrained passenger in a high-speed motor vehicle accident. The tissues that tolerate well the blunt trauma from tissue displacement during temporary cavitation stretch also tolerate blunt trauma from other causes well [ 3 ].

Missile mass and velocity establish the upper limit of the tissue damage a moving bullet can cause: the bullet's wounding potential. Bullets of equal wounding potential may produce wounds of very different severity.

The amount of wounding potential actually used and the amount of resulting tissue disruption depend on bullet construction and the physical properties of the tissue penetrated [ 2 ]. Whether the bullet has enough mass and velocity to reach the depth of vital structures can determine final outcome [ 4 ]. Bullets crush the tissue and run into, killing that tissue. The bullet may also cause a splash in tissue, stretching tissue by displacement temporary cavitation.

This may or may not damage tissue, depending on tissue type [ 4 ]. Bullets with equal wounding potential often do not produce similar wounds. Even if similar amounts of wounding potential are available, this potential may or may not be used up in the wounded subject. If used, the same amount of wounding potential may be used as varying amounts of tissue crush and tissue stretch temporary cavitation , depending on the velocity, mass and diameter of the bullet [ 2 ].

No matter how much wounding potential is used, the severity of the wound produced is very tissue dependent. Tissue stretch will be tolerated very differently by different tissues. A heavier and slower bullet crushes more tissue but induces less temporary cavitation, most of the wounding potential of a lighter, faster bullet is likely to be used up forming a larger temporary cavity, but this bullet leaves a smaller permanent cavity crushes less tissue [ 4 ].

A center-fire "high-velocity" rifle bullet, if it traverses only elastic tissue, such as skeletal muscle, does not yaw significantly, does not fragment or deform and does not hit a major blood vessel or nerve. It usually causes a fairly minor wound. It will exit the extremity with most of its wounding potential unspent. If this same bullet hits a large bone, fragments and does not exit, it will crush a large volume of tissue, will create secondary missiles, such as bone fracture fragments, which also crush tissue and is likely to disrupt the neurovascular integrity of the area wounded, expending all its wounding potential in the patient and usually producing a severe wound.

The amount of tissue crushed by a bullet depends on its size and shape and whether it deforms or fragments [ 5 ]. If the tissue wounded is relatively elastic and cohesive, the amount of tissue crushed is the primary determinant of wounding [ 2 ].

All crushed tissue is killed. Tissue stretch temporary cavitation often has relatively little wounding effect in elastic cohesive tissue, such as skeletal muscle or lung. If an organ is inelastic, near-water density and not very cohesive, such as brain or liver, temporary cavitation can cause a severe wound [ 5 ]. Bullet penetration depth is directly related to bullet mass and bullet velocity and inversely related to bullet diameter including the effect of increased diameter from mushrooming.

If a bullet lacks sufficient mass or velocity or expands to such an extent that it uses up its wounding potential crushing superficial tissues and causing temporary cavitation stretch, it may not reach the depth of vital structures, such as the heart. It will not hurt what it does not reach [ 4 , 5 ]. It is wrong to think that one can predict the wound produced according to whether a bullet is "high velocity" or "low velocity.

Kinetic energy expended in elastic tissue may produce little damage, as tissue stretch may be well tolerated. If a rubber ball and a raw egg of equal weight are dropped onto a cement floor from the same height, then it is possible these two missiles of equal kinetic energy to sustain different degrees of damage. The rubber ball behaves like skeletal muscle or lung and the raw egg like brain or liver. The amount of kinetic energy in tissue is not a good predictor of wound severity.

Collisions between bullets and tissue are not elastic and kinetic energy is not conserved. Most is lost as heat [ 4 , 5 ]. An understanding of wound ballistics allows the physician to evaluate and treat missile wounds without repeating the errors of "conventional wisdom". Many papers have been printed suggesting harmful and unnecessary treatment for gunshot wounds as a result of common misconceptions about wound ballistics4.

An example of such an unnecessary and harmful recommendation is for mandatory surgical excision of the tissue surrounding the bullet path whenever an extremity wound is caused by a high-velocity bullet.

Military and civilian experts have taught that, such excision of the wound path, to be important, because tissue exposed to temporary cavity formation rarely survives and will become necrotic. Clinical experience and research show this notion to be false, particularly in the case of extremity wounds4.

Experiments in wounding mammalian animals with military rifle bullets have been performed. An important feature of these experiments is that a control group of animals was wounded, but not treated surgically. These experiments have disproved the assertion that all tissue exposed to temporary cavitation does not survive.

They also show that in extremity wounds, complete excision of the bullet path and extensive debridement usually are not necessary. This finding corroborates many observations in humans with rifle bullet wounds of the extremities. In addition, the large exit wound produced by the M16 or AK- 47 military rifle bullet often creates its own excellent wound drainage, which assists healing [ 5 ].

Intense local vasospasm after the passage of a high velocity bullet lasts about 3 hours and often includes a substantial amount of tissue around the permanent wound channel. If patients are operated on very soon after wounding, the extent of apparently devitalized tissue will be increased by this intense vasoconstriction around the bullet path.

The tissue, when examined at surgery, may have poor colour, bleeding, contractility and consistency. These are the four C's, by which surgeons sometimes decide whether tissue is viable.

After a rifle bullet extremity wound, more tissue often is viable than is apparent at the initial surgical examination6. After the initial period of vasoconstriction, a period of hyperemia follows. Missiles are passing through tissue wound by only two mechanisms. These are crush and stretch.

Tissue crush is the crushing of the tissue struck by the projectile forming the permanent cavity. Tissue stretch refers to the radial stretching of the projectile path walls during temporary cavity formation. The sonic pressure wave preceding the bullet through tissue does not damage tissue [ 2 ]. Both missile and tissue characteristics determine the nature of the wound. Bullet mass which is related to bullet diameter and length often determines whether the bullet will penetrate tissue to the depth of vital structures, bullet construction determines whether the bullet will deform or fragment and bullet shape and center of mass determine how soon it will yaw in its path through tissue.

If it does not deform into a mushroom shape, the thickness of the body part wounded determines whether the bullet has a long enough path through tissue to deform or yaw tissue type e. Also, it decides tissue elasticity, density, specific gravity and internal cohesiveness and determines how well the tissue will withstand temporary cavitation stretch. All of these characteristics are extremely important, in addition to bullet velocity, in determining the nature of the wound produced.

Wound classification systems based on bullet kinetic energy or velocity markedly overemphasize the importance of velocity, in determining the wound produced and largely ignore the other factors [ 2 , 6 ].

A missile crushes the tissue it strikes, thereby creating the permanent cavity. Yaw is the angle between the longitudinal axis of the bullet and its path of flight. If the bullet strikes an intermediate target, before striking the patient, the bullet may yaw, deform or decelerate.

Its wounding properties will be altered, sometimes increasing wound severity and other times decreasing it [ 1 , 7 ]. When striking soft tissue with sufficient velocity, soft point and hollow-point bullets are designed to deform at the tip into a mushroom shape.

If the mushroomed diameter is 2. Thus, the deformed bullet makes a larger diameter hole the permanent cavity than would the original unexpanded bullet have made [ 1 , 7 ].

This barrel fouling is avoided, if a bullet jacket made of a harder metal such as copper or a copper alloy is used to surround the lead. The jacket of a military bullet completely covers the bullet tip a full metal - jacket or "ball" bullet.

They do not deform into a mushroom shape [ 7 ]. Civilians often use hollow-point or soft point bullets. Hollow-point bullets have a hole in the jacket at the bullet tip. Soft-point bullets have some of the lead core of the bullet exposed at the bullet tip. These constructions weaken the bullet tip, flattening on impact into a mushroom shape. If it does not deform, a pointed civilian bullet will behave like a full-metaljacket bullet, yawing at some point in its path through tissue [ 8 ].

If a bullet is partially or completely jacketed, the bullet jacket usually cannot be distinguished from the lead core on standard radiographs, as the entire bullet.

Terminal Ballistics

Forensic serologist Marcella Jones notes that forensic serology is the analysis of body fluids as they relate to forensic cases, including DNA analysis and accordingly, the role of the forensic serologist involves: Examining evidence for the presence of body fluids e. Forensic Ballistics. In this document, forensic document examiner, Mark Songer, provides an introduction to the science of forensic handwriting analysis. The course will put particular emphasis on issues relating to the admissibility of forensic evidence and the evidentiary weight which results from the manner of identification, isolation, collection and analysis of such evidence. Forensic Ballistics: Forensic Ballistics involves the analysis of any evidence related to firearms bullets, bullet marks, shell casings, gunpowder residue etc. It is a separate field of expertise from forensic pathology requiring specialized training and instruments of its own. Firearms Ballistics Virtual Lab

Terminal Ballistics - Ebook

Background: The tissue factors important in wound ballistics provide a useful insight into the pathophysiology of organ injury in all traumas. Wound ballistics includes penetrating and blunt trauma mechanisms. Although the mechanism of a traumatic event may be pure blunt or penetrating trauma, the mechanism of tissue injury may be mixed. The aim of the present study was to review the literature about Blunt and Penetrating Trauma Mechanisms.

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For those of you with an urged to delve deeper into the field of ballistics the following reading list may be of some interest to you. This list was compiled from several sources including bibliographies in some of the books listed, NTIS listings, and recommendations from associates in the various fields. These books and reports were written by various acknowledged experts in the field and not gun rag writers. None are light reading and most are fairly heavy on the math or technical information, but these probably most of the truly important works on the subject. An incredible wealth of ballistics information from the old Frankfort Arsenal, Aberdeen Proving Ground, and other government sources is available through the National Technical Information Service www.

Terminal Ballistics: A Text and Atlas of Gunshot Wounds

Three Mistakes of My Life by Chetan Bhagat

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Directory of Open Access Journals Sweden. Full Text Available Penetrating abdominal trauma has been traditionally treated by exploratory laparotomy. Nowadays laparoscopy has become an accepted practice in hemodynamically stable patient without signs of peritonitis. We report a case of a lower anterior abdominal gunshot patient treated laparoscopically. A year-old male presented to the Emergency Department with complaint of gunshot penetrating injury at left lower anterior abdominal wall.

Wound ballistics: analysis of blunt and penetrating trauma mechanisms

Learning the lessons from conflict: pre-hospital cervical spine stabilisation following ballistic neck trauma. Current ATLS protocols dictate that spinal precautions should be in place when a casualty has sustained trauma from a significant mechanism of injury likely to damage the cervical spine. In hostile environments, the application of these precautions can place pre-hospital medical teams at considerable personal risk.

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ГЛАВА 30 Альфонсо XIII оказался небольшим четырехзвездочным отелем, расположенным в некотором отдалении от Пуэрта-де-Хереса и окруженным кованой чугунной оградой и кустами сирени. Поднявшись по мраморным ступенькам, Дэвид подошел к двери, и она точно по волшебству открылась. Привратник проводил его в фойе.

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