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Why is it important to know what type of firearm was used?
The type of firearm and their projectile determines the nature of the injuries sustained. Shotguns fire a cartridge of pellets which disperse. The injury caused depends on the range from which the weapon was fired - at close range they cause severe injury but when fired from a longer range injuries are more superficial. Rifles and handguns fire a single bullet which can cause direct injury, as well as injury at a distance from the bullet due to the associated shockwave.
Chest
- Bullet entry site inferior to the right scapula with associated intramuscular haematoma and small locules of gas. No scapular fracture.
- Bullet fragments (likely to have shattered with multiple paths after hitting right 8th rib) - lodged into the inferior aspect of the right 8th lateral rib; right lobe of liver; right pericardium overlying right ventricle; right lower lobe of lung.
- Moderate haemopericardium. No right ventricular compression to suggest tamponade.
- Right haemopneumothorax.
- Right pulmonary haematomas in the lower and middle lobes with pneumatoceles in the path of the bullet fragments.
- Delayed images were obtained of the chest to ensure there was no active bleeding from the right 8th intercostal artery. No bleeding was identified.
Upper abdomen
- Superior right lobe liver laceration (ASST Grade III).