Page 836 - Cote clinical veterinary advisor dogs and cats 4th

400 Gunshot Wounds

Client Education SUGGESTED READING AUTHORS: Krista N. Adamovich, DVM, DACVS; Philipp
Be aware that several grass awns often penetrate, Shultz RM, et al: Radiographic, computed tomo- D. Mayhew, BVM&S, DACVS
EDITOR: Elizabeth A. Swanson, DVM, MS, DACVS
VetBooks.ir Prevention is strongly recommended to avoid migrating intrathoracic grass awns in dogs and
and removal of one does not guarantee cure.
graphic, and ultrasonographic findings with
future recurrence.
cats. Vet Radiol Ultrasound 49:249-255, 2008.

Gunshot Wounds Client Education
Sheet

BASIC INFORMATION PHYSICAL EXAM FINDINGS • Most handguns are low-velocity weapons
• Open wounds with less destructive capability. Larger-caliber
Definition ○ Circular, oval, or angular cutaneous entry handguns are capable of extensive tissue
A type of projectile injury involving handguns, wounds with solitary projectiles, often destruction.
air-powered weapons, shotguns, or rifles smaller than the projectile • High-velocity rifles cause tremendous soft-
○ Cutaneous burns/lesions if firearm muzzle tissue and bone destruction by producing
Epidemiology was at close range shock waves in the tissues.
SPECIES, AGE, SEX ○ There may be no exit wound if the pro-
• Dogs and cats of any age jectile is retained; low-velocity projectiles DIAGNOSIS
• Male (intact) dogs may be overrepresented. are more likely to be retained than high-
velocity projectiles. Diagnostic Overview
RISK FACTORS ○ Exit wounds are frequently larger and • Bullets, BBs, and pellets may be an incidental
• Unsupervised roaming; especially night and irregular in shape. Bullet deformation finding on radiographs, causing confusion when
early morning hours and secondary projectiles (bone shards) evaluating an acutely ill or injured patient; acute
• Dogs threatening the public or law enforce- increase exit wound size. Wounds may gunshot wounds have an entry wound.
ment officers appear smaller if swelling present. • Gunshot wounds are commonly mistaken
• Stray dogs in rural areas (e.g., deliberately ○ At close range, shotgun injuries can cause for bite wounds and vehicular trauma.
shot if considered a nuisance or potential extensive destruction of the skin and • Radiographs are an important tool for
threat to livestock) underlying tissues. assessing evidence of a retained projectile.
• During hunting season, dogs may be shot ○ Low-velocity BBs and pellets (air powered)
mistakenly as game or maliciously for sport. create small entry wounds. Because of their Differential Diagnosis
• Guard dogs, police dogs, and hunting dogs low mass and comparatively low velocity, Other penetrating objects (e.g., sticks, pointed
are at risk for being shot during work. many of these projectiles are retained (no metallic objects) can create a skin opening that
exit wound). mimics a bullet wound.
GEOGRAPHY AND SEASONALITY • Internal injuries
• Higher-crime urban neighborhoods ○ Clinical signs are commensurate with Initial Database
• Rural areas: shotgun and rifle injuries more tissues impacted and the severity of • CBC, serum chemistry profile, blood typing,
common trauma (orthopedic, spinal, ocular, and urinalysis for massive soft-tissue wounds
• Air-powered weapons: more likely in gastrointestinal, pulmonary involvement). or wounds that penetrate the abdomen or
residential or rural areas ○ Elastic tissues (lung, muscle) can stretch, thorax
partially dissipating the kinetic energy of the • Radiographs (two-view minimum) for the body
Clinical Presentation projectile. Inelastic organs, such as the liver region shot, based on bullet retention or entry/
DISEASE FORMS/SUBTYPES (low collagen content), may show massive exit wound locations. In a gunshot wound with
Subtypes: tissue destruction from a high-velocity rifle no evidence of exit, additional views may be
• Pellet and BB guns (air-powered projectiles) round compared with a low-velocity bullet. needed to locate a retained projectile.
• Handguns ○ Abdominal gunshot wounds have a high • Focused assessment by sonography for triage
• Rifles probability for peritonitis (gastrointestinal of the abdomen (AFAST) and/or thorax
• Shotguns tract penetration). (TFAST) can be helpful (p. 1102).
HISTORY, CHIEF COMPLAINT Etiology and Pathophysiology Advanced or Confirmatory Testing
• Pets may present with respiratory distress, • Bullets may have an outer metallic jacket to • Ultrasonography, abdominocentesis (p.
internal hemorrhage, neurologic injury, or control the shape or expansion of the bullet 1056), fluid analysis, cytology, Gram stains,
musculoskeletal injuries (fracture). as it impacts a target. and culture and susceptibility (aerobic and
• Pets with abdominal gunshot wounds may ○ Hollow points mushroom on impact. anaerobic) to confirm peritonitis
present with life-threatening peritonitis, ○ Frangible bullets break apart on impact. • Thoracocentesis (p. 1164) can be lifesaving
especially with delayed presentation or ○ Military-style full metal jacket bullets are and diagnostic for patients with pneumo-
treatment. designed to minimize deformation. thorax or hemothorax; aerobic and anaerobic
• Wounds may escape notice or be mistaken • Projectiles can lodge and then migrate cultures if infection is suspected
for bite wounds, especially if event was not through the respiratory tract, urogenital
witnessed. tract, gastrointestinal tract, cardiovascular TREATMENT
• Dogs and cats with extensive blood loss system, and fascial planes.
present in shock (p. 911). • Shotgun pellets expand in a conical pattern; Treatment Overview
• Patient may present in pain; minor cases they are particularly destructive within 10 A team effort by doctors and technical support
may present with little evidence of overt meters of the muzzle. Shotguns also may is necessary to efficiently stabilize critically
discomfort. fire slugs for larger game. injured patients.

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