Gunshot Wounds: How to Treat 4 Types

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

How to Treat 4 Types of Gunshot Wounds (From One Shot?)

Bullet casing

Bullet casing.

by James Hubbard, M.D., M.P.H.

A paramedic told me that when she was in training, a patient came in who had been shot in the right upper chest. They ended up finding the bullet not in the back, not even in the other side of the chest, but way down in the right butt cheek, pushing against the skin.

In my last post, I covered general gunshot-wound treatment—the basics for survival situations when you can’t get to a doctor. Now, I’ll go into more detail for specific wounds.

As I said in the first post, one bullet can cause multiple injuries—both internal and external. Even if you can’t get expert treatment right away, you need to get it as soon as you can. There are some lifesaving things I don’t cover here that you just can’t do outside a hospital.


Signs of Internal Bleeding

Since you can’t see all the bleeding, it’s important to note the initial vital signs. Warning signs of internal bleeding include:

  • Decreasing alertness
  • Nausea/vomiting
  • Weak pulse
  • Lowering blood pressure, or faster and faster pulse.
Important Note

These treatments for gunshot wounds are complicated and require advanced knowledge. I can’t cover everything in a blog post. (I’ll be writing about gunshot wounds in a future book.)

I’ve tried to give you a good overview so you have the best chance to save a life, but as always, my blog isn’t meant to be your sole source of information.

Someone with internal bleeding is probably not going to survive without rapid transfer to a medical facility.


For a Gunshot Wound in the Head

Think about: the airway.

Tips:

  1. Attempt to control the bleeding with direct pressure as best you can (no tourniquets around the neck).
  2. Make sure the blood doesn’t choke the person. You can have a conscious person sit up and lean forward, or turn an unconscious person on their side and bend the top knee forward to keep them that way.
  3. If you believe a carotid artery (that large artery on either side of the neck that supplies the brain) is nicked, you can apply soft direct pressure, and include an occlusive dressing. (See the box to the right.)
How to Make an Occlusive Dressing out of a Driver’s License

For an open, or “sucking,” chest wound, you want to keep air from getting in but also let excess air escape.

One makeshift way to do this is to lay a driver’s license or plastic wrap on the wound. When the diaphragm contracts and pulls in air (the same mechanism that makes us breathe), the vaccuum will suck the object onto the wound. But if air needs to escape, it can easily push the object up.

You could also use Vaseline gauze or put petroleum jelly on gauze. No petroleum jelly? Try any type of ointment or even honey.

The victim needs other treatment, such as a chest tube, right away. The occlusive dressing is just a temporary treatment to keep the situation from getting worse.

Learn how to treat other wounds when there is no doctor in The Survival Doctor’s Guide to Wounds.


For a Gunshot Wound in the Chest

Think about: air sucking, spine injury.

Tips:

  1. Open chest wounds are also nicknamed sucking chest wounds because they suck air in and can lead to a collapsed lung. You can help stop the sucking by closing the open wound with an occlusive dressing.
  2. Remember the spine is also included in the back of the chest. Be very careful about movement of these victims. You want to keep them as still as possible and not damage the spinal cord.
  3. If the heart, the lungs, the spine, or a large blood vessel is damaged, there’s not much you can do outside getting immediate expert medical care.


For a Gunshot Wound in the Abdomen

Think about: organ protection.

Tips:

  1. If the wound is open and you can see the intestines, find a moist, sterile dressing to place on top of the wound (to protect the organs).
  2. If the intestines are ripped open, the victim needs immediate medical care. If they don’t bleed to death, they’ll likely die of the coming severe infection.
  3. The victim should take nothing at all by mouth until the pain lets up, and then wait a day or two. This is obviously a difficult situation, but this step is very important and a time when a slow drip of IV fluids would be useful.
leg and arm arteries

If an arm wound won’t stop bleeding despite direct pressure to the wound and elevation, press on the brachial artery around the place where the arrow in the left picture is pointing (below the armpit). Do this by grabbing underneath the person’s arm, wrapping your fingers to the artery (inner arm), and pressing firmly on it with your fingers. You’ll know you probably have it right when the bleeding slows down. If it’s still not controlled, try pressure nearer to the heart.

Here’s a trick to try it out now: Get a partner, and find the person’s radial pulse (in the wrist on the thumb side). Then grab the upper arm as described above. You should feel the pulse stop. Only do this for a couple of seconds, of course, since you’re stopping blood flow.

For a leg wound that won’t stop bleeding, apply pressure to the femoral artery, shown in the picture on the right. The best place to do this is in the middle of the bend between the front of leg and the hip. (This is not the place where the arrow is pointing; it’s above it.)

 


For a Gunshot Wound in the Arms or Legs

Think about: bones.

Tips:

  1. Direct pressure, elevation, pressure bandage—in that order. Elevate the wound above the heart, and apply a pressure bandage. Then if it’s still bleeding, take your fingers and apply pressure to the brachial artery for the arm or the femoral artery for the leg. (See the box to the right.)
  2. If all else fails in an extremity, go to a tourniquet. (It may come down to “lose a limb or lose a life.” See The Survival Doctor’s Guide to Wounds for dos and don’ts of tourniquet use.)
  3. If the area is rapidly swelling, that’s a sign of internal bleeding. Also, consider that a bone might have been injured, even shattered. If you suspect this, the area needs to be splinted.


For a Superficial Wound

If the gunshot wound is superficial, clean it as much as you can and follow the steps in “Puncture Wounds” in my e-book The Survival Doctor’s Guide to Wounds. Start antibiotics when you’re finished taking care of the wounds.


One More Thing: What About the Bullet?

In most circumstances, you don’t want to remove an implanted bullet. It’s almost impossible to find, and it may actually be corking up a big blood vessel.

Thousands of military members live daily with shrapnel in their bodies. Unless there’s initial infection from the wound itself, the body adapts to most metal without much serious problem.

Gunshot wounds can run the gamut. Some people are too severely injured to save. Get expert treatment as soon as possible.

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Artery photos by Rob Swatski, assistant professor of biology, Harrisburg Area Community College – York Campus, York, PA. Email: rjswatsk@hacc.edu.

  • Steve

    My wife leaves bullets in all the time. If the patient requests removal she usually informs them that the Detroit Police Department needs to be present to take custody of the bullet for evidence. Or she tells them we could just leave it in there and it will just encapsulate itself off. The always opt for the latter.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks, Steve. I assume your wife is a doctor?

  • raina

    If a man is shot in the chest, more specifically the heart, what possible injuries could he sustain without dying? And what other internal organs in the chest area could also potentially suffer/be affected? I’ve been trying to find a detailed description of the anatomy of the damage that could be done and the process of the surgery as well, but I can’t find a lot of direct information.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      If a bullet penetrates the heart, it’s highly unlikely the man will survive unless he were to have immediate surgery. A bullet could hit a lung and collapse it. It could damage a blood vessel (aorta and others) and cause bleeding. It could hit the spine and cause paralysis. It could hit the esophagus or stomach. Portions of the liver, spleen, and large intestine are underneath the rib cage.

      • raina

        Thank you so much for answering. If it’s not too much trouble, could you elaborate further on what would be done concerning injury to an aorta then? For example, if the bullet nicked the blood vessel? And if so, what events would follow? I apologize for the bombardment, but I’m an aspiring novelist and I wish to make the situation I’m attempting to create as believable as possible.

        • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

          If you nicked the aorta you would bleed to death unless you had immediate surgery to repair the wound.

  • Amy

    What if the bullet is on the shoulder blade? Can you take the bullet out? And how would you treat that?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      All gunshot wounds are different but, to me, the least worry is getting the bullet out. You would apply pressure for the bleeding and worry the bullet broke the shoulder blade increasing risk of serious bone infection. If you could not get to expert help, you would clean the wound as thoroughly as you can squirting in water (see my post on cleaning a wound) and start on antibiotics as soon as possible. You’d probably put the arm on the injured side in a sling. After all of that, if you feel the bullet and think you could easily get it out, you could try, but if you dig around too much without a sterile environment, you run the risk of contaminating the wound even more and causing more damage to the surrounding tissue.

  • David P Hill

    What antibiotics would you prescribe after someone had a bullet removed from them?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      For a bullet in the soft tissue, cephalexin, amoxicillin/clavulanate, ciprofoxicin. A bullet that has pierced the abdominal cavity would need IV antibiotics.

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  • kbcl

    My boyfriend was recently shot in the head. The Dr.’s have told me that it entered his right frontal lobe and is now in his left occipital lobe. I don’t really understand this midline thing they have mentioned except that I believe it just means it went from one side across the middle to the other side. My boyfriend was conscious after it happened and was talking to me and knew what happened to him all the way up until his surgery, they say they aren’t sure how he will be after they take him off the meds they have him on to keep him in this medically induced coma. I just don’t understand how he could be awake and know everything to possible not knowing.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Those are questions you should ask the surgeon. Even the nurse in the ICU could explain his particular situation better than I could. I suspect he has quite a bit of brain swelling and inflammation from the injury. Some of the injured areas are not able to get normal blood flow. In general they induce the coma to decrease the brain’s metabolism and need for that blood flow–the brain tissue, under a coma, has a better chance of staying alive with less blood flow than it does if he were awake. When that brain tissue has had time to heal, they’ll take him out of the coma. Here’s a good post on it http://www.scientificamerican.com/article.cfm?id=what-is-a-medically-induced-coma

  • Emmikate M.

    I am writing a book and need to know what kind of a shot could be survived without proper medical attention. Either the torso or shoulder area. Would a through and through shot be best and if so what area? Thanks :)

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      A bullet that hit the outside of the arm and went through muscle, and didn’t hit bone. On the torso, a bullet that went through muscle and didn’t penetrate the chest or abdominal cavity.

      • Emmikate M.

        Thank you so much

  • mark

    I only have one question on one comment of yours of a mans finger away of a trigger the problem is Is I don’t like going to counceling but if a person had a friend as a medic or emt but IF a person accidently had a gun go off and accidently hit the trigger and it go’s off is this wrong for watching videos and learning on in case if a accidental shooting happens at a gun club this just bothers me because kicking myself in the butt over it but my aunt was a medic in the army but retired I am only happy that it nevered hurt the person but can deal with it mentally just trying to forget about it all I can say is that it was to close for comfort. Or would you just forget about it like it nevered happened but it bothers me because wanting friends to go duck hunting but don’t want them be affaid of me with a shotgun as long as one shots first then the other shoots second then its alright.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Mark, you need to speak to your personal doctor about this.

  • daisey

    My friend was shot in the leg a few years ago and now the bullet is protruding out his leg. Like you can actually feel the bullet. The whole thing. He was in the shower and it kinda popped out some, just a little. Can we just squeeze it and see if it pops out?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Unless the actual bullet is poking out through the skin, I wouldn’t do. However, if all that is separating the bullet from the outside is skin and not muscle, it would come out with a small cut in the skin. I advise you letting a doctor do it in the office under sterile conditions.

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