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.


  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.


  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.


  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.


  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: [email protected]

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  • Phil Verhey

    ACTS and PROVE

    Assume all firearms and air-guns are loaded
    Control the muzzle direction and stability
    Trigger safety, keep your finger and object out of the trigger guard
    See that is it in fact unloaded

    Point the muzzle in the safest direction, and maintain the safest direction even if it changes
    Remove any cartridges from the firearm, even if you think they’re dummy, spent or not live
    Observe the chamber & breach, and magazine for any obstructions or rounds of any kind
    Verify the feeding path of the gun, remove the magazine and with bright light make sure no round is hung up in the path.
    Examine the bore with the action open and after all other steps, look down the barrel for objects of any kind.

    and if anyone is handing you a fire arm, don’t accept it until, the action is open and safety is on, if either is not.. ask them to do it and remind them “dude, you gotta do that”

  • Johnny Geen

    i do a fictional research what of course unfortunately play a head shot in the real life shot wound, from sources of the internet I have learned that with a 9 mm caliber the chance of survival is between 5-10%. However I see nothing stand survivability with the huge heavy caliber: Desert eagle .50ae 300Grain hollow point hornady .xtp 1475fps. I know there are sometimes deer here killed instantly. My question is can you search under if there is a very small chance of survival exists as a person of four metres away by the forehead was shot with that 50AE? To analyze how much the percentage in% of survival. I don’t know if Sun research costs money if so keep this question and give me the price indication.
    If you want to help me with this research, I am very grateful to you Regards johnny

    • James Hubbard, MD, MPH

      Johnny, All would depend on what part of your head was hit and the angle. For instance, if it nicked your skull or, maybe a sinus, you’d have a much better chance of survival than if the bullet entered and damaged a good portion of your brain.

      • Johnny Geen

        Okay I would mean a shot in the frontal sinus with a 50AE Is it possible to calculate/analyse how much odds survival there is with those 50AE? If there is a 350 grain hollow point hornady .xtp is used? It is more energy than a 9 mm 4.16 maybe I help you to

        • James Hubbard, MD, MPH

          Johnny, sorry, I don’t know.

          • Johnny Geen

            Okay it’s it impossible to know what are the survival chances are with the large hand and revolver guns?

          • Phil Verhey

            yes, for fictional games you can, in a game you must already keep the bullets’ trajectory in order for it to hit anything. using that and a map of the human head, you can easily calculate if the round has impacted the brain beyond the frontal lobe.

            Any impact beyond going through the cheek and missing all bone though will remove any player from combat.. that’s just common sense… many games have already done this, and included slow-motion internal animations of the bullets entering the human body and assigning damage and scores based on the human anatomy.

          • Johnny Geen

            Okay but thats not what i asked i asked can i stay alive if someone shoot me from 13 feeth away in the T-Box with a 50AE with 350 Grain JHP Bullet?

          • Jim Byrd

            SImply………….. no

          • Phil Verhey

            It’s exactly what you asked. You want to simulate gunshot wounds and know the “odds” and “calculate” survivability… odds are a set number of a number of instances, without having suicidal volunteers to experiment on, you need to calculate it in a fictional simulation. Player vs player offers the variables of attempted aim vs attempted dodging, anotomic scoring takes human anatomy as a factor, and replays illustrate to you why the shot was survivable. .. also being a game you can setup repeatable experiments. Physics are known, anatomy is known, doctors consult and the games that do this are very accurate. If this is something you really want answers to, it’s your only way to build a knowledge database.

      • Johnny Geen

        Okay I would mean a shot in the frontal sinus with a 50AE Is it possible to calculate/analyse how much odds survival there is with those 50AE? If there is a 350 grain hollow point hornady .xtp is used? It is more energy than a 9 mm 4.16 maybe I help you to

  • Johnny Geen


    I’m Doing a fictief research quest,  About the survival chance with these two revolver guns! I have a a discussion from different people.  In real life i would’t to know.
    Look if someone shoot me from 13 feeth away in the middle of my forehead How much %. Chance do i have to survival with these 2 guns in range individuel?

    1. Magnum. 357 with 240 Grain Hollow Point hornady xtp..

    2. Desert eagle. 50AE with 300 Grain hollow point hornady xtp….

    So thank for u answer if you know it

    Regards. Mulders

  • skjarvis

    I was shot in the upper leg/thigh in April 2015. It was a through and through, and although I was shot with a hollow point, it never expanded. I got lucky, it didn’t hit any bone or arteries either. However for a long time the area where the bullet passed through was fully numb. I was told it was nerve damage and it would probably stay that way. The past few weeks I have been in a considerable amount of pain. The area above, below and over the healed wound are quite painful. I can not bear to have those areas touched. The scar tissue as well takes up a large area. Is this normal?

    • James Hubbard, MD, MPH

      I wouldn’t think so. I’d have it checked out.

  • Mary DeTar

    Hi my daughter was shot in the back with a shotgun. It is not 6 months later and about 70 pellets were left in her back. She gets extreme pain and well as nerve pain in her leg. If anyone can help us figure out why I would appreciate it. Thank you

    • James Hubbard, MD, MPH

      If her lower back, buttocks or thighs were damaged it could have injured a nerve. Hopefully that will be checked into to see if she needs a nerve conduction study and if she needs any of the pellets may be causing persistent problems and need to be removed.

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  • Cristi

    My daughters dad was shot in the back and the bullet was left in due to the doctors decision. Now the bullet is poking through his chest , ripping his skin, draining fluid. They said that in time the bullet will come out. Is this part of the NORMAL process or should he see the doctor to see about getting it removed?

    • James Hubbard, MD, MPH

      See a doctor. They’ll probably want to remove it now.

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  • Nick

    Could Quick Clot be useful in a gunshot situation?

    • James Hubbard, MD, MPH

      Definitely. But only to areas you can reach, not the internal injuries deep in the chest, abdomen, or head.