scholarly journals A Case of Aggressive Resuscitation and Timely Surgical Intervention to Reverse Severe Acidosis After Multiple Gunshot Wounds to the Chest, Abdomen, and Left Shoulder With a Bullet Fragment Retained in the Heart

Cureus ◽  
2021 ◽  
Author(s):  
Michael Rosenberger ◽  
Jonathan Lo ◽  
Gudata Hinika ◽  
Monika Shenouda ◽  
Moses Salibian
Keyword(s):  
Surgical Intervention ◽  
Gunshot Wounds ◽  
Left Shoulder ◽  
Bullet Fragment

scholarly journals Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110308
Author(s):  
Andrew Platt ◽  
Mostafa H. El Dafrawy ◽  
Michael J. Lee ◽  
Martin H. Herman ◽  
Edwin Ramos
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Gunshot Wounds ◽  
Operative Management ◽  
Operative Intervention ◽  
Lumbosacral Spine ◽  
Random Effects Model ◽  
Significant Difference

Study Design: Systematic review and meta-analysis. Objectives: Indications for surgical decompression of gunshot wounds to the lumbosacral spine are controversial and based on limited data. Methods: A systematic review of literature was conducted to identify studies that directly compare neurologic outcomes following operative and non-operative management of gunshot wounds to the lumbosacral spine. Studies were evaluated for degree of neurologic improvement, complications, and antibiotic usage. An odds ratio and 95% confidence interval were calculated for dichotomous outcomes which were then pooled by random-effects model meta-analysis. Results: Five studies were included that met inclusion criteria. The total rate of neurologic improvement was 72.3% following surgical intervention and 61.7% following non-operative intervention. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 1.07; 95% CI 0.45, 2.53; P = 0.88). In civilian only studies, a random-effects model meta-analysis failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 0.75; 95% CI 0.21, 2.72; P = 0.66). Meta-analysis further failed to show a statistically significant difference in the rate of neurologic improvement between patients with either complete (OR 4.13; 95% CI 0.55, 30.80; P = 0.17) or incomplete (OR 0.38; 95% CI 0.10, 1.52; P = 0.17) neurologic injuries who underwent surgical and non-operative intervention. There were no significant differences in the number of infections and other complications between patients who underwent surgical and non-operative intervention. Conclusions: There were no statistically significant differences in the rate of neurologic improvement between those who underwent surgical or non-operative intervention. Further research is necessary to determine if surgical intervention for gunshot wounds to the lumbosacral spine, including in the case of retained bullet within the spinal canal, is efficacious.

Analysis of 76 civilian craniocerebral gunshot wounds

1986 ◽  
Vol 65 (1) ◽  
pp. 9-14 ◽  
Author(s):  
W. Craig Clark ◽  
Michael S. Muhlbauer ◽  
Clarence B. Watridge ◽  
Morris W. Ray
Keyword(s):  
Mortality Rate ◽  
Management Practices ◽  
Surgical Intervention ◽  
Gunshot Wounds ◽  
Content Type ◽  
Multicenter Trials ◽  
Intracranial Hematomas ◽  
Gcs Score ◽  
Admission Glasgow Coma Scale ◽  
Fine Print

✓ A retrospective analysis of 76 civilian craniocerebral gunshot wounds treated over a 20-month period is presented. The authors report a 62% mortality rate and conclude that the admission Glasgow Coma Scale (GCS) score is a valuable prognosticator of outcome. Other important findings were: 1) patients with a GCS score of 3 invariably died, with or without surgical intervention; and 2) the presence of intracranial hematomas, ventricular injury, or bihemispheric wounding was associated with a poor outcome. Standardized methods of data reporting should be adopted in order to allow multicenter trials or comparisons that might lead to management practices that could improve results.

scholarly journals Nerves Transfer Procedure in Patients with Left Upper Extremities Weakness Following Gunshot Wounds: A Case Report

2021 ◽  
Vol 9 (C) ◽  
pp. 140-145
Author(s):  
Indra Rukmana Tri Pratistha ◽  
Nyoman Gede Bimantara ◽  
I. Gede Mahardika Putra ◽  
Made Bramantya Karna ◽  
Anak Agung Gde Yuda Asmara ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Gunshot Wound ◽  
Nerve Transfer ◽  
Gunshot Wounds ◽  
Clinical Findings ◽  
Upper Extremities ◽  
Left Shoulder ◽  
Early Exploration ◽  
Peripheral Nerve Trauma

BACKGROUND: Gunshot wounds (GSWs) to the extremities can result in damage to the neurovascular structure which results in high morbidity and loss of function. According to the Centers for Disease Control report, the incidence of non-fatal GSWs has increased in the past decade. Trauma to the brachial plexus is a type of peripheral nerve trauma that is most difficult to treat due to its complex surgical procedures. Early exploration and reconstruction of peripheral nerve trauma are still being debated to this day. However, most recommend surgical exploration when the suspicion of neurovascular trauma is very high based on clinical findings. Nerve transfer is one of the recommended methods of nerve reconstruction even in pre-ganglionic lesions. We report a case of a patient with weakness of the upper limb after a gunshot wound to his left shoulder. Based on clinical considerations and investigations, nerve transfer procedure is carried out to restore patient’s shoulder function. CASE REPORT: Male, 32 years old, working as a policeman, complained difficulty on moving his shoulder for 3 months. Patients had a history of GSWs to the left shoulder which also results in a left clavicular fracture. First aid, debridement, and fracture management were performed at Bhayangkara Hospital, Palu. Physical examination revealed winging scapula positive on his left shoulder, shoulder abduction 5/1, and hypoesthesia at left C5 level. Electromyographic examination revealed lesions on the left posterior chord and left brachial plexus. Based on clinical findings and supporting examination, we performed nerve transfers procedure from the accessory nerve to suprascapular notch. In the previous study, 63% of cases GSWs associated with nerve dysfunction. About 75% of patients with nerve palsy are associated with nerve lacerations during surgical exploration. However, many surgeons continue to recommend early exploration after GSWs to the upper extremities, especially in patients who will undergo surgical treatment for other indications. Based on this, we suggest the probable cause of brachial plexus lesions in this case resulted from gunshot wound which injures the brachial plexus or as a complication from previous procedures. Surgery that is too early can interfere with the spontaneous reinnervation process, but late surgical procedures can result in failure of reinnervation. In general, optimal time is set between 3 and 6 months after trauma. Nerve transfer is one method of reconstructing peripheral nerve lesions that can be applied to pre-ganglionic or post-ganglionic lesions. CONCLUSION: This procedure has several benefits, namely, the proximity of the donor and the recipient nerve anatomy, shorter operating time and does not require grafts. Brachial plexus trauma due to trauma or non-trauma together has an impact on the patient’s quality of life. However, advances in surgical techniques and further understanding of nerve physiology have led clinicians and patients to better outcomes. The current trend of treatment strategies for brachial plexus trauma is surgical reconstruction with the nerve transfer procedure.

The Role of Early Surgical Intervention in Civilian Gunshot Wounds to the Head

1992 ◽  
Vol 32 (3) ◽  
pp. 398-400 ◽  
Author(s):  
THOMAS S. HELLING ◽  
W KENDALL McNABNEY ◽  
C KEITH WHITTAKER ◽  
CHARLES C. SCHULTZ ◽  
MARIANE WATKINS
Keyword(s):  
Surgical Intervention ◽  
Gunshot Wounds ◽  
Early Surgical Intervention

Penetrating gunshot wounds of the cervical spine in civilians

1975 ◽  
Vol 42 (5) ◽  
pp. 575-579 ◽  
Author(s):  
James S. Heiden ◽  
Martin H. Weiss ◽  
Alan W. Rosenberg ◽  
Theodore Kurze ◽  
Michael L. J. Apuzzo
Keyword(s):  
Cervical Spine ◽  
Neurological Deficit ◽  
Surgical Intervention ◽  
Gunshot Wounds ◽  
Neurological Recovery ◽  
Content Type ◽  
Initial Injury ◽  
Progressive Neurological Deficit ◽  
Nonsurgical Therapy ◽  
Fine Print

✓ The authors present a series of 38 civilian patients with cervical gunshot injuries, and compare neurological recovery in patients with complete lesions and patients with incomplete lesions according to whether therapy was surgical or nonsurgical. In patients with incomplete injury, ultimate recovery was a function of the initial injury more than surgical or nonsurgical therapy; nor did patients with complete lesions show significant change in outcome with either mode of therapy. Cord pathology at laminectomy rarely provided a clue about neurological recovery, and dural decompression did not alter neurological outcome. The authors conclude that the sole indication for routine surgical intervention appears to be progressive neurological deficit.

scholarly journals On the issue of surgical intervention for gunshot wounds of the skull and its contents, according to observations in the war of 1914-1917

2021 ◽  
Vol 17 (1) ◽  
pp. 91-105
Author(s):  
M. O. Friedland
Keyword(s):  
Surgical Intervention ◽  
Gunshot Wounds

Surgeons who worked in the last European war at the front on the question of the nature and timing of surgical intervention for gunshot wounds to the skull and its contents were divided into 3 camps: some were the principal supporters of the view of Bergmanna and his associates

Management of gunshot wounds of the foot

Injury ◽  
1997 ◽  
Vol 28 ◽  
pp. S ◽  
Author(s):  
R Durkin
Keyword(s):  
Gunshot Wounds

Gunshot wounds to the mandible and midface: Evaluation, treatment, and avoidance of complications

1994 ◽  
Vol 111 (6) ◽  
pp. 739-745 ◽  
Author(s):  
R COLE ◽  
J BROWNE ◽  
C PHIPPS
Keyword(s):  
Gunshot Wounds

Thrombolysis in Arterial Occlusion

1999 ◽  
Vol 82 (S 01) ◽  
pp. 109-111 ◽  
Author(s):  
Raymond Verhaeghe
Keyword(s):  
Clinical Practice ◽  
Thrombolytic Therapy ◽  
Hemorrhagic Stroke ◽  
Surgical Intervention ◽  
Bypass Graft ◽  
Surgical Techniques ◽  
Arterial Occlusion ◽  
Second Step ◽  
Severe Bleeding ◽  
Initial Management

SummaryIntra-arterial thrombolytic therapy has replaced systemic intravenous infusion of thrombolytic agents as a treatment modality for arterial occlusion in the limbs. Several catheter-guided techniques and various infusion methods and schemes have been developed. At present there is no scientific proof of definite superiority of any agent in terms of efficacy or safety but clinical practice favours the use of urokinase or alteplase. Studies which compared thrombolysis to surgical intervention suggest that thrombolytic therapy is an appropriate initial management in patients with acute occlusion of a native leg artery or a bypass graft. Underlying causative lesions are treated in a second step by endovascular or open surgical techniques. Severe bleeding is the most feared complication: the risk of hemorrhagic stroke is 1-2%.

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