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9/19/2017 7:27:10 PM
Posted: 12/29/2002 8:41:57 PM EDT
[Last Edit: 12/29/2002 8:47:42 PM EDT by soylent_green]
After soliciting the approval of other board members concerning appropriateness, respect for victims, etc, I have decided to go ahead with this post. The images you will see here come from my workplace which is an inner-city emergency department. No faces are shown with one exception, and that is only due to the fact that it is too badly distorted to be recognized by anyone including the patient. This is not meant as a puerile "gross out" fest, but rather to illustrate the awesome and horrible effects of even low powered rounds. It is absolutely vital that those of us who take on the resposibility of firearm ownership understand the terrible power we command. Comments are appreciated.

GSW#1
This is a woman in her 40s. She was shot at less than 5 feet in the back by her estranged husband when she opened her door. She turned and ducked as she ran. She was shot with a 12ga shotgun loaded with steel birdshot. The shot entered her body at the point in the wound closest to her spine, bounced off of her scapula (shoulderblade) fracturing it, and exited. No pellets remained in the wound, but the muscle was totally destroyed. The husband was arrested shortly thereafter.


GSW#2
This is a picture of a young man who shot himself in the face with a .32ACP using ball ammo. He had a disagreement with his fiancee and attempted suicide. The exit wound wasn't much different, so it wasn't included. Note the black semi-circle beneath the wound. This is called an "oil ring". It is a tattoo caused by burning powder. The round ruptured the globe of the left eye completely destroying, skipped along the cheekbone badly damaging the left frontal sinus, punched a neat hole through both lacrimal bones(the part of the nose you pinch when you have a headache), damaged the right eye, and exited. He was taken to a hospital with the proper equipment for eye surgery in an attempt to save his remaining eye. The CT (CAT scan) was very illustrative, but I can't get the computer to release the image to me. The track of the bullet shows up very vividly, and shows many bone fragments along the track.


GSW#3
This is a young man who was the victim of an attempted carjacking. He was shot through his jeans with the weapon almost contacting his leg. There are no powder burns because his pants protected the skin. The wound you are looking at is the exit wound. The entry wound is not shown because it is nearly identical. The thug used 9mm ball ammunition. We irrigated the wound, gave him a dose of IV antibiotics, a tetanus shot, a prescription for oral antibiotics, and sent him home after we saw that his Xray was clear. He was lucky. Two inches lower and he might have had his femoral artery hit. A femoral artery bleed can kill you in about 30-60 seconds.


GSW#4
This is a photo of an Xray. The actual wound wasn't all that impressive. There was a little swelling, and the cavity of the wound itself, but not much else on the outside. There wasn't even an exit wound. The weapon used was once again a 12ga shotgun, this time with lead #7 shot. We initially thought it was steel. The wound was sustained by a woman in her 60s. She went to collect some late rent from a mentally unstable tenant who shot her at the door when she asked for the rent. Remarkably the shot completely missed her brachial artery and radial nerve. If you showed the Xray to any competent radiologist he would almost certainly predict a neural deficit, but the brachial plexus of nerves, a large improtant bundle of nerves that runs through your armpit, and the radial nerve, which runs along the humerus were both completely intact. Note the shattered humerus which needed to be wired back together around a steel rod in order to be repaired. She recovered.


I have seen only one instance of an "assault weapon" being used in the 2 years I have been at this hospital. It was reported as an AK style weapon, there were no entry wounds other than one small punctate hole that would never have been seen if it hadn't been weeping tiny drops of blood. The exit wounds weren't very impressive either, but the former drug dealer had four of them and he was dead. I did not have my camera at the time. From time to time as I take other pictures I will post them here if I feel they are illustrative, Some I have in my posession I have chosen to not post since they were just gory, and not terribly educational.
Link Posted: 12/29/2002 8:49:47 PM EDT
very interesting, thanks for sharing SG.
Link Posted: 12/29/2002 8:54:55 PM EDT
Nice pics [b]soylent_green[/b]! Awesome captions too!
Link Posted: 12/29/2002 8:59:09 PM EDT
Very educational. People should have to see the effects of the guns they carry.
Link Posted: 12/29/2002 9:03:28 PM EDT
I agree with 7IDL, very educational. I've seen "military" wounds but civilian injuries seem to be different (in the sense that there's often only one projectile or load involved), especially when it's one civilian doing it to another. I'm guessing that wounds resulting from a run in with the law will have a somewhat different placement with the occasional exception.
Link Posted: 12/30/2002 8:19:26 AM EDT
Thanks for the information provided with each pic. I know they say a picture is worth a thousand words, but such pics as these really need some background information in order for them to really have any educational value. Thanks also for letting us know the prognosis for the victim in each case; It tends to lessen the "horror" of such pictures if you know how the person ended up in the end.
Link Posted: 12/30/2002 8:30:03 AM EDT
Very interesting. I agree with several here who have said we need to see this type of thing. It can and should help us to be MORE careful. I have a greater respect for both the frailty and the surviveability of the human body after seeing these pictures. Hard to believe the young man survived, bet he wishes he had'nt. I'd like to see more in the future.
Link Posted: 12/30/2002 8:54:02 AM EDT
Excellent and informative post. Bravo, [b]soylent_green[/b]!
Link Posted: 12/30/2002 9:11:34 AM EDT
Originally Posted By skullworks: I agree with 7IDL, very educational. I've seen "military" wounds but civilian injuries seem to be different (in the sense that there's often only one projectile or load involved), especially when it's one civilian doing it to another. I'm guessing that wounds resulting from a run in with the law will have a somewhat different placement with the occasional exception.
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Actually we have had two patients that I was unable to photograph come in in the past year or so who were involved in bad drug deals and were shot multiple times. Both were shot with 9mm, one survived. Both looked like they had be shot with a burst from an MP5. With the advent of the Glock and the large capacity mags the number of times shot when a person is attacked has gone up. Revolver attacks would typically leave a guy with 3 or 4 entrance wounds, automatics you see generally a higher number. I counted 19 holes, entry and exit, in a guy in Chicago one night.
Link Posted: 12/30/2002 10:24:40 AM EDT
Green, thanks for taking your time to do this. This is very educational and I hope others feel the same way. Thanks again.
Link Posted: 12/30/2002 10:49:14 AM EDT
Interesting pictures. Soylent_Green, what is your role in the ER (other than gifted photgrapher)?
Link Posted: 12/30/2002 11:41:12 AM EDT
Link Posted: 12/30/2002 11:51:46 AM EDT
How about some knife wounds? A lot of the wounds you see above are contact or close to contact range. At the same range and depending on the weapon used, a knife could possibly have done more damage and ensured that the above victims never even made to the ER. I agree this is a very important area for people to explore when it comes down to owning a firearm for self-defense. Possessing verifiable knowledge of the horror that an edged weapon can leave behind could prove valuable should you ever find yourself in court defending your life. If the jury is just aching to know why you shot the man with a knife 20 feet away from you, the opportunity to demonstrate the Tueller Drill presents itself. But when they want to know why a guy with a gun needs to be afraid of somebody holding an edged weapon, and you can say that you're aware that the wounds caused by a knife are often many times worse than that from a 9mm - and further if you can attach an actual photograph to the mental imagery behind that - well, I think that would do a good job of convincing me.
Link Posted: 12/30/2002 12:50:03 PM EDT
Originally Posted By Phil_A_Steen: Interesting pictures. Soylent_Green, what is your role in the ER (other than gifted photgrapher)?
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I am a medical researcher and an MD.
Link Posted: 12/30/2002 12:53:12 PM EDT
Originally Posted By Dolomite: How about some knife wounds?
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We really don't see them. I have seen more industrial related digit amputations than combat related knife wounds. It takes real balls to get up close and personal like that, and criminals are typically pretty ball-less. Plus we are Americans, we like labor saving gadgets.
Link Posted: 12/30/2002 1:07:16 PM EDT
Originally Posted By soylent_green:
Originally Posted By Dolomite: How about some knife wounds?
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We really don't see them. I have seen more industrial related digit amputations than combat related knife wounds. It takes real balls to get up close and personal like that, and criminals are typically pretty ball-less. Plus we are Americans, we like labor saving gadgets.
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Labor saving gadgets! HA! Indeed it is sad when you look at the circumstances under which the above photos happened. Aside the attempted suicide, we've got one woman shot in the back and another woman shot through a door. Ball-less criminality at it's finest.
Link Posted: 12/30/2002 3:41:23 PM EDT
From the many gunshot wounds I have seen the actual gasses of the round being fired at close range are FAR more devastating than the actual projectiles. A saw a self inflicted shotgun wound that removed most of a mans head. I have also seen time and time again that a .25 auto will often not penetrate the human skull at point blank range but the .32 tends to actually break a lot of bone by comparison and can usually make a head shot effective even at 20 feet. Thats why I dont ever consider a .22 or .25 for concealed carry.
Link Posted: 12/30/2002 9:30:41 PM EDT
Link Posted: 12/30/2002 9:54:34 PM EDT
Shoot .22 LR from a .25 ACP-sized gun and you'll get terminal performance that's virtually identical to .25 ACP.
Link Posted: 12/31/2002 6:34:36 AM EDT
I have not seen you around in forever Mr Dodson. What happened to your updates on your site? One day they just quit being updated. Did everything go to the pay for E-zine?
Link Posted: 12/31/2002 7:54:22 AM EDT
I helped ferry a GSW from AirScare to the ED tonight. 12 gauge entry just below, and left of the shooter's wife's boyfriend's genitals. Either the husband knew what he was doing, or he was a bit off of his target. You make the call. Nearly 40 units of blood, and about an hour later, the boyfriend was "pronounced". That femoral artery is a big, bad bleeder. Word to the wise... Have sex at your own home. With your spouse. Does "12 minutes out" and "21 and 22 units hanging" mean anything to you? Think about it. Tim
Link Posted: 12/31/2002 10:49:35 AM EDT
I was an E.R. Tech at Loyola in Maywood (W. of Chicago for those who don't know) and saw many more auto-accident patients than GSWs, but the "lead catchers" definitely kept us busy. I saw one guy with three 9mm holes in his chest and he sailed through surgery, while another one had only one 9mm wound, but it transversed his upper chest from R to L and destroyed nearly all of his L innominate vein. I think we wound up putting 20 units into the guy, plus using a plasma scavenger (forget the proper term, sorry) during surgery to keep his volume up (I was allowed to observe the surgery). It just goes to show how much luck determines what that bullet hits on its way through.
Link Posted: 12/31/2002 11:17:21 AM EDT
We call it a "cell saver". I've operaten on GSW patients that required over 100 units of blood products. One I remember in particular used all but 12 units of blood available in our level 1 trauma center. Blunt traumas can be even worse.
Link Posted: 12/31/2002 1:17:09 PM EDT
"Cell Saver", yes, that's it. Thanks!
Link Posted: 12/31/2002 3:56:00 PM EDT
Those are going to leave marks!!!!!!!!!1
Link Posted: 12/31/2002 4:36:04 PM EDT
I agree it is important to really see what damage can result from firearms. Does anybody have any images of GSW sustained from 5.56 or .308 NATO?
Link Posted: 12/31/2002 5:35:18 PM EDT
I work in the innercity and these are my own personal pictures. Since nobody in criminal circles outside of government uses 5.56x45mm or 7.62x51mm I don't have any pictures of that. Since the idea here is to illustrate wounding potential with no supposition or fantasy getting in the way, it would be difficult to vouch for the authenticity of anything I picked up on the web. Several members have offered pictures they have personally taken, but none have been sent yet. My father has several pictures of Viet Namese wounded or killed by 7.62x51mm rounds from M14s and M60s that he personally took, but I have no scanner, and I don't think they would scan well anyway.
Link Posted: 12/31/2002 9:35:01 PM EDT
Originally Posted By soylent_green: ...Since nobody in criminal circles [i]outside[/i] of government...
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(Emphasis added) ROTFLMAO!!! Gabe
Link Posted: 1/1/2003 12:34:02 AM EDT
Originally Posted By gman552:
Originally Posted By soylent_green: ...Since nobody in criminal circles [i]outside[/i] of government...
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(Emphasis added) ROTFLMAO!!! Gabe
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Uh huh... Most of the GSW's I see in the ED are... drug deals gone bad... (9mm, .22, .25 auto) self inflicted...(.38 or 357) hunters or jealous spouses (12 gauge) 4 years into it, I have yet to see a 5.56, .308, or a .50 cal wound. I guess I'm just lucky. Or, just maybe, there's not much crime committed with high dollar weapons, such as [i]some people[/i] like to collect. That should fully explain the AWB. I cover the whole Level 1 Trauma Center, so I am not in the ED 24/7, but I do have "friends in low places". And we do take care of our own, 24/7. Some of us, anyways....
Link Posted: 1/1/2003 7:49:23 AM EDT
I hope no one thought I was laughing at these people, I was remarking on the "criminals outside of government". This implies, of course, that there are criminals *inside* of government, which we all know is true [;)]. They just use higher-dollar taxpayer-funded tools [:(!] I'm a physician assistant (PA) in dermatology, so I don't see ED trauma. But I do remember several cases from my PA school rotation in the medical examiner's office: Case 1: 30+ y.o. male who "ate" his father's .357 Mag revolver loaded with .38 Special lead semi-wadcutter in his father's driveway. The bullet traversed through the palate, brain, and exited through the top of the skull. Bullet was found in the wood siding just above the garage door (he was facing the street.) The deceased was recently divorced, had lost custody of his kids, and had been drinking for several days before the suicide. Several-year history of depression. Case 2A, 2B, 2C: Two male and one female GSW victims, all in their early 20's. The two male victims (2A, 2B) were shot multiple times with 9mm Parabellum FMJ (cases were found in the parking lot.) The two had apparently driven up to a club where members of an opposing gang were standing outside, and were flashing their gang signs at those people. The other gang surrounded the car, and an argument started. The two deceased attempted to drive away, but the car stalled. The driver was shot through his open window at least four times in the shoulder, head and neck. The passenger attempted to exit his door, but was shot multiple times through the forearms (defensive wounds?), chest and head. The female victim (2C) was a bystander who was outside the car and had crouched down by the right rear passenger door when shots were fired. She was facing the car. A 9mm FMJ bullet fired from fifty feet away at the car's 5 o'clock position ricocheted off the right rear fender and traversed through her left arm, left thorax, aorta, and was found lodged in the right chest wall. Autopsy revealed copious amounts of blood in the chest cavity from the perforated aorta. The ME estimated she lost consciousness almost instantly. Just a few weeks ago, one of my 18-year old acne patients was accidentally shot dead by his classmate at his friend's house. Apparently they were playing chess, and the friend "showed off" his father's .22LR pistol. It is unknown if he had permission from his father to have the gun. The friend put the gun back in his pocket, then pulled it out again to "put it up." The gun "accidentally" fired, and the single .22LR bullet struck my patient in the chest. He later died at a local trauma center. The "friend" is being charged with manslaughter. I heard about his death two weeks later when his mother called to cancel his appointments. Lessons: 1. Keep firearms away from severely depressed or drunk (or both) people. 2. Don't pick fights with people who are probably armed and are known to be violent. 3. Immediately leave the target area (if possible) if shots are fired and take cover. I don't know what to say about my patient's situation, except that I want to bitch-slap the stupid f**k who shot him. Sorry for rambling. Gabe
Link Posted: 6/9/2003 5:54:18 AM EDT
BTT. In process of adding new pics.
Link Posted: 6/9/2003 1:24:46 PM EDT
soylent_green, I'm kind of shocked you don't see more knife wounds in your ER. I work as a city cop and it seems most decent DVs are via knife. Nice pics, I think many people miss out on what their weapons can do when they only punch paper. For every death I see from a GSW, I see several guys crying like babies screaming for mommy. Then they are told that they are going to be fine, and they go back to acting like the street thugs they are. ER docs do good work.
Link Posted: 6/9/2003 11:41:52 PM EDT
Soylent Not to be a spoiler, I am a gun fan and an MD too, but aren't these pics, even anonymous as they are, covered by HIPAA? faldoc
Link Posted: 6/10/2003 7:15:43 AM EDT
FALDOC - they were posted in 2002 - HIPPA hadn't taken effect, it would be expostfacto.
Link Posted: 6/10/2003 8:21:55 AM EDT
Originally Posted By faldoc: Soylent Not to be a spoiler, I am a gun fan and an MD too, but aren't these pics, even anonymous as they are, covered by HIPAA? faldoc
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Go to the privacy guidelines put out by the hospital/hospitals you have priviledge with and you will see that this is acceptable. There is no difference here between properly anonymized photos being used in a conference and what is here. This is meant to dryly educate and illustrate what weapons can do. It in no way violates HIPAA, and in fact HIPAA contains clauses that address the uses of photos and case histories for educational purposes. Even the idiots who came up with the bloated stupidity that is HIPAA understand that education is a must, and thus case histories must be used. I believe my personal as well as professional ethics are well enough defined and decent that I do not need HIPAA, and I don't believe anyone could reasonably find fault with what is posted here.
Link Posted: 6/10/2003 11:25:59 AM EDT
Proof that birdshot is more than enough for CQ home defense, thanks for posting those pic's.
Link Posted: 6/10/2003 4:57:35 PM EDT
In Chicago if it isn't GSW it's screwdrivers and hammers. So much for Chicago's ban on handguns in the city (<1982 exempt by permit). I will say these kids just shoot because its cool and it is a way to show to is running the turf where the Good Doctor Works. Cook County Sure Gets lots of GSW everyday. Very informative pictures BTW and please post more when available. Glad I am not an Physician
Link Posted: 6/10/2003 5:03:13 PM EDT
Educational, thank you.
Link Posted: 6/10/2003 5:13:19 PM EDT
Thanks for these informative pics soylent_green. keep em coming!
Link Posted: 6/13/2003 3:18:48 PM EDT
Damn, soylent_green. I owe you a beer if you ever get out to play with us. (Beer is AFTER the shooting. [:D]). I couldn't stomach much of that stuff. I'm sure greatful for people like you who help us wimps. Thanks for sharing. BTW, I just ate diner and I suddenly am not feeling very well. [;)]
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