From the Guidelines
ICU doctors play a crucial role in treating patients with gunshot wounds, particularly those with severe injuries requiring intensive care. When a patient with a gunshot wound arrives at a hospital, they typically first go through the emergency department for initial assessment and stabilization. If the injuries are life-threatening or require continuous monitoring and advanced support, the patient is transferred to the Intensive Care Unit (ICU). In the ICU, specialized critical care physicians manage complications like shock, respiratory failure, or organ damage, as highlighted in the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1.
Key Aspects of Treatment
- Coordination of care with trauma surgeons, who perform necessary operations, and other specialists depending on the location of the injury
- Treatment may include mechanical ventilation, vasopressor medications like norepinephrine or vasopressin to maintain blood pressure, broad-spectrum antibiotics such as piperacillin-tazobactam or cefepime to prevent infection, blood transfusions, and pain management with medications like fentanyl or hydromorphone
- The selection of patients with severe shock for direct operative room trauma intervention was also beneficial for outcomes when compared with an expected TRISS score, as observed in a study of 271 patients undergoing immediate laparotomy for gunshot wounds 1
Importance of Early Intervention
The need for early surgical bleeding control in patients with gunshot wounds, especially those presenting with signs of severe hypovolaemic shock, is emphasized in both the updated European guideline from 2013 1 and the more recent sixth edition of the European guideline from 2023 1. Early intervention is critical in reducing morbidity and mortality in these patients. The relationship between time and bleeding control or “door-to-embolisation time” has also been observed for complex pelvic fractures, underscoring the importance of prompt action in trauma cases 1.
From the Research
ICU Treatment for Gunshot Wounds
- ICU doctors do treat gunshot wounds, as evidenced by the study 2 which investigated the outcome of patients admitted to intensive care unit (ICU) for gunshot wounds.
- The study 2 found that the 28-day mortality rate for patients admitted to ICU with gunshot wounds was 24.7%, with 77.5% of deaths occurring within the first 48 hours after ICU admission.
- Gunshot wounds can be complex and require specialized treatment, including surgical intervention, as noted in the study 3 which evaluated the treatment of 104 patients with gunshot wounds.
Treatment Approaches
- The treatment approach for gunshot wounds depends on the location and severity of the injury, as well as the patient's overall condition, as discussed in the study 4 which provides a comprehensive review on the management of ballistic injuries in the emergency department.
- Surgical treatment is often indicated for gunshot wounds, particularly for penetrating injuries or those with significant soft-tissue damage, as noted in the study 3.
- Non-surgical management may be appropriate for patients with minimal soft-tissue disruption and no nerve, intra-articular, or vascular injury, as discussed in the study 5.
Epidemiology and Outcomes
- Gunshot wounds are a significant public health problem, accounting for a substantial number of deaths and disabilities, as noted in the study 6.
- The epidemiology of gunshot wounds varies depending on the population and setting, with different mechanisms and outcomes reported in different studies, such as 2 which found that assault was the most common mechanism of injury.
- The outcomes for patients with gunshot wounds can be poor, particularly for those with head injuries or bleeding, as reported in the study 2.