Penetrating Injuries for Certified Emergency Nursing (CEN)

Penetrating Injuries

Definition/Etiology:

• Penetrating injuries from guns, industrial accidents, paint guns, and nail guns
• Appearance of entrance wound does not always reflect the amount of damage beneath
• Do not remove impaling objects

Pathophysiology:

• Firearm injuries can result in extensive damage to underlying tissues and organs
• Fragments from shattered bones can form secondary projectiles
• Passage of the bullet in a gunshot wound (GSW) forms a negative pressure cavity that pulls debris into the wound
• Shock waves travel through tissues, causing shearing and crushing of nerves, vessels, muscles, and organs
• Bullets from rifles have a higher velocity than those from handguns and are associated with greater tissue damage
• High-pressure injuries such as from paint guns or grease guns that are designed to inject these substances into hard-to-reach places
• When forced against the skin, such guns inject paint or grease for several centimeters, typically following tissue plane
• In the volar aspect of the hand, paint or grease can travel down tendon sheaths and along the digits

Collaborative Management:

Interventions:

• ABCs – High-flow supplemental oxygen, bleeding control, frequent vital signs/monitoring
• IV x2
• IVF resuscitation, antibiotics, tetanus
• Projectile path unpredictable, wound evaluation (location, number)
• Preserve forensic evidence
• Surgical vs. nonsurgical

Linchpins: (Key Points)

• Penetrating injuries from guns, industrial accidents, paint guns, and nail guns
• Do not remove impaling objects
• Determine type of projectile, potential for multiple internal injuries, may be more than one projectile (how many shots?)