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Hisaradi
02-17-2016, 07:33 PM
A 28 year old male detective has been shot in the upper arm -- the bullet didn't penetrate, but his cephalic vein was damaged. An ambulance is called immediately and he is taken to the hospital.

Would he require surgery? If so, how long would that take, and what's a rough idea of what it would entail (conscious or unconscious, etc.)?

Would he need stitches or just a compression dressing? Sling or no sling? If yes to the sling, for how long?

Would he need to stay in the hospital for any amount of time? If so, for how long?

Glyax
02-17-2016, 07:47 PM
Question for clarification... The bullet didn't penetrate at all? Or it just didn't pass all the way through his arm? If the bullet just hit his arm, and didn't even break skin, I'm curious as to why an ambulance would be called.

From your later questions, it implies that the bullet did enter, which would make sense in the whole getting shot category. I guess it would also depend on what type of bullet, how deep it went, etc

Hisaradi
02-17-2016, 11:19 PM
Question for clarification... The bullet didn't penetrate at all? Or it just didn't pass all the way through his arm?

Sorry about the confusion, the bullet did hit his arm but it was a graze -- it left a furrow rather than a hole, if that helps to clarify. The gun used was a .38 revolver.

Glyax
02-17-2016, 11:27 PM
Hmm, I'm no medical expert, only trained in combat lifesaving first aid :P, so hopefully someone else can come around and tell me I'm wrong. But in my opinion/experience, I know it would get a pressure bandage, stitches are a possibility, but I wouldn't think he would need a sling for it. when you get into the details of the vein being damage etc, I think we need someone with more experience/knowledge than me to answer that...I'm just trying to help move us along so the pro's can give ya the finisher :)

Hisaradi
02-17-2016, 11:41 PM
Alright. Any information is helpful, really, so thank you.

MDSchafer
02-18-2016, 08:24 AM
I know people don't like this answer, but it depends. Bullets rarely leave furrows, so the guy us super lucky to begin with, and any damage done is probably going to be superficial.

The cephalic vein is pretty medial on most people, especially in the upper arm, so it would be difficult to damage with a graze. Also veins are floppy things, so it's difficult to damage. If a graze did manage to damage a vein it would probably clot off and repair itself. We blow veins all the time when we start IVs, it rarely, if ever, a cause for alarm.

So, to answer your question he'd be checked out and released in a couple of hours without being admitted. ED workers typically love cops, so he'd get preferential treatment, unless they're super backed up or the cop acts like an ass. The wound might need stitches, but typically pressure will stop the bleeding and allow the body to report it.

GeorgeK
02-18-2016, 11:10 AM
I know people don't like this answer, but it depends. Bullets rarely leave furrows, so the guy us super lucky to begin with, and any damage done is probably going to be superficial.

The cephalic vein is pretty medial on most people, especially in the upper arm, so it would be difficult to damage with a graze. Also veins are floppy things, so it's difficult to damage. If a graze did manage to damage a vein it would probably clot off and repair itself. We blow veins all the time when we start IVs, it rarely, if ever, a cause for alarm.

So, to answer your question he'd be checked out and released in a couple of hours without being admitted. ED workers typically love cops, so he'd get preferential treatment, unless they're super backed up or the cop acts like an ass. The wound might need stitches, but typically pressure will stop the bleeding and allow the body to report it.

https://www.innerbody.com/image_cardov/card23.html

You appear to have medial and lateral confused. The cephalic vein is one of the more easily visible veins of superficial anatomy. Veins also are very easy to damage. That's why it's fortunate that our veins for the most part are a plexus or net rather than end organs. If you look at a histology slide of a cross section of a vein they do not have a muscular layer. Pretty much what keeps them intact is a connective tissue sheath which will also have at least an artery, vein and lymphatic vessels. Those that run with the cephalic vein deal mostly with superficial stuff. Most likely all this patient would need is cleaning and a good bandage. It's possible a stitch or two may be in order but certainly no major surgery or even an overnight stay in a hospital, unless it's a military hospital that gets paid by the number of beds filled.

You are correct however about furrows from GSW's. They don't exist. Skin isn't rigid so a roughed up laceration wouldn't look like a furrow.

Hisaradi
02-18-2016, 06:18 PM
Thank you both for the information, that's exactly what I needed. I used "furrow" for lack of a better word -- what would be a better word?

WeaselFire
02-18-2016, 08:28 PM
The wound you're talking about looks more like a bad burn, like if you leaned on the edge of a barbecue grill or the like. Bullet speed usually does a pretty good job of cauterizing these wounds and they don't usually have a lot of blood, mostly seeping and not spurting.

To get a decent amount of blood, have the bullet puncture the flesh and break the cephalic vein. Not life threatening, vein damage rarely is anyway, and the wound is still pretty superficial although not a true grazing wound. The wound can vary dramatically as well. If you need a more ragged wound, have the bullet hit a wall or parked vehicle or something and tumble when it hits the guy. Less chance of the neat little puncture wound and more tearing action.

Also, maybe a stitch but usually just a bandage for treatment. Unless there are other factors, it's an outpatient treatment at any rate, no admittance.

Jeff

Hisaradi
02-19-2016, 12:37 AM
So a puncture wound wouldn't cause too much damage? From initial searching I was under the impression that it might give him some permanent aftereffects, but if I can get away with a puncture then that would be great. How ragged would the wound be if the bullet went through a window?

MDSchafer
02-19-2016, 05:05 PM
https://www.innerbody.com/image_cardov/card23.html

You appear to have medial and lateral confused. The cephalic vein is one of the more easily visible veins of superficial anatomy. Veins also are very easy to damage. That's why it's fortunate that our veins for the most part are a plexus or net rather than end organs. If you look at a histology slide of a cross section of a vein they do not have a muscular layer. Pretty much what keeps them intact is a connective tissue sheath which will also have at least an artery, vein and lymphatic vessels. Those that run with the cephalic vein deal mostly with superficial stuff. Most likely all this patient would need is cleaning and a good bandage. It's possible a stitch or two may be in order but certainly no major surgery or even an overnight stay in a hospital, unless it's a military hospital that gets paid by the number of beds filled.

You are correct however about furrows from GSW's. They don't exist. Skin isn't rigid so a roughed up laceration wouldn't look like a furrow.

I don't know why you made a personal comment, but read the original post.


A 28 year old male detective has been shot in the upper arm

In the upper arm the cephalic vein runs medial to the deltoid, making the scenario of grazing the cephalic vein in the upper arm implausible. Unless I'm misunderstanding what he means but "Upper arm."

http://static1.squarespace.com/static/536a936ae4b09724c1063b54/t/548de237e4b04ff00dd87262/1418584634271/

GeorgeK
02-20-2016, 01:14 AM
I don't know why you made a personal comment, but read the original post.



In the upper arm the cephalic vein runs medial to the deltoid, making the scenario of grazing the cephalic vein in the upper arm implausible. Unless I'm misunderstanding what he means but "Upper arm."

http://static1.squarespace.com/static/536a936ae4b09724c1063b54/t/548de237e4b04ff00dd87262/1418584634271/
It is not a personal attack to point out a mistake. Upper is not a medical term. Most people consider the deltoids part of the shoulder. If you think veins are not easy to injure talk to any phlebotomist, IV therapist or nurse.

MDSchafer
02-20-2016, 01:40 AM
It is not a personal attack to point out a mistake. Upper is not a medical term. Most people consider the deltoids part of the shoulder. If you think veins are not easy to injure talk to any phlebotomist, IV therapist or nurse.

I am a nurse. There was no mistake, you and I have different, yet completely valid understanding of language. I'm not interested having a discussion about where the layman understanding of "Upper arm" is in anatomical terms.

I also said veins start all the time, so the mistake I made, I suppose was not adding a qualifier like, "Significantly damage," for people like you, who must have read over that part.


You are correct however about furrows from GSW's. They don't exist. Skin isn't rigid so a roughed up laceration wouldn't look like a furrow.

I suppose it depends on your definition of the word furrow. I've seen enough to refrain from saying that a certain traumatic injury doesn't exist. I found this image on a gun safety website where someone shot at the range. I suppose it all goes back to how technical you want to be, and what your mental image of a furrow looks like. This might be what the OP was going for.

http://www.thetruthaboutguns.com/2015/05/foghorn/gunshot-wound-on-the-range-what-to-do/


http://www.thetruthaboutguns.com/wp-content/uploads/2015/05/IMG_20150516_113442-730x542.jpg

WeaselFire
02-21-2016, 01:41 AM
How ragged would the wound be if the bullet went through a window?

As ragged as you need it. Bullets don't slice, they tear, and the wound can be clean to really messy. A puncture wound isn't serious just because it's a puncture wound. It's what gets punctured that's the issue. A puncture wound in your butt hurts. Then it heals. A puncture wound in your eye hurts too. And leaves you with some serious complications.

Jeff

GeorgeK
02-22-2016, 11:19 PM
This might be what the OP was going for.

http://www.thetruthaboutguns.com/2015/05/foghorn/gunshot-wound-on-the-range-what-to-do/


http://www.thetruthaboutguns.com/wp-content/uploads/2015/05/IMG_20150516_113442-730x542.jpgI am a surgeon. For practical purposes GSW's do not result in furrows. They can under a very specific set of circumstances, namely self inflicted wounds and very up front and personal close combat which I hadn't considered as the OP was not describing that sort of situation. If you look at that wound you will see charring. Charring is what is necessary to give the skin edges rigidity. That's from the powder burns. Most likely, given the location that patient was attempting a quickdraw. Without the burn it would look much like any laceration from a not particularly sharp object.