Yet another gunshot wound question…

GSW to Stomach

I may offer some help on one element...

My brother was head operating guy of a MASH unit (UK version) and he was often in hot spots...

Interesting supper conversation with him once, he told me that the stomach cannot heal within the human body and, it has to be lifted out of the body and placed in a sterile liquid medium. The tubes etc that connect stomach to rest of organs pass through slits in skin. The patient basically carries around his stomach in a baggie... I can't recall the timeline.

• Would the impact knock him over? It's not like the movies. One gunshot, even with the caliber you're describing would not necessarily knock him off his feet. The pain and blood loss (depending on what injuries you ultimately pen in) may drop him, but the impact of the bullet itself? No - it wouldn't "knock him over."
• Would he feel pain immediately and how severe would it be? Large caliber weapon from fairly close range? Yep - pretty darn painful. The severity would depend on his adrenalin, pain threshold and what organs were hit.
• What kind of blood loss would there be? From the wound? Unless a large vessel was hit, there may not be much. Skin has an amazing ability to stretch as the bullet rips through, so it would [somewhat] close. Entry wounds are smaller - exit wounds are horrific. The entry wound would leak some blood out of the wound. Internally, depending on what you have get hit by the bullet [am I sounding repetitive?], your character could lose a fair amount of blood. If his aorta (main blood vessel carrying oxygen-rich blood from the heart to the rest of the body) is hit - he could bleed to death initernally within minutes. Other arteries (such as those that supply the colon or small intestine) could lead to death by blood loss internally unless caught and operated on. The range in endless, depending on what you "need" from the injury and time frame you're trying to create.
• Would he remain conscious? Depends on the blood loss you want/need. If you want him to, then he will. If you need him to go out.... so be it.
• What kind of internal damage might the victim suffer [it needs to be serious but non-fatal!] and where might the bullet lodge? If I read your description correctly, he was shot from the front and the bullet enters "to the right." His right? You're looking at possible small and/or large intestine damage, kidney damage, spinal damage if it tracks toward the midline... a .357 from that distance would put a serious hurt on him internally... especially if you have him shot with some of the more brutal types of ammunition (Black Talon, Hydrashock, hollow-points, etc.) It could lodge anywhere you want - spine (with or without nerve damage), kidney, muscles of the back... Is there a reason you need it to lodge in him? A serious, but non-lethal gunshot could be a through-and-through entering from the front, travelling across the abdomen and exiting from the back, but near the side. It could hit intestine and necessitate surgery to save him, but not kill him...
• Could there possibly be any collateral damage from bone/bullet fragments; scraps of fabric in the wound? [It’s an hour or so before his friends can get him to hospital] A scrap of fabric in his wound would be the least of his worries. Assuming you're getting him to a hospital and surgery, he's about to be cut open and have people put their (hopefully sterile) hands in him... a piece of his shirt won't be the death of him. The collateral damage would all depend on what you want hit and what you want the recovery time/course to be.
• How long might surgery take and what are the risks that his recovery might be hampered by infection? Depending on what was hit, surgery could take anywhere from an hour to several hours... does his spine get hit? Does he need a tedious, microscopic neurosurgery? Do you need to call in specialists? Is his colon injured to the point of needing a colostomy? Permanently? Temorarily? Will he need follow-up surgeries? Up to you. Infection is always a risk. The would would be flushed during surgery with antibiotic solution and a course of intravenous antibiotics administered during his stay in the hospital, but sure - there's always a chance of infection. It's up to you if you need/want him to have to fight off infection or not.
• Would there be any long-term health consequences [this guy is in the military so needs to be pretty fit to return to his line of work]. You got it... depends on what was hit. My "minor" gunshot (not that I want to be shot with a .357 myself, no matter how 'minor' you call it...) scenario could end up with exploratory surgery, repair of the bowel w/o colostomy, a hospital stay of a few days to a week or so and no real long-term consequences.

Huge thanks to anyone who can help… I have tried to get info online but it’s all really dense medical research! My suggestion? Try to interview a trauma surgeon or emergency room doctor. Fifteen minutes of their time will give you all you need (and more).

JD65 said:

• Would the impact knock him over? It's not like the movies. One gunshot, even with the caliber you're describing would not necessarily knock him off his feet. The pain and blood loss (depending on what injuries you ultimately pen in) may drop him, but the impact of the bullet itself? No - it wouldn't "knock him over."

Click to expand...

True, dat. Even a shotgun blast won't send you flying backwards. Doesn't have the kinetic energy. If it did, it would knock back the shooter, too. They often just go limp and drop. Sometimes they won't seem to react at all, at first.

Since you say he's shot with a .357 the setting must be modern. Gut shot wounds used to nearly always be fatal with the pain getting worse with time.
Even with modern medicine he isn't likely to return to combat duty in less then a year and would most likely be 'sent to the States' or equivilent.

Kentuk

There's a great little book called 'Cause of Death', by Keith D. Wilson, MD, in the 'Howdunit Series' of Writers Digest Books. It discusses a situation much like yours, from the gun shot to the emergency room and beyond. The chapter on autopsy was excellent, as were the chapters on weapons, projectiles and all the forensics appertaining thereto.

Gunshot

Bullets, even when they hit bone, do not knock men over. But it sometimes looks like they do when the muscles contract and release.

Without treatment within roughly four hours at most, nearly all gunshots wounds to the abdomen are fatal. And they hurt like a son of a *****, though the pain may take a few minutes to set in. If nothing major is hit, on teh other hand, nearly all abdominal wounds are survivable, if treatment is received in time.

Hello folks,

Here is an exact case study of the type of wound you are wondering about.

Larry Flindt, the publisher of HUSTLER magazine, was shot in the abomen over a decade ago. The shooter used a 44 magnum. The gut shot was horrendous, requiring major surgery (Larry almost died). Since the shooting he has been paralysed and confined to a wheel chair. He also became addicted to pain medication.

Glen T. Brock

He gets shot by a .357 Magnum from a distance of around 8-10 feet away; bullet enters to the right and 3-4 inches above the navel and lodges… well, somewhere!

Can anyone help with these questions:

• Would the impact knock him over? The impact of a supersonic bullet is going to paralyse his diaphragm ... it's like getting punched in the gut by a heavyweight, but worse. He'll crumple and flop, may have a muscle jerk that lurches away from where he's standing.
• Would he feel pain immediately and how severe would it be? He'll be in shock so fast he'll barely feel it. • What kind of blood loss would there be? Massive. The liver, kidneys and spleen have lots of BIG arteries and veins. He'll bleed to death in less than five minutes.

• Would he remain conscious? Maybe for a minute, until the shock from blood loss hits.

• What kind of internal damage might the victim suffer [it needs to be serious but non-fatal!] and where might the bullet lodge?

With the scenario you describe, he could get shot in the ER of a major trauma center and not survive. That's a big-motha gun from almost point-blank range into a spot that's stuffed full of vital organs and arteries. If he was wearing a Kevlar vest the punch of the slug could rupture his spleen and damage his liver and kidneys.

I think it's going to lodge in the wall behind him (if it's masonry) leaving an exit wound big enough to put a large man's fist into. That's a huge round with a lot of velocity. My dad shot a bear with a Colt 45 (smaller calibre than your proposed weapon) from that distance, and the bullet lodged in a tree on the other side of the bear. The bear dropped dead in its tracks, with a gaping exit wound on the far side of his ribcage.

Look at an anatomy book. Either the liver (victim's right, shooter's left) or the spleen (victim's left, shooter's right) is going to be blown to hamburger. The kidneys are tucked under the lowest part of the rib cage ... right about where the bullet is going to hit. The "hydrostatic shock" (pressure wave from the impact) will do a lot of soft tissue damage.

• Could there possibly be any collateral damage from bone/bullet fragments; scraps of fabric in the wound? [It’s an hour or so before his friends can get him to hospital]

He'll be dead of hypovolemic shock (blood loss) long before the hour is up.

• How long might surgery take and what are the risks that his recovery might be hampered by infection?

• Would there be any long-term health consequences [this guy is in the military so needs to be pretty fit to return to his line of work].

Thought Leadership said:

I may offer some help on one element...

My brother was head operating guy of a MASH unit (UK version) and he was often in hot spots...

Interesting supper conversation with him once, he told me that the stomach cannot heal within the human body and, it has to be lifted out of the body and placed in a sterile liquid medium. The tubes etc that connect stomach to rest of organs pass through slits in skin. The patient basically carries around his stomach in a baggie... I can't recall the timeline.

Click to expand...

NO

I went into Urologic Surgery to get away from the GSW's and stabbings on trauma surgery. Taking care of GSW's is a pain, so much damage from such a little piece of metal. Look at some anatomy texts and read about the difference between high velocity and low velocity GSW's. 4" above and to the right of the patient's navel is the liver. A 357 mag is a high velocity round that will most likely have a much bigger exit wound than entrance and a liver hit is likely to be fatal even with modern medicine. 10 feet vs 100 feet really doesn't matter. What matters is how lucky someone gets with the trajectory and whether there was anything the bullet hit first to take away some of its energy. If you want them to be anything but dead and incapacitated and dead and bleeding and dead, then have it be a grazing wound with no violation of the abdominal cavity, but a nasty soft tissue wound to the skin and muscle. I remember taking out 38's and 22's, but if my memory serves me, then all the 357's I saw were through and throughs on organ harvests. Bullets can do some freaky stuff though. I saw a rifle round, from a AK-47 clone, like "762?" full metal jacket, barely deformed just peeking through the fold between 2 fingers from a head wound. The bullet hit the head, tracked along the neck and somehow was deflected by the shoulder blade and down the arm. Why it wasn't a through and through I'll never figure out. I took a 38 out of a guy's bladder that had tracked between the mucosa and serosa (the inner and outermost layers) it enteres the anterior pelvis, tracked aroound the bladder and hit the interior of the front pelvic bones on the contralateral side, so that the path of the bullet was a "U".

If you get a chance, the Walter Reed Medical Museum has some fascinating stuff though mostly it relates to civil war gsw's.