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■ Tissue type: Inelastic tissue (brain, liver, spleen, and bone) is more prone
to cavitation injury. By contrast, highly elastic tissue such as muscle may
be injured by crush but not by cavitation.

Shotgun pellets tend to produce less damage owing to small size and spherical
shape, unless fired at close range. At close range the pellets clump together
and cause much deeper tissue penetration.

EXAM

■ Determination of entrance and exit sites is prone to error and has potential
legal implications.

TREATMENT/COMPLICATIONS

■ To preserve evidence in GS victims do not:
■ Cut through bullet holes on clothing
■ Cut through bullet holes on skin unless medically necessary
■ Handle bullets/fragments with metal instruments so as not to disturb/
cause markings
■ Describe wounds as entrance or exit
■ Bullets can embolize.
■ If bullets are not found in their expected location, further workup is
warranted.
■ In general embolized bullets must be removed.

TRAUMA

Lime (calcium oxide) Cement Exothermic rxn when Profuse water via First, brush away dry

neutralized with water strong stream to particles.

prevent burn

Metals Agricultural Molten metal burns Mineral oil and Metal can ignite when

excision—no water in contact with air or

water.

Hydrocarbons Gasoline and tar Fat-dissolving corrosive Decontamination Frostbite and

injury Polysorbate to dehydration from skin

remove tar contact

Vesicants DMSO Deep penetration, Water irrigation or Anoxic necrosis

Cantharides blisters, ulcers adsorbent powder

Mustard gas

Alkyl mercury Disinfectant Erythema and blistering Debride and drain Blisters contain

Fungicide blisters mercury.

Wood preservative Water irrigation

White phosphorus Explosives Deep and superficial Water irrigation May ignite when dry,

Insecticides Copper sulfate keep wet

Determinant of injury:

Crush—mass, deformation,

yaw

Cavitation—velocity, tissue

elasticity

Handguns fire low-velocity

bullets.

TABLE 3.14. Chemical Burns (Continued)

WHEREFOUND DAMAGE TREATMENT SPECIAL