Firearm injuries continue to be a major public health problem
Firearm injuries continue to be a major public health problem (Oapublishinglondon.com, 2018).
Plastic surgeons usually undergo a lot of difficulty with facial gunshot wounds. Gunshot wounds make up a large percentage for visits to the emergency department.
As a bullet moves through any soft tissue it creates a cavity which is known as a permanent cavity. This permanent cavities size is determined by several factors, which include:
? The mass of the bullet
? The material of the bullet
? The design of the bullet
? The density of the bullet
? The elasticity of the bullet
Organs with a high density may undergo more damage than tissues or organs with a low density. Hence, the skin would not undergo much damage but the bony structures that compose the face would undergo massive damage due to the reasoning that bone is very dense.
According to Shvyrkov and Yanushevich who stated that in high-velocity projectile wounds the sparing of soft tissue in gunshot wound debridement can result in the following:
? multiple surgical interventions
? prolonged duration of treatment.
According to Shvyrkov and Yanushevich who recommended that radical primary surgical debridement of gunshot wounds, as well as excision of soft tissue wound margins to a certain point of active capillary bleeding (indicative of normal functioning micro circulation system in the remaining viable soft tissues which heal rapidly) (Oapublishinglondon.com , 2018).
With a gunshot to the face wound, the extent of damage to soft tissue is not wholly apparent immediately after the injury. In order for the practitioner to obtain optimal recovery for his or her patient; the following is required from the time the patient is injured by a gunshot to the face:
? Initial stabilisation
? Definitive reconstruction
? Potential secondary refinement
Primary concern with a gunshot facial patient is devoting all your attention to the airway management of the patient. the patients airway could be compromised by direct laryngeal injury, any aspirated teeth or bone fragments and any excessive bleeding. Further advanced airway management will be needed if the airway becomes severely compromised and if extreme angioedema occurs. Intubation and a tracheotomy should be considered if the airway becomes compromised.
With regards to the patient of interest in this case study, there was no critical angioedema present, however angioedema was present due to the laceration on the tongue and the response directed by the body. The patient could maintain his airway with the aid of orophyrangeal suctioning every five to ten minute time intervals.
A most critical segment of the initial management includes a thorough neurological evaluation. The Glascow Coma scale (GCS) is the most accepted method to assess neurological status. Changes of levels of consciousness can also occur with gunshot facial patients. However, with the patient discussed above, the ILS crew from Sizamed had confirmed that the patient did not experience any loss of consciousness after the gunshot had penetrated through his facial structure. Assessment of the eye reaction to pain stimulis or voice, verbal response and motor reonse is assessed in the glascow coma scale method.
A glascow coma scale of 15/15 was obtained for the above mentioned patient. each aspect of the glascow coma scale has a score assigned to it, all accounting to a total of 15. A score of 15/15 is given when all 3 of the glascow coma scale is assessed and present in the patient being assessed.
Even though it is extremely easy to be distracted by the more impressive or larger injuries or the significant swelling that is visible without physical examination of the patient. it is not wrong to tend to the more impressive injuries first as they can be extremely detrimental to the patient.
However, by overlooking the minor or less significant problems on the patient could also to be very dangerous for the patient. In addition to the above, the patient described above had also obtained a focused secondary survey by the doctor on shift that day as well as I.
Oral cavity assessment should also be conducted to assess if any foreign body objects, teeth or bone fragments were present in the oral cavity. Practitioners should also beware of both maxillary and mandibular injuries as they cause malocclusion. Any slight change in occlusion can be sensed in the patient and it can make the patient vey agitated. In light of the above, the patients airway was assessed; no foreign body objects were found, although broken teeth were noted. The patient also presented with epistaxis. The patient also became agitated when blood started pooling in his oral cavity as it was making it difficult to breath. The origin of the free flowing blood was due to the laceration on the patients tongue (Li Z, Li ZB, 2011).
Using a computed tomography scanner (CT scanner) is one of the best ways to determine the severity of the head injury. If the fractures seem more complicated, visualisation of the injuries extent can be determined by a three dimensional reconstruction of the facial skeleton. The patient used for this case study had also undergone a CT scan; the scan was comprised of the top of the cranium all through to the base of the mandible in one millimetre axial views.
The radiographer also obtained a three dimensional reconstruction of the facial skeleton. Dr Kasunzuma ordered the CT facial bones scan due to the extent of damage that occurred in event of the gunshot. Due to the gun being placed so close to the patients face, the high velocity and impact had caused countable number of fractures which include tiny bone fragments.
Gunshot wounds to the face should be treated accorded to the American Trauma Life Support (ATLS) protocol (Rana M et.al, 2018).
Tranexamic acid which is also called by its trade name Cylcokapron, is a medication which is used to treat excessive bleeding, nosebleeds, tooth removals etc. the use of cyclokapron is extremely vast. Tranexamic acid belongs to a class of medications known as antifibronilytic agents. With severe trauma or a medical condition that a patient may have, the body tends to break down blood clots extremely fast, and this in turn does not allow the bleeding to stop or allow time for the wound to heal (Cold. F et.al, 2018).
Tranexamic acid or Cyclokapron works in the body by blocking and inhibiting the breakdown of clots. The time period in which the medication is administered is dependant on the condition being treated. The patient of subject in this case study was administered 1.5g of cyclokapron. Upon assessment after administration of cyclokapron, active bleeding had reduced drastically (Cold. F et.al, 2018).
Cefazolin, also known by its trade name Kefzol falls under the category of antibiotics. This antibiotic is used to treat various types of bacterial infections. This antibiotic falls under a class known as cephalosporin antibiotics. The basic action of the antibiotic is to inhibit the growth of the bacteria (Cold. F et.al, 2018).
With regards to the dosages of Kefzol, it is highly dependent upon the patient’s medical condition or trauma and the patient’s reaction to the medication or treatment.
Based on this case study the patient was administered Kefzol 1g, IVI, stat.