Management of Abdominal Gunshot Wounds: Clinical Roles and Responsibilities of Emergency Medical Technicians
Abstract
Background: Abdominal gunshot wounds (GSWs) represent a severe and high-mortality subset of penetrating trauma. The damage is complex, driven by ballistic principles like kinetic energy transfer and cavitation, and frequently involves multiple intra-abdominal organs. Rapid clinical deterioration from hemorrhage and contamination necessitates an urgent, systematic response.
Aim: This review outlines the comprehensive management of abdominal GSWs, emphasizing the critical roles of prehospital care, emergency department evaluation, and the integrated, multidisciplinary approach required for optimal patient outcomes.
Methods: A narrative synthesis of clinical protocols and evidence-based practices is presented, covering pathophysiology, epidemiology, diagnostic evaluation (including the Extended FAST exam and CT imaging), and definitive treatment strategies guided by the patient's hemodynamic status.
Results: Management begins with prehospital ABCs (Airway, Breathing, Circulation) and hemorrhage control. In the emergency department, hemodynamic status dictates the pathway: unstable patients proceed directly to exploratory laparotomy, while stable patients undergo CT scanning for injury characterization. The EFAST exam is a vital bedside tool for detecting hemoperitoneum in unstable cases. Definitive treatment is overwhelmingly surgical for patients with peritonitis or instability. Non-operative management is reserved for a highly select, stable subset. Core management includes aggressive resuscitation, often with massive transfusion protocols, broad-spectrum antibiotics, and tetanus prophylaxis.
Conclusion: Successful management of abdominal GSWs hinges on rapid recognition, immediate resuscitation, and timely surgical intervention coordinated by a multidisciplinary trauma team. Despite advances, mortality remains high, underscoring the need for efficient trauma systems and ongoing advocacy for primary prevention of firearm violence.
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Authors
Copyright (c) 2025 Fisal Mohammed Abdullhadi Sarwr, Meshari Abed Jadullah Hamad, Yasir Ahmed Abdolgader Ghabban, Ahmed Mohammed A. ALmuntashiri, Shabaan Saleh Hussain ALmaslamani, Majed Abdullah Mohammed Asiri, Mashhour Shaqi D ALruwaili, Mohanad Awdah M Albalwe, Murdi Fayed Eid Al-Shammari, Hamoud Nahi Alanazi, Abdullah Hamad Al-Anazi
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