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Forensic Files

How Is a Gunshot Wound to the Chest Treated?

Q: My character suffers three small caliber gunshot wounds to his lungs with a not-so-good time lapse before hospitalization (say half an hour, maybe 45 minutes) and pretty bad internal bleeding. How would they treat him? Surgery to repair the internal wounds and stop the bleeding? What about the lung tissue? Then post-op: what drugs might be used and what medical concerns might arise? In the end, a friend smuggles him out of the hospital, because he'd rather die at his apartment. Would this work?

A: What happens to your shooting victim and how he is treated depends upon what injuries he received.

A gunshot wound (GSW) can be a minor flesh wound or can be immediately deadly or anywhere in between.

It all depends on the caliber and speed of the bullet and the exact structures it hits. A shot to the heart might kill instantly or not. The victim could die in a few minutes or survive for days or could recover completely with proper medical care and surgery. It’s highly variable but ask any surgeon or ER doctor and they will tell you that it’s hard to kill someone with a gun. Even with a shot or two to the chest. The bottom line is that whatever happens, happens.

Your victim is shot in the lungs, so he would likely cough up blood, be very short of breath, and could die from bleeding into the lungs — basically drowning in his own blood. Or the lung could collapse and again cause pain and shortness of breath. But we have two lungs and unless the GSWs are to both lungs and both lungs collapse the person would be able to breathe, speak, even run away, call for help, or fight off the attacker.

Whatever happens, happens.

Most likely your guy would be very short of breath, cough and wheeze out blood in a fine mist or in larger droplets and even cough out a few clots. He would quickly become very weak, dizzy, and slip into shock.

Here his blood pressure would be very low and with the injury to his lungs the oxygen content of his blood would dip to very low levels and he would lose consciousness. Or not. Your call.

Once rescued, the paramedics would probably place an endotracheal (ET) tube into his lungs to help with breathing, start an IV to give IV fluids, and transport him to the hospital immediately. He would then be seen by a trauma surgeon or chest surgeon and immediately undergo surgery to remove the bullets (if possible) and to repair the damaged lung and whatever else was injured. The surgeon might simply repair the lung or he might have to remove an entire lobe of the injured lung. Each lung has three lobes — upper, middle, and lower.

After surgery, he would be on a ventilator for as long as needed but usually only overnight. We always try to remove ET tubes as soon as we safely can since there are many complications if they remain in place for several days. Most commonly this is pneumonia. Also, being tied to an ET tube and a ventilator immobilizes the patient and sets him up for deep venous thrombosis (DVT — clots in the leg veins) and a pulmonary embolus (PE) — this is when a leg clot breaks free and travels to the lungs. Very dangerous, deadly, and a common occurrence in these situations.

He would have a chest tube (actually a thoracostomy tube but we call then chest tubes) in place. This is a flexible plastic tube that is inserted in surgery through the chest wall and into the chest cavity — but outside the lung. It is attached to a suction device and is used to evacuate any residual blood or body fluids from the   

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