Experience of using SNOM in gunshot wounds of the head, chest, abdomen and soft tissues
Background. The goal is to demonstrate the peculiarities of diagnosis and treatment in gunshot wounds of the head, chest, abdomen and soft tissues using selective nonoperative management (SNOM). Materials and methods. The article analyzes the use of SNOM in gunshot wounds of the head, chest, abdomen...
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| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Zaslavsky O.Yu.
2025-06-01
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| Series: | Медицина неотложных состояний |
| Subjects: | |
| Online Access: | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1884 |
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| Summary: | Background. The goal is to demonstrate the peculiarities of diagnosis and treatment in gunshot wounds of the head, chest, abdomen and soft tissues using selective nonoperative management (SNOM). Materials and methods. The article analyzes the use of SNOM in gunshot wounds of the head, chest, abdomen, and soft tissues in the conditions of the Military Medical Clinical Center of the Northern Region of the Armed Forces of the Armed Forces of Ukraine over three years. All patients were male, had gunshot fragment wounds of different location. The average age of participants was 43.6 ± 0.8 years. According to our data, the structure of injuries by condition was as follows: mild — 61.4 %, moderate — 29.2 %; severe and extremely severe — 9.4 %. By location: head — 13.3 %, neck — 2.1 %, spine — 1.4 %, chest — 9.4 %, abdomen — 7 %, pelvis — 5.4 %, limbs — 61.3 % of cases. In terms of combination of injuries: combined head and limb injury — 18 %, explosive injury with extremity avulsion complicated by acute renal failure — 15 %, combined injury to the head, chest, abdomen and extremities — 13 %, combined injury to the abdomen and extremities — 11 %, isolated head injury — 10 %, isolated injury to the spine — 8 %, combined injury to the chest and abdomen — 7 %, combined injury to the chest, abdomen and extremities — 7 %, combined injury to the head, chest and extremities — 6 %, combined injury to the chest and limbs — 4 %. All patients were examined, complaints and anamnesis were studied. Laboratory tests were performed such as general clinical blood, urine tests, biochemical blood analysis, blood coagulogram, blood group and Rh factor. Ultrasound examination of the chest and abdominal organs according to the FAST protocol was conducted. A multislice spiral computed tomography of the head, thoracic, abdominal organs, and pelvis was performed, as well as X-ray examinations of the organs of the chest and abdominal cavity; video esophagogastroduadenoscopy and video colonoscopy; electrocardiography. Inclusion and exclusion criteria were defined. All patients received analgesia, antibiotic prophylaxis, tetanus toxoid, multivitamin therapy, bandages. Results. The distribution of selective nonoperative management of gunshot wounds by years (2022, 2023, 2024) is as follows: head (4.1, 3.8, 4.7 %), chest (3.6, 5.3, 10.3 %), abdomen (1, 2.1, 12.2 %), soft tissues (28.7, 32.1, 34.2 %). The distribution of operative interventions after the use of SNOM by years (2022, 2023, 2024) is as follows: head (1.1, 1, 1 %), chest (0.1, 0.2, 0.1 %), abdomen (2.3, 2.5, 2.4 %), soft tissues (1.4, 1, 1 %). On average, the frequency of operative interventions after the use of SNOM is 1.2 ± 0.1 % and is a constant value in dynamics. When SNOM is used in penetrating gunshot wounds to the chest, lung injuries prevail (97 % of cases), followed by mediastinal organs (2 %) and the heart (1 %). When SNOM is used in penetrating gunshot wounds to the abdomen, liver damage prevails — 43.2 %, followed by retroperitoneal space — 17.6 %, two organs — 10.8 %, kidney — 9.5 %, greater omentum — 8.1 %, mesentery — 6.7 %, and spleen — 4.0 % of cases. Damage to parenchymal organs predominates. The average duration of treatment was 5.2 ± 0.3 days. Conclusions. There is a positive increase in the rate of using SNOM for gunshot wounds of the head, chest, abdomen, and soft tissues, while the number of operative interventions after SNOM remains unchanged. Selective nonoperative management for penetrating gunshot wounds of the head, chest, abdomen, and soft tissue gunshot wounds is performed when the indications for this method are met (according to the criteria). When applying selective nonoperative management in penetrating gunshot wounds of the chest, lung injuries prevail. When using selective nonoperative management for penetrating gunshot wounds of the abdomen, damage to parenchymal organs prevails. This strategy can be used in the presence of expert-class equipment, experienced specialists in the conditions of tertiary care and interaction between secondary and tertiary levels of medical care. |
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| ISSN: | 2224-0586 2307-1230 |