04 GUNSHOT WOUNDS AND OTHER PHYSICAL INJURIES
E.R. LAHOZ, MD|September 3, 2019
GUNSHOT, SHOTGUN WOUNDS AND OTHER
PHYSICAL INJURIES
Magazine- where the bullets are found
Firing pin- type of force: chemical
-chemical is contained w/in the bullet, firing pin will
hit the center of the slug, that will trigger the gun
powder, expelling the slug
Rifling- the bullet will rotate, then rifling will leave marks on
the bullet as it is expelled
RIFLING
Helical grooves (rifling), cut into the bore of a barrel of a
firearm during production, increase the accuracy of that
firearm
Effects:
• Spin
• Stabilized- to hit the target accurately
• Marks on the bullets (lands and grooves)
This is important in identifying the firearm used in a crime
This is like a fingerprint of the firearm.
They will try to match the rifling of the crime bullet with a test
bullet. If they have the same rifling, that will now identify if
the recovered firearm is the really the one that was used in
the crime.
BULLET IDENTIFICATION
• Bullets collected for comparison to a specific
firearm are examined first to see if they are of a
caliber that could have been fired form the
submitted firearm.
• They are then examined to determine if the pattern
of rifling impressions found on the bullet match the
pattern rifling impressions found on the bullet
match the pattern of rifling contained in the barrel
of the questioned firearm.
• If these class characteristics agree the next step is
to try to make a positive match between the
individual characteristics that may have transferred
the bullet from the barrel.
FIREARM EVIDENCE SUBMITTED TO FORENSIC
LABORATORIES
✓ In addition to comparing ammunition components
to firearms, firearm examiners conduct other
examinations that usually include the following:
o Testing firearms to determine if they
function properly
o Examine clothing and other items for
gunshot residues and/or shot patterns in
an attempt to determine a muzzle-to-
garment distance. Inspect also for gun
powder on the body of the victim.
o Determine caliber and manufacturer of
ammunition components. Including the
examination of various shot shell
components.
o Determine the manufacturer/s of
firearms that may have fired a particular
bullet or cartridge case.
BIOMECHANICS OF BULLET
VELOCITY
- The wounding capability of a bullet increases
markedly above the critical velocity of 2000ft/sec
(600m/sec)
- Longer firearm= faster bullet, more accurate
- Depending on the velocity of the missile, the
diameter of this cavity can be up to 30 times that of
the bullet. Even if the bullet is small, it can create
massive damage on the body.
Flat= more damaging
LMMJ | GUNSHOT WOUNDS T3

THE WOUND AT THE POINT OF BULLET IMPACT IS

DETERMINED BY
➢ The shape of the missile (“mushroom”)
The size of the cavity that is created depends on
➢ The position of the missile relative to the impact site
the degree of the yaw.
(tumble, yaw)
➢ Fragmentations (shotgun, bullet fragments, special
bullets). There are bullets that fragment upon
impact. Fragmented slug= more damage
➢ Yaw (orientation of the longitudinal axis of the
missile to its trajectory) and tumble increase the
surface area of the bullet with respect to the tissue
it contacts and therefore, increase the amount of
energy transferred.
➢ Bullets do not tumble in flight but will tumble as they
lose kinetic energy in tissue.
➢ In general, the later the bullet begins to yaw after
penetrating tissue, the deeper the maximum injury
➢ Bullet deformation and fragmentation of semi-
jacked ammunition increase surface area relative
to the tissue and the dissipation of kinetic energy

- “ricochet”
If the bullet hits a hard object, it can bounce depending
on the angulation. This is not yaw (yaw= within the
body).
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LMMJ | GUNSHOT WOUNDS T3
GUNSHOT WOUNDS Factors To Consider
CONTUSION COLLAR 1. Inherent on the missile
- The wider side points to the surface of the missile • Speed of the bullet
Contusion= reddening around the entry (faster= more damaging= mas matagal
SMUDGING AND TATTOING ang yaw)
- The site with more or intense deposit to the source • Size and shape of bullet
of the missile (flat= more damage)
- Due to the gun powder • Character of the missile movement in
- There could be smudging/ tattoing depending on flight
the distance 2. Nature of the target
DETERMINATION OF THE PROBABLE CALIBER of the • Density of the target
fire arm used in the infliction • Length of tissue involvement
-Measure a centimeter the diameter of the gunshot • Nature of media traversed
wound→ the shortest is the probable caliber • Vitality of the organ involved
ENTRY/EXIT WOUNDS When we do x-rays, we place marks on the entry and exit
point. We always assume that it is a straight line from entry
GUNSHOT to exit. Determine the organs traversed by the bullet.
ENTRY EXIT
Presence of Wound Always present May be absent RANGE OF FIRE EFFECTS ON MORPHOLOGY OF
(lodge inside the RIFLED GUNSHOT WOUNDS (ADAPTED FROM KNIGHT
body) 1996)
Size Smaller than Bigger than 1. Hard Contact
missile (wala missile a. Over Soft Tissues
pang yaw) • Circular hole
Edges Inverted Everted
• Abrasion collar
Shape Oval or round NO definite
depending on shape • Bruising
angle of • Local reddening (heat and CO)
approach • Little or no surface burning
Contusion Collar (+) (-) • Little or no propellant soiling /
Tattooing/Smudging (+) if near (-) powder tattooing
Underlying tissue Not protruding May be seen • +/- muzzle impression
from the wound
b. Over Bone (like in suicide cases)
Paraffin Test (evidence (+) (-)
of gun powder) • Split / cruciate wound
Odd vs. Even Rule: • Local reddening
Odd (number of wounds) -> No exit wound • Bruising
When operating on this patient, look for the bullet that maybe • Little or no surface burning/
lodged inside the body (may naiwan) propellant soiling
• Abrasion collar partially lost on
skin tags
2. <15 cm
• Circular hole
• Abrasion collar
• Burnt hairs
• Soot/smoke soiling
• Punctate propellant tattoing marks
• Unburnt propellant flakes
• Little / no CO in tissues
3. 15-30cm
• No soot
• +/- tattoing
• No CO
• Rarely flame burns
4. >40-60cm
• circular hole w/ abrasion collar
• no burning / soiling (malayo na ang
firearm, ubos na ang gun powder)
• no burnt hairs
• no CO
5. ‘Far Distant’ (at limit of range)
• Larger irregular hole
Entry: Left -smaller
• Irregular abrasion collar
Exit: Right -larger, everted tissue
• Irregular abrasion rim (“tumbling bullet”)
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ACOON | ANACTA | BALTAZAR BORROMEO  CABAHUG CABILAN CARDENAS
“GO! GO! GO! – Rufa Mae Quinto
LMMJ | GUNSHOT WOUNDS T3

Entry wound- circular in shape, there is inversion

Distant- no smudging/tattoing Gun powder- pedeng sya ung nag trigger
if may gun powder sa hand ng victim pedeng suicide

Entry- note stippling caused by the bullet fragments

Do not just concentrate on the wound, but also on the
surrounding area.

Preserve the clothing kse titignan ung butas that was created
by that fire arm (pattern of bleeding)
Entry (Near) - contusion collar, inverted, smudging
This is NOT suicide. This is NOT hard contact. Hard contact
has NO smudging.

Entry – collar abrasion, smudging – close range wound

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ACOON | ANACTA | BALTAZAR BORROMEO  CABAHUG CABILAN CARDENAS
“GO! GO! GO! – Rufa Mae Quinto
LMMJ | GUNSHOT WOUNDS T3
May slug sa within the heart not within the trajectory of the
missile not just the heart pero khit sa ibang part –
Pag pumunta sa big vessel pedeng makapunta sa heart
Pag big artery pede pumunta sa brain and sa distribution
system ng blood vessel

Entry – coz of stippling (stippling effect is a sign of entry

wound)

Entry – contusion collar (reddening around the wound)

Exit – irregular, no contusion collar

Entry-burn- hard contact (merong imprint)

Need to determine at entry and exit - direction (para

malaman kung anong organ ung nahit, and kung saan ung
position ng assailant)
Yung entry ung mas maliit exit ung Malaki

Entry – smudging

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ACOON | ANACTA | BALTAZAR BORROMEO  CABAHUG CABILAN CARDENAS
“GO! GO! GO! – Rufa Mae Quinto
LMMJ | GUNSHOT WOUNDS T3

Left – entry – contusion

Right – entry – contusion
Paregong entry magkaiba lng ng type ng caliber
Upper left – near kse magkakadikit
Ung iba medyo magkakalayo na

WOUND PATH
• Organs injured
• Position of assailant vs. victim
• Fatal vs. non-fatal

Lower Left – exit wound – irregular shape

Upper right – entry wound - smaller

SHOTGUN WOUNDS
Gun shot – only 1 slug pero pag shot gun
Multiple missile with one shell Usually X ray – to determine the position or the location of
Contact Or Near Contact – Entrance (<6 Inches) the slug
Not CT scan or MRI kse metal(slug) magbobounce back lng
• More damage – due to higher power(because of
ang sonic
the many shots it can cause more damage)
REPORTING OF GSW
• Wound border is smooth to slightly rugged
• Entrance wound is burned 1. Complete description of wound entrance/exits
Multiple entries 2. Location of the wound/s
• Blackening due to smoke a. Part of the body involved
b. Distance of wound from the midline
• Gunpowder tattooing
c. Distance from heel or buttocks
• Contusion – blackened by gunpowder
3. Direction and length of the bullet tract
• Singeing of hair 4. Organs or tissues involved in its course
• Subcutaneous and deeper tissue severely 5. Location of missile of lodge in the body
disrupted 6. Diagram, photography, sketch, or drawing the
• Blood and tissue along bullet track – carbon location and number of wounds (x-ray is important)
monoxide Preserve slugs→ rifling (ballistic examination)
• Fragments may be recovered. Preserve clothing
Long range shot entrance (>6 inches) Make sure the slug recovered (to be presented sa court) is
• 2-3 ft – single wound the same slug found in the victim
• 3-4 ft – serrated or scalloped – rat hole
• 5-6 ft – independent injury – usually abrasion
• 6 ft – shot begins to separate
• 10 ft – each shot produces independent entry
• Smudging (+) up to 15 inches
• Gunpowder tattooing (+) up to 24 inches.
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ACOON | ANACTA | BALTAZAR BORROMEO  CABAHUG CABILAN CARDENAS
“GO! GO! GO! – Rufa Mae Quinto
LMMJ | GUNSHOT WOUNDS T3

This a type of blast injury

Scald burn
PHYSICAL INJURIES SECONDARY TO EXPLOSIONS
1. Disruption/fragmentation of body parts – close to DEATH OR INJURY – COLD
explosive Local Effects:
2. Dismemberment, third of punctuate bruises, • Blanching/paleness of skin (vascular spasm)
abrasions and lacerations • Erythema, edema/swelling (vascular dilatation)
3. Shrapnel wounds • Blister formation (vascular paralysis)extreme cold
4. Blast wave – bronchus laceration; ear may be could also cause blister formation
damaged coz of loud noise • Necrosis, thrombosis, gangrene (vascular
5. Burns occlusion)
6. Asphyxia Systemic Effects:
7. Carbon monoxide/gas poisoning • Lowering temperature → stiffness, weariness,
drowsiness
• Lethargy → coma → death
• Delusion, convulsion, delirium
• Cutaneous surface – hardening, coldness

DEATH OR INJURY - HEAT

Local Effects:
• Scald
• Burns
Systemic Effects:
• Heat cramps
• Heat exhaustion
Gunshot • Heat stroke
Proof Victim Alive Before Burned To Death:
1. Presence of smoke in air passages
2. Increase carboxyhemoglobin level
3. Dermal erythema, edema and vesicle formation
4. Subendocardial left ventricular hemorrhage
Suffocation is the cause of death in fire, the victim might
died even before being burned.
Chemical Burns
1. Sulfuric acid
2. Nitric acid
3. Hydrochloric acid
4. Caustic soda and potash
Alkaline more damage than acid because acid precipitates
Shotgun
Chemical Heat
(-) blister (+) blister usually
Stained clothing none
(+)corrosion-chemical (-) corrosion
Borders distinct Lesion is diffuse

Frostbite coz of vasoconstriction

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ACOON | ANACTA | BALTAZAR BORROMEO  CABAHUG CABILAN CARDENAS
“GO! GO! GO! – Rufa Mae Quinto
LMMJ | GUNSHOT WOUNDS T3
DEATH BY BAROTRAUMA Nakahiga tapos nilagyan ng pillow is a type of
(ATMOSPHERIC PRESSURE) SMOTHERING
Common in scuba divers, most common cause of death is DROWNING
air embolism due sudden ascent. Drowning average time of death : 2-5 minutes
Floats within 24hrs

Conclusive Findings:
1. Presence of foreign bodies in the hand of victim
2. Increase in volume and edema in the lungs
3. 3.water and fluid in the stomach contents
4. Froth, foam, or foreign bodies in air passages
5. Water in the middle ear

DEATH BY ASPHYXIA
1. Anoxic death- lack of O2 maybe due to respiratory
failure
2. Anemic anoxic death- lack hgb
3. Stagnant anoxic death- most common due to MI
4. Histotoxic anoxic death—like for example cyanide
Phases Of Asphyxia Death
1. Dyspneic phase- increase RR, use of accessory
muscles
2. Convulsive phase
3. Apneic phase- shallow respiration
Classification of Asphyxial Death
1. Hanging
2. Strangulation
3. Suffocation
4. Drowning
5. Pressure on the chest
6. Irrespirable gases
HANGING VS STRANGULATION
Hanging Strangulation
Hyoid bone is injured Spared hyoid bone
Ligature mark inverted v Ligature mark horizontal
shape and knot is on the same
horizontal plane
Ligature groove – deepest Ligature is uniform in depth
opposite know
Ligature at level of hyoid Ligature below larynx
Vertebral injury frequent Vertebral injury is not
observed
C2 Fractures- Hangman’s Fracture

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ACOON | ANACTA | BALTAZAR BORROMEO  CABAHUG CABILAN CARDENAS
“GO! GO! GO! – Rufa Mae Quinto