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Interviewer: It could possibly be the easiest ER or Not? we've ever done. A gunshot wound, what should you do? We'll talk about that next on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician and Ï㽶ÊÓƵ of Utah Health Care and today's ER or Not, where you try to decide whether or not something that's happened to you is worth going to the ER is probably the easiest one we've ever done. But it would still be interesting to know what somebody should do if it happens to them. A gunshot wound. I'm going to go ahead and go out on a limb here and say ER.

Dr Madsen: Yes.

Interviewer: And I would say that if you can, probably call 911 regardless of how serious you think it is.

Dr Madsen: Sure, yeah.

Interviewer: Yeah. But is there anything that somebody could do after it happens, you know, to help whatever it is you're going to do. And I'm talking like, it could be a hunting accident, it could be an accident in the home, any sort of thing like that.

Dr Madsen: Yeah, well with this, it's obviously the answer is pretty clear. If you do get shot by a gun you need to go to the ER and probably not an urgent care. They will probably send you to the ER. But it's funny because some people have actually questioned this and have been shot by a gun or thought maybe they were shot by a gun and thought "Wow, it's just a small hole. It doesn't appear to have done a lot of damage," and some gunshot wounds can be very small holes.

Interviewer: Okay, well sure, that sounds reasonable. But still.

Dr Madsen: But still, you need to go to the ER. And we do have cases of people who have come in after getting shot by a gun or multiple gunshots and you really have to look them all over very carefully for these gunshot wounds because sometimes they can be really small and just look like a mole and you could really miss it, but the damage they can do internally is fairly significant. But in terms of what you can do at home, let's say, and it's probably worth pointing out that it depends where you work, but where we work most gunshot wounds we see are actually self-inflicted.

Interviewer: Okay.

Dr Madsen: Either intentional or accidental. Sometimes people cleaning their guns or doing different things with their guns, something may misfire, there may be something in there, a bullet they just didn't know about, and they get shot. Oftentimes these gunshot wounds are through the leg, that's something we often see, sometimes in the hand. But in terms of what you do at home, first of all you control the bleeding, apply pressure to it.

If it's something where it's not bleeding profusely and it's say, through your hand or through your foot and you can put pressure on it, maybe you don't need to come in by an ambulance. I'm hesitant to just put that out there, but that's a possibility where if it's not like an arterial bleed where you're putting lots of blood out, you can have someone drive you into the ER. But definitely, you're going to want to hold pressure there and get to the ER to get things addressed.

The biggest thing we need to worry about again, is not just what you're seeing on the surface, but all the damage it can do internally. Maybe damage to ligaments, to nerves, to tendons, bones, all these sorts of things that we're going to be looking for once you get to the ER.

Interviewer: I have questions to ask but at the end of the day it really doesn't matter just because you would go to the ER and they would sort all this out. But, if a bullet goes all the way through versus lodges within you, is that a different situation insofar as what I would do to maybe prepare to go to the ER?

Dr Madsen: Yeah, not so much. Again, you've got two holes versus one that you're putting pressure on.

Interviewer: Sure, okay.

Dr Madsen: The damage that is done internally, the bleeding that could be happening internally, there's not a whole lot you can do about that and you need to get to the ER. Typically if you have a gunshot wound through your chest or your abdomen, you're going to go to the operating room.

Interviewer: Yeah.

Dr Madsen: In most cases, and I can't think of a lot of cases where you wouldn't, but if you have a gunshot wound through those very serious areas, you're going to go to the operating room so the surgeon can explore and try to find out exactly what kind of damage this has done. Maybe you get a CT scan first, assuming your blood pressure is stable, to look for exactly where this damage is, but often it does require going to the operating room.

Interviewer: Can you tell if you're bleeding internally? Is that something a human is aware of?

Dr Madsen: The one sign you might have of it would be you feel lightheaded, you feel like you're going to pass out. If that's the case, maybe it's because of the pain you're experiencing, maybe it's because of internal blood loss. You could look and see that your abdomen is expanding, which would be a sign of some very, very serious internal bleeding. Those are all things you might see, but it's not like there's anything where you could rule it out and you could say "Wow, I've been shot by a gun. I'm going to be just fine." There's going to be additional testing that's needed.

Interviewer: And I guess ultimately, don't drive yourself to the ER because the pain could cloud your judgment, internal blood loss could cloud your judgment, you could lose consciousness.

Dr Madsen: Exactly, I wouldn't recommend driving yourself. Especially, the only times I'm even thinking you could maybe drive or have someone drive you would be if you got shot through the hand or the foot, but there you can't really drive if you've got a gunshot wound through your hand or your foot,

Interviewer: Not if you're keeping it and 10 and 2 you can't.

Dr Madsen: You sure can't if you're trying to do that. So you're going to have to have someone drive you in at a minimum or call 911 and have them get you in, especially with these more serious gunshot wounds because time really is of the essence if you have some sort of internal bleeding.

One other question that does come up sometimes, you mentioned if you have a gunshot that goes through you and the bullet exits versus if it's in you. I have had patients who have asked me "Well, doc, aren't you going to take the bullet out?" Some of these gunshot wounds they get lodged in there and it's more effort and more risk to go in there and try to remove this bullet than to just leave it in there.

And I've had cases of people who were shot years before and have then come into the ER as this bullet has worked its way out near their spine or wherever this was lodged, and you see it as it's kind of worked its way out near the surface and we can just easily remove it at that point. But some of these bullets, they will eventually work their way out but it's not like "Hey, we've got to get the bullet out," like you see in the movies.

Interviewer: That's not the danger.

Dr Madsen: It's not the danger, exactly. And there's often more risk from doing that than from just leaving it there.
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