Eli5: What do they do to people who have been shot?

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How do they actually save people who have been shot? I know movies aren’t realistic but most people die pretty quickly from gun shots, so how do doctors/nurses save them?

In: Other

They remove the bullet, repair any organs that were damaged, and close the wound. Blood transfusions keep the patient alive while they do this.

> I know movies aren’t realistic but most people die pretty quickly from gun shots, so how do doctors/nurses save them?

What makes you say that? Unless a bullet hits something really vital (say a major artery, organ or the brain) it can actually take some time before death comes. The Human body is actually quite durable and fairly redundant, if you get to the hospital and have a pulse your odds are pretty good.

As for what they do, it’s exactly the things you expect. Stop the bleeding, remove the bullets if they are still in, hook them up to a bag of blood if needed. Even if the bullet hit something fairly major like an organ that still isn’t outside their scope. Might need to do surgery but then it’s the same story: stabilize the patient, repair anything that needs fixing, get them comfortable and let the healing start.

That’s going to depend very highly on where they got shot and also sometimes other factors like medications they’re on (blood thinners) or other medical issues they already have. Some gunshot wounds are just not very severe while others are so immediately severe that they can’t realistically be saved.

I work in an ER (in a pharmacy capacity) and also as an EMT. I once spoke with a patient that had been shot twice with her own gun by a home invader, once in the lower shoulder and once through the neck. Amazingly neither bullet hit anything vital, and this woman had so much adrenaline from the event all she could do was excitedly tell everyone that came into her room that she got to ride in a helicopter. In that case, since the bullets had gone through, they were treated like most any other puncture wound would be with bleeding control, antibiotics, and a tetanus shot.

A medication called tranexamic acid is often used to help control bleeding along with physical methods of bandaging and packing the wound. If a patient is on blood thinners they’ll often receive a medication to temporarily reverse the effects of their blood thinner so that their wound can clot. They also replace any blood lost with donated blood and a saline fluid to increase blood volume and pressure

If vital organs were damaged they’ll often use machines to complete those organs’ tasks while a surgeon/specialist repairs the damaged organ

The art of this is what happens in trauma bays. This is the gist of it.

In the field:

EMS will quickly assess what’s bleeding, and apply pressure or even tourniquets to help slow the bleeding. If the patient can’t breath safely on their own, they may intubate them and start breathing for them. They’ll give fluids and sometimes blood to help support the patient’s blood pressure.

Once they arrive to the ED: They’ll give a quick rundown of what has happened for. The trauma team will typically use principles taught in a course called ATLS to help quickly stabilize the patient. It’s very organized, and addresses things of most importance first.

Airway: is the patient alert enough to protect their airway? Is there too much blood or secretions for them to safely breath? This is where you consider possibly intubating.

Breathing: are they getting enough oxgyen? Do they need supplemental oxygen? Are they moving air well on both sides, or do they possibly have a collapsed lung? If you suspect this sort of thing, you address it here.

Circulation: how is their blood pressure and delivery of blood to the extremities? Are their pulses strong or weak? Do you see a bunch of blood in their abdomen or chest with your ultrasound machine? Are there any bleeding wounds that you can quickly address to make sure they’re not bleeding. Here, you might give more blood products or maybe medicine to help support their blood pressure.

Disability: How is their neurologic status? GCS, pupils, movements? Is there evidence of spinal damage?

Exposure: What their temp? Do they have caustic materials on their skin that need to be addressed? Remove all their clothes, so you can see wtf is going on. The patient gets rolled to their side to make sure nothing is missed on the back.

Then there will typically be a chest and pelvis X-ray shot, which can show you if there is a bunch of air or blood around the lungs or heart. Or where the breathing tube is (if one was placed). Or pelvic fractures.

Then the secondary survey begins. This is basically a closer head-to-toe inspection looking for any other wounds or evidence of broken bones. This should only take a couple minutes.

Now, ideally, the patient is stable. Depending on what injuries you’ve found, you get to decide what happens next. Do they need to go straight to the operating room? Should they get CT scans first? Or do they even need a CT scan at all?

This is how people get saved from gunshots. It’s usually not by emergency surgery. Sometimes that happens though. If it does, it’s typically stopping bleeding by repairing some major vessel that was damaged. If this needs to happen, then they get whisked away from the trauma bay to the OR, and can get sedated, intubated, and prepped for surgery within minutes.

This is more or less what ACTUALLY happens after you get shot, and how you will be kept alive.

They fix the hole, stop the bleeding, take out the bullet, give blood to replace what was lost, etc.

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