Penetrating Abdominal Air Gun Injuries: Pitfalls in Recognition and Management,☆☆,

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Abstract

Emergency health care providers often underestimate the potential for pellet and BB guns to inflict life-threatening penetrating injuries. We present four children with intraabdominal injuries caused by air guns and summarize the characteristics of 12 similar cases reported in the literature. In the context of injury potential, the epidemiology of air gun injuries and the mechanical characteristics of air guns are reviewed. In addition, we suggest a general approach to the triage and management of children with air guninflicted abdominal wounds. Finally, preventive strategies are discussed.

[DiGiulio GA, Kulik RM, Garcia VF: Penetrating abdominal air gun injuries: Pitfalls in recognition and management. Ann Emerg Med August 1995;26:224-228.]

Section snippets

INTRODUCTION

Recognition of the injury potential of conventional firearms has led to established protocols designed to ensure that patients with gunshot wounds are triaged expeditiously and that life-threatening injuries are rapidly recognized and appropriately managed. In contrast, the injury potential of air guns, most commonly referred to as "BB" or "pellet" guns, remains generally underestimated by the public and by emergency care personnel. Although the risk of eye injuries is well recognized,1 serious

CASE REPORTS

Case 1 A 6-year-old boy presented to the ED after sustaining a BB gun injury to the abdomen. An 8-year-old sibling shot him from a distance of 3 feet with a multiple-pump air gun (MPAG). The prehospital personnel gave no advance notification despite medical control base station being located within the ED. On the patient's arrival, a triage nurse assessed the child and then consulted the attending emergency physician. On the basis of the assumption that a BB gun was unlikely to have caused

LITERATURE REVIEW

We identified 12 additional reports of air gun-related abdominal injuries through a comprehensive Medline search and a review of reference lists.4, 5, 6, 7 Our experience, together with these reports, yields a series of 16 cases.

Intraperitoneal injury occurred in 15 of 16 patients. Ages ranged between 2 and 15 years. Fifteen of the 16 injuries occurred in children younger than 12 years. Fourteen were boys. In the 10 cases in which the distance between the gun and the victim was noted, the

DISCUSSION

This case series illustrates that currently available air guns can inflict serious intraabdominal injuries and that emergency care providers may underestimate the wounding potential of these weapons. In our four patients, serious injury was not anticipated by prehospital personnel, nursing triage, or physicians. In cases 1 and 3, it was not until signs of peritoneal injury were discovered that the possibility of intraabdominal injury received adequate consideration. Furthermore, both the ED

SUMMARY

Currently available air guns, when fired at close range, are cap able of inflicting significant intraabdominal injury. These injuries may occur in the absence of peritoneal signs. Plain radiographs are helpful in determining the location of the pellet. We recommend an expeditious, trauma-oriented approach to these children and exploratory celiotomy in those with peritoneal injuries.

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From the Department of Pediatrics, Division of Emergency Medicine*, and the Department of Surgery, Division of Pediatric Surgery, University of Cincinnati College of Medicine, Children's Hospital Medical Center, Cincinnati, Ohio.

☆☆

Address for reprints: Gregg A DiGiulio, MD, Division of Emergency Medicine, OSB-4, Children's Hospital Medical Center, 3333 Burnett Avenue, Cincinnati, Ohio 45229-3039, 513-559-7966, Fax 513-559-7967

Reprint no. 47/1/61071

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