Hypothetical question(s): GSW to Large Toe

Captryan

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A man is shot in the big toe with a bullet from a 9mm handgun from above at a distance of 3 to 4 feet. He is wearing leather basketball shoes.
Would he pass out from the pain?
If he remained conscious, would he go into shock?
How quickly?
If dropped off at a hospital emergency room, what treatment would he receive?
What type of pain killer would be administered?
How long would he be kept sedated?
How soon before he could walk?
Would he have a permanent limp?
Thanks in advance to anyone able and willing to provide answers.
 
Doing research for your story?

It all depends on what anatomical structures the bullet hit in the foot. As far as passing out, that would depend on your character's tolerance for pain and the sight of his own blood.

http://www.northcoastfootcare.com/footcare-info/foot-anatomy.html

If the blood struck a bone or lacerated a tendon and/or nerve, surgical repair may be needed with pins and a cast. An MRI might be arranged to check how extensive the damage is. If it is a flesh wound that missed the vital structures, irrigating (cleaning), a couple of sutures(but not always recommended), a tetanus shot, an antibiotic and a bandage will suffice. Crutches for a few days could be a possibility. Some hospitals may keep the patient for a couple of days for IV antibiotics. If treated immediately, the chances for cellulititis and infection are reduced significantly.
A limb and foot drop are possibilities depending on the damage.
 
Yes, it's for a story. Thankyou for your reply.
 
A man is shot in the big toe with a bullet from a 9mm handgun from above at a distance of 3 to 4 feet. He is wearing leather basketball shoes.
Would he pass out from the pain?
Most likely not, but it really depends on the person. Passing out is usually one's response to seeing their own condition (blood and guts) and pain. How much pain the guy "feels" really depends on his pain tolerance. I had a construction worker act like it was no big deal having a few fingers cut off, and I've had a ten year old hyperventilate from a paper cut.
If he remained conscious, would he go into shock?
He could, if left untreated long enough, but I'd bet not.
If dropped off at a hospital emergency room, what treatment would he receive?
Here is my complete uniformed protocol. Really, I'm only an EMT-B!

  1. First, you always do a full assessment and note any deficits.
  2. I see him getting a round of shots to prevent infection.
  3. Time for an X-ray, an MRI would come later if the service is available.
  4. Possibly removing the shrapnel/bullet if any is present
  5. Cleaning up the wound/fractured bone
  6. Then it would be cleaned again (infection is a huge issue), sutured up, and bandaged.
He'd be on crutches and released relatively quickly.

What type of pain killer would be administered?
Anesthetize the area with Lidocaine? Morphine for general pain?
How long would he be kept sedated?
Why sedate the patient? Sedation wouldn't help.
How soon before he could walk?
Could or should?
Would he have a permanent limp?
It's amazing what the big toe does for a guy, but it's also amazing how much the body can compensate. Possibly.

I hope that helps!
 
Sorry, by sedate I meant giving him something to kill the pain. Wouldn't morphine knock him out or close to it? I have someone sneaking him out of the hospital in a wheelchair about 24 hours after he gets shot. Does that make sense or would the timeline be different and he would more likely be able to leave on his own? I was also assuming that a bullet (a hollowpoint) through the toe would result in his losing it but from what you say that's not necessarily so. I appreciate your expertise on this as I most definitely want the episode to be realistic.
 
1. I had morphine and was walking on crutches a few hours later.
2. Almost everyone with some sort of trauma/treatment leaves the hospital in a wheelchair, it's just policy.
3. The timeline works, though he would most likely be released around then.
4. He definitely could lose the toe, depending on where it hit and what type of injury it causes. I'm no gun expert, but 9 mm sounds big. Maybe he'd lose it, or part of it.
 
[*]Time for an X-ray, an MRI would come later if the service is available.

Could you do an MRI for a GSW, considering the shrapnal could be magnetic?

Rip the rest of his foot off! :ph34r:
 
I understand what you're saying, but I know for a fact that I've heard of GSW victims receiving MRIs.
 
Thanks you to all of you who have responded to my query. Let me approach this from a slightly different angle. My rough draft goes something like this: bullet goes through the big toe during the commission of a crime. The victim is driven to an emergency room (the trip takes about 15 minutes) by his accomplices. When he arrives he is immediately placed on a gurney with his foot elevated and a temporary bandage is applied to stem the bleeding. Because it is a GSW (a new acronym I just learned) the police will be notified and will want to ask some questions. His accomplices dropped him off and left. Because he's a bad guy and wants nothing to do with the cops he wants to leave the hospital ASAP (I was already familiar with that acronym). Someone sneaks him out in a wheelchair in the middle of the night approximately 24 hours after his arrival. Is the above scenario realistic.
P.S. I have him loosing the toe and permanently limping afterwards.
 
Make him a "Toe" Truck operator for a touch of irony.
or even worse....
He escapes from the hospital prison ward in a stolen "Toe" Truck.

Sorry, I had to say it. :blush:
 
Would he pass out from the pain? No, unless he is a puss

If he remained conscious, would he go into shock? No, doubtful if in regards to life threatening type there is several types of shock

How quickly? See above
If dropped off at a hospital emergency room, what treatment would he receive?
Have a seat in the lobby if they are busy (really) and it is not bleeding severely. After being triaged, he would get a anesthetized locally. An x-ray of the foot, with emphasis on the greater toe (we do not call it "big toe)..Tetanus shot usually a booster, wound cleansed with betadine solution and debrided (cleaning of dead or injured tissue) Dependent on size of ammunition, size of wound if wound would be stitched or left open for drainage. Usually, antibiotic therapy such as Ancef IV, and common prescription of Duricef and to follow up with orthopedics. Again, all dependent on type of wound, caliber, etc.

What type of pain killer would be administered? Usually anything from Tylenol III to Lortab dependent on how nice the Doc is.

How long would he be kept sedated? Never...

How soon before he could walk? Usually no weight bearing until follow up from orthopedics. Usually 1-2 weeks in open toe boot.
Would he have a permanent limp? Doubtful

Thanks you to all of you who have responded to my query. Let me approach this from a slightly different angle. My rough draft goes something like this: bullet goes through the big toe during the commission of a crime. The victim is driven to an emergency room (the trip takes about 15 minutes) by his accomplices. When he arrives he is immediately placed on a gurney with his foot elevated and a temporary bandage is applied to stem the bleeding. Because it is a GSW (a new acronym I just learned) the police will be notified and will want to ask some questions. His accomplices dropped him off and left. Because he's a bad guy and wants nothing to do with the cops he wants to leave the hospital ASAP (I was already familiar with that acronym). Someone sneaks him out in a wheelchair in the middle of the night approximately 24 hours after his arrival. Is the above scenario realistic.
P.S. I have him loosing the toe and permanently limping afterwards.


Ever tried to sneak out of wheel chair? Every hall way usually has cameras as well most doors in regarding patient to outside has either Police or Security. This is caused by infant abductions, so there is more security on whom leaves than enters, as well most staff have to have picture I.D. Stealing an wheel chair is more difficult than a patient.. staff fights over being able to get them..

R/r 911
 
Thanks you to all of you who have responded to my query. Let me approach this from a slightly different angle. My rough draft goes something like this: bullet goes through the big toe during the commission of a crime. The victim is driven to an emergency room (the trip takes about 15 minutes) by his accomplices. When he arrives he is immediately placed on a gurney with his foot elevated and a temporary bandage is applied to stem the bleeding. Because it is a GSW (a new acronym I just learned) the police will be notified and will want to ask some questions. His accomplices dropped him off and left. Because he's a bad guy and wants nothing to do with the cops he wants to leave the hospital ASAP (I was already familiar with that acronym). Someone sneaks him out in a wheelchair in the middle of the night approximately 24 hours after his arrival. Is the above scenario realistic.
P.S. I have him loosing the toe and permanently limping afterwards.
I think your scenario would be realistic in the sense of "TV" real, but let me throw some of my reality into it.
1. When the hospital realizes that it's a GSW, and they will, they always call local PD.
2. Even with a GSW to the toe, the guy will most likely be evaluated and spend a lot of time waiting.

Of course the public doesn't know any of this, and this isn't how it's portrayed, so I'd go with your more dramatic version. I'd be careful with the limp though, even as as reader I think it's a bit fishy. Why not go for a GSW to the foot? That's a lot more believable. Heck, make it a shotgun!
 
R/r911 & MMiz - I had assumed that a guy showing up in emergency with a toe blown off would be given top priority and be kept in a room for 3 or 4 days. From your comments, it sounds like I was off base and the injury needs to be more serious. The way the guy is injured in my draft is that he trips and falls accidentally shooting off his toe. Would a bullet to an ankle or kneecap bring the hospital scenario closer to what I have in mind. What do you think?
 
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I understand what you're saying, but I know for a fact that I've heard of GSW victims receiving MRIs.

I don't doubt it, I just wonder how they would clear a patient for an MRI, probably would have to know the kind of bullet? Or would a bullet not be affected?


*(not to steal from the original poster)
 
A regular X-ray will allow fragments to be seen. The bullet may have been removed or had already passed through. The MRI will determine the damage done.

If the toe has to be removed, the patient will wear a weight in his shoe where the toe had been to help maintain some balance but will still limp.
 
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After being triaged, he would get a anesthetized locally. An x-ray of the foot, with emphasis on the greater toe (we do not call it "big toe)

R/r 911
i call it the Hallux in general and always get looks when i say it. guess some people have a hard time at remembering anatomy. i will also break the hallux down into the proximal and distal phalanx.
 
Also most MRI are held off because fragmentation's that could be moved. Sorry, GSW to the the greater toe is not usually that dangerous of a scenario except for the humor that will be given outside the patients room...

R/r 911
 
-- MRI safety --
Most all modern pistol bullets are either solid copper (.44 magnum 305 grain solids by cor-bon for bear and other large animals, as an example) or a copper jacket around a lead core with a hollowed out cavity in the front to aid expansion, although entering a toe, it's highly unlikely any bullet (except perhaps a .25 cal) would have sufficient time to expand (mushroom) or fragment at all. The reason I mention this, is that I'm unsure of the effect of an MRI on a basically non-magnetic metal. I do however think that using an MRI for a toe wound would be overkill.

-- 9mm size --
A 9 mm bullet isn't actually that 'large' (it's approximately .354 inch in diameter) in the whole scheme of firearms, but does travel quite swiftly (Fed. Hydra-shock approx 1120 fps at the muzzle) adding to the damage done.

-- Damage done by a 9mm --
If a 9mm directly struck the bone of the great toe, I'd believe it would have a probability of removing most of the toe or at least doing enough damage to require removal of the remaining tissue, mostly due to the fragmentation of the bone as the bullet passes through. A hit off to one side in which only the relative soft tissue was struck probably would not do a whole lot of damage.
Just remember that damage done by a bullet is dependent upon multiple things, just a few of which are: What is actually hit (tissues/bones, organs, vessels), compliance of the tissue that is hit (does it stretch or does it tear when exposed to the hydrostatic forces exerted on it), how is the bullet constructed (solid points, hollow points, prefragmented, mini-shot shells, etc), how fast the bullet is going when it hits, is the bullet stable or unstable (does it tumble when it hits), the diameter of the bullet, material intervening (clothing can "stop up" some hollowpoints preventing their expansion), did the bullet pass through or remain in the target, etc, etc... There have been several attempts to create an 'equation' for a bullet's stopping power, most of which have had little success in predicting 'one shot stops' (none have been entirely successful).
Also a person's reaction to being shot can have as many or more variables.

-- Semi-useless information --
I've had a female patient who was shot in the left ankle (anterior-posterior) approximately 3 inches up from the sole of the foot with a 9mm and she was not in shock, nor was she screaming/writhing. As best we could tell, she was not intoxicated, the bullet passing into her ankle simply did not cause her (individual response) to perceive enough pain to bother her. External bleeding was easily controlled, oddly enough it was not a through and through. We did not, however, let her walk on it.

-- Useless Information Follows --
9mm is sort of considered the "minimum" size of handgun round to use as a defensive weapon, often used by police (and gangs :( ) due to the large number of rounds that can be held by many 9mm magazines (Glock 17 can hold 19 rounds), although I believe several law enforcement agencies are moving to .40 caliber, which is a slightly larger bullet, but still retains the ability to hold several rounds in a standard size pistol. Some people use firearms of lower power as backup or hideout guns (check out a .380 auto or a .38 airweight Smith & Wesson).

People who know far more than I have spoken of the 9mm as somewhat inadequate in stopping power when used against a person under the influence of drugs (unless of course a vital organ is hit), also historically when used with "ball ammo" (the solid round nose bullets) had a tendency to pass through the initial target and threaten people or objects behind that initial person who was hit.
-- -- -- -- --

Sorry for the excess information, I'm sort of a gun nerd even though I don't own but a couple, but I love debating various firearms & ammunition combos.

Take care
-B
 
If you have the guy injured seriously enough to be sedated and admitted to the hospital for a few days, then Law Enforcement will already know who he is and what he's done before he comes out of anesthetic. Depending on the seriousness of his past history with LE, he may have his mobility seriously limited before he comes to. Hospital safety isn't going to let a felon at large run loose throughout the hospital.

Ditto about the cameras etc. knowing his history is going to mean a real challenge in him getting out of there.
 
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