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The Even-number Guide And Imaging Ballistic Injuries

Purpose It is important to account for all bullets or shrapnel in patients with multiple ballistic injuries, whether they have lodged in the patient’s body or exited through a wound. Recent combat experience involving ballistic injuries and explosive fragments underscores this requirement.

Methods The even-number guide described in this paper can be a useful tool to quickly account for all metallic foreign bodies that have entered a patient in a blast or multiple shootings. Cases are presented to illustrate the guide. Also, an evolving technology called total-body digital radiography (DR) is introduced that may help to quickly account for all ballistics in patients.

Results and Conclusions Patients with injuries from multiple bullets or shrapnel should have an even number of entrance and exit wounds and retained metallic fragments. Deviation from this guide should prompt a radiographic hunt for embolized, migrated or ricocheted fragments. The authors conclude that the guide allows for effective communication among members of multispecialty trauma teams.