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Mon May 30 14:11:42 BST 2005

You are correct that I mis typed and mis stated the muzzle velocity of , AK 47 round.    I was hurredly typing on my blackberry.   I did give an immediate reTraction and statement of an incorrect decimmal point
-----Original Message-----
From: Jeremy Hawk <akulahawk at earthlink.net>
Date: Mon, 30 May 2005 07:32:56 
To:Trauma & Critical Care mailing list <trauma-list at trauma.org>
Subject: Re: AK-47 to the hip, with rectal blood

Dr. Mattox,

I, a Paramedic, hold you, and many others on this list, in high regard as a Surgeon and Physician. I would feel comfortable under your care as a trauma patient.

However, I would like to say that you mis-stated an AK47's bullet velocities. An AK47 fires a 7.62x39mm bullet and is LESS powerful than common DEER hunting calibers. I'm not saying that it's not effective for what it was designed for, nor am I saying that the damage in this case was or was not caused by an AK47 bullet, just that it is not a "High-powered Rifle." Don't use it on big game or at long ranges. Ask any Police sniper what they use and why.

I just did a quick estimation of the velocities you listed (below), and what you said in your post was that, in effect, the AK47 (bullet) achieves at least orbital velocity. 28k ft./sec to 32k ft/sec is equivalent to approximately 19,100 mph to 21,800 mph. I do not know of any hand-held weapon that can generate that kind of velocity. An impact from a projectile going that fast would cause unimaginable damage, provided the bullet survived the intense heat generated by such fast flight in relatively dense air.

I do not have much training in ballistics, but I do know enough to know that orbital velocities just aren't possible with small arms.

Below are common velocity and energy levels developed by various rifle calibers.

7.62x39, 125 gr bullet, 2365 fps, 1527 ft lbs
30-30, 150 gr bullet, 2390 fps, 1902 ft lbs
.308, 150 gr bullet, 2820 fps, 2649 ft lbs.   
5.56x45 (.223), 77 gr bullet, 2750 fps, 1295 ft lbs.

And a couple hand gun calibers...

.44 Magnum, 250 gr bullet, 1303 fps, 1130 ft lbs.
9mm, 127 gr bullet, 1247 fps, 437 ft lbs.

Regards,
Jeremy Hawk, Paramedic

-----Original Message-----
From: Avi Roy Shapira <avir at bgumail.bgu.ac.il>
Sent: May 29, 2005 1:26 AM
To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
Cc: ccm-l at ccm-l.org
Subject: Re: AK-47 to the hip, with rectal blood

Ken, 

High velocity and cavitation injuries are a myth. See the numerous
publications by Col Fackler on this issue.  They are readily available on
the internet (the best source is:  Wound ballistics. A review of common
misconceptions M. L. Fackler JAMA. 1988;259:2730-2736.)

You can get secondary blast effect, from fragments of bones etc, but in
general, an AK-47 bullet, unlike an M-16 bullet, does not fragment or
deform.

Unfortunately, I treated a number of AK-47 injuries, which are more common
here than handguns. Fact is that a 0.45 slug from a "low velocity" Colt
peacemaker may do more damage, and its tract is more unpredicatable.

We should treat the wound, not the bullet. Extensive debridement of such
wounds does more harm than good.  In the presence of extensive hematoma it
is hard to tell viable from dead muscle, but in general, most of the
muscle will be viable.  

Furthermore, the vessels in this region are really inaccessible sugically,
and as a rule, when you start debriding in this area, you will get
troublesome bleeding, and packing does not work very well
(because there is nothing to pack against). Eventualy, you
will end up in the angio suit trying to embolize. Unless the hematoma is
expanding, it is better to leave it alone. If it is expanding, I agree
with Yoram that angiographic embolization is the way to go.   

Since there is rectal bleeding (I missed that on the original description)
there is no need to do any studies to confirm rectal injury, and diversion
is in order. Since you need to do a laparotomy anyway for the diversion, I
agree that CT is not indicated.  However, based on the trajectory of the
bullet, I will be surprized if you should find any intraabdominal
injuries.

Avi 

 On Sat, 28 May 2005 KMATTOX at aol.com wrote:

> This patient needs to go to the OR, perhaps a quick proctoscopy to document  
> the blood and rectal injury, and have a laparotomy, take care of injuries 
> above  the peritoneal reflection, and as described have a diverting sigmoid  
> colostomy.   At this point he should be closed, rolled over and have  the buttocks 
> wound explored and debrided.
>  
> An AK 47 is a high velocity missile, traveling from 28,000 to 32,000  ft/sec, 
> depending on the load of the powder.   It creates a great deal  of cavitation 
> and as described will have a contaminated soft tissue space both  from the 
> wound and from the enteric injury.   The debrided buttocks  wound should be 
> packed OPEN and taken back to OR for dressing changes daily or  every other day 
> till granulation is seen.    
>  
> The debridment is more important than any antibiotic that you may put him  
> on.   There is NO NEED for rectal washout or placement of presacral  drains.  
>  
> k
> --
> trauma-list : TRAUMA.ORG
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==========================================================================
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School 
the Critical Care Unit               POB 151, Beer Sheva, Israel

email:avir at bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390

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AK-47 to the hip, with rectal blood