Forensic Medicine &

Toxicology
9/14/2014 1
Firearm Wounds
By
Dr. Amina Afzal Rao
Demonstrator KMS Medical College,
Sialkot
Firearm Wounds
By
Dr. Arif Rasheed Malik
Associate Professor & Head
Department of Forensic Medicine & Toxicology,
SIMS, Lahore
9/14/2014 2
Weapons are fashion accessories and
easily available
9/14/2014 3
9/14/2014 4
FIREARM WOUNDS
Firearm wounding is a special form of trauma producing a breech through the body of a person by a bullet or shot charge
Principles & Practice of Forensic Medicine by Nasib R. Awan
Firearm
An instrument or device with which it is possible
to propel a projectile by means of the expansive
force of the gases generated by the combustion
of an explosive substance
History of Firearms
Firearms came to Europe from China
To produce an efficient firearm, there are three basic criteria to be
met.
Weapon should be capable of causing substantial damage
It should be reliable & convenient to use
It should be reasonably accurate







Reverend Alexander John Forsythe, in 1807, living near Aberdeen, Scotland, held the
first patent for a percussion ignition system..

9/14/2014 5
History of Projectile weaponry
Earliest weapons: bow and
arrow, crossbow, simple catapult
to huge ballistics / trebuchet
Gunpowder developed in china
1500 yrs ago; came to Europe
and from 14
th
century used as
weapon
Gunpowder= Charcoal, Saltpetre
(Potassium Nitrite), Sulphur
Earliest guns were cannons, front
then breech loading
Early guns flintlock muzzle
loading with 3 parts lock, stock
and barrel

9/14/2014 6




Assault rifles


9/14/2014 7




AK-47 Assault rifle
Developed: 1974
Mikael Kalashnikov
Caliber: 5.45mm
Magazine capacity: 30
Loaded weight: 3,600g
Killing range: 1,350m


Ballistics
Knowledge of physical forces acting on the
projectile & missile by Nasib R. Awan
Interior Ballistics
Exterior Ballistics
Terminal / Wound Ballistics
9/14/2014 8
9/14/2014 9
Interior ballistics
Exterior ballistics
T
H
E
O
R
E
T
I
C
A
L
P
R
A
C
T
I
C
A
L
Wound ballistics
Clear Concept
Ballistics
INTERIOR BALLISTICS
Knowledge of the forces responsible for
propulsion of projectile within the bore of the
barrel till the end of the projectile.
9/14/2014 10
Understanding pre-requires knowledge of:-
1- Missile design & cycle of fire.
2- Ammunition design.
Missile design & cycle of fire
Missile design:-
a- Portion containing mechanical device (not important).
b- Barrel for jetting of the projectile (Important because it
has relation to WOUND BALLISTICS).
9/14/2014 11
Firearm Design
9/14/2014 12
Grip Action Barrel
Grip or
But Stock
Action
Barrel
Firearms
9/14/2014 13
Thompson
9 mm
Luger 9mm
Colt 45
5.7 mm
Classification of Firearms
Barrel
Steel tube for jetting of the
projectile. Two ends ---
Breach & Muzzle end
Bore
Internal diameter of the
barrel. May be SMOOTH or
RIFLED
9/14/2014 14
Classified on the basis of Barrel
Classification of Firearms
Smooth Bored
Choked
Non choked
Rifled
Short Barrel
Long Barrel
9/14/2014 15
Barrel
Rifling
Choking of Smooth bore Firearm
9/14/2014 16
18.80 mm 18.40 mm
Cylindrical portion
TYPES OF CHOKING OF BARREL OF SHOT GUN
CHOKE PERCENTAGE OF PELLETS AT
40 YARDS IN 30 INCH CIRCLE
FULL CHOKE 65 - 75
MODIFIED CHOKE 45 - 55
IMPROVED CYLINDER 35 - 45
CYLINDER 25 - 35
9/14/2014 17
Cycle of fire:- Three stages:-
i- Cartridge feeding and chambering.
ii- Striking of fire
iii- Extraction of fire cartridge.
9/14/2014 18
Ammunition Design
Projectile consists of:-
Cartridge Case
Primer
Powder charge (Black or Smokeless)
Plastic Wad
Shot charge (Bullet or Lead shots)
9/14/2014 19
C
A
R
T
R
I
D
G
E
B
U
L
L
E
T
9/14/2014 20
CARTRIDGE CASE

Function: expands and seals chamber against rearward
escape of gases.

Composition: usually brass (70% copper 30% zinc); also
plastic and paper in shotgun shell tubes.

Shape: (a) straight ("always" pistol ammunition)
(b) bottleneck ("always" rifle ammunition)
(c) tapered ("obsolete").

Extractor flange: configuration at base; rimmed, semi-rimmed,
rimless ,belted, rebated.

Headstamp: manufacturers identifiction imprinted or embossed
on cartridge case.

Cartridge Case

9/14/2014 21
I. Cartridge cases (outer covering of the cartridge) are
made up of Cardboard & plastic.
II. Bullet cases are made of brass (70% copper and
30% zinc).
III. A few have a nickel coating.
IV. Primer cases are of similar composition (Cu-Zn).
V. Bullet cores are most often lead and antimony,
with a very few having a ferrous alloy core.
VI. Bullet jackets are usually brass (90% copper with
10% zinc), but some are a ferrous alloy and some
are aluminum. Some bullet coatings may also
contain nickel (Ravreby, 1982)
FUNCTIONS OF CARTRIDGE CASE
CONTAINS AND KEEPS THE INNER CONTENTS IN
POSITION
PREVENTS THE BACK ESCAPE OF GASES
PROTECTION TO THE CONTENTS
TYPES OF CARTRIDGE CASES
Rimmed, Semi rimmed, Rimless, Rebated, Belted
CSAELESS CARTRIDGE
9/14/2014 22
Primer
9/14/2014 23
The major primer elements are Lead styphnate(Pb), Barium
nitrate (Ba), or a Antimony sulphide(Sb). Usually, all three are
present.
Less common elements include Aluminum (Al), Sulfur (S), Tin
(Sn), Calcium (Ca), Potassium (K), Chlorine (Cl), or Silicon (Si).
Primer elements may be easier to detect in residues because
they do not get as hot as the powder, and compounds (not just
elements) may be detectable. (Tassa et al, 1982b)







9/14/2014 24

Function: explodes on compression igniting the propellant.

Location: (a) centrefire. Centrally placed primer assembly
comprising primer cup (struck by firing pin), primer, anvil with flash
holes. Boxer design (USA) or Berdan design (Europe).

(b) rimfire. No primer assembly. Primer spun into rim
of cartridge case (rim struck by firing pin) and in contact with
propellant.
Various types of Ammunition
9/14/2014 25
Powder Charge
Modern gunpowder, or "smokeless" powder, can contain up
to 23 organic compounds (FBI study) Nitrocellulose is virtually
always present, along with other compounds containing
nitrate or nitrogen.
One of these compounds, diphenylamine (used as a stabilizer
in the powder), can be detected using reagents containing
sulfuric acid. (Maloney et al, 1982).
Modern gun powders are also described as "single-base"
when the basic ingredient is nitrocellulose and as "double-
base" when there is additionally 1 to 40% nitroglycerine
added. If nitroguanidine it is Triple base.
Hardy and Chera (1979) describe a method to differentiate
them using a mass spectrometer .
9/14/2014 26
BLACK GUN POWDER
POTASSIUM NITRATE
OR SALT PETER
75%
Charcoal is the fuel,
potassium nitrate the
oxygen supplier gives the
mixture more density and
makes it more readily
ignitable
CHARCOAL 15%
SULPHUR 10%
9/14/2014 27
9/14/2014 28
PROPELLANT

Function: burns to produce large volumes of gases under
pressure.

Shape: sheets of smokeless powder cut into disc, flake or
cylinder shapes.
Alternatively produced as ball and flattened ball smokeless
powder (Winchester) which may be coated with silver-black
graphite.
Chain of Events
9/14/2014 29
Strike
Primer ignites
Powder charge burns
Temperature increases
Gases produce
Chamber pressure increases
Bullet/Shot charge moves
Exit of bullet
Chamber pressure zero
Gases produced: Carbon dioxide, Carbon monoxide
Nitrogen, Sulphurated hydrogen
CHAMBER PRESSURE:-
i- Revolver:- 4 tons
ii- Pistol:- 6 tons
iii- Rifle:- 20 tons
Bullet:- Forward & rotational motion.
Shot charge:- Forward movement.

9/14/2014 30
Exterior Ballistics
Interactions of forces:-
1- Forces originating from the bullet motion
a- Velocity:- i- Forward (Rate of motion (speed) and
Direction
ii- Rotational :- It varies (length of the barrel)
b- Velocity of bullet at the muzzle end for various firearms:-
i- Revolver:- 600 900ft/sec
ii- Pistol:- 1200 1440 ft/sec
iii- Rifle:- 2000 3500 ft/sec
2- Forces present in the medium
a- Air resistance
b- Gravity
9/14/2014 31
Knowledge of forces acting on the shot while it
leaves the barrel till it reaches the target

Forces originating from the projectile
Velocity
1- Speed or Rate of motion also called Muzzle
velocity
Rifles upto 2000 3000 fps

2- Direction of motion
Forward motion
Also Rotational motion in bullets due to rifling

9/14/2014 32
Bullets do
not typically
follow a
straight line
to the target.
Rotational
forces are in
effect that
keep the
bullet off a
straight axis
of flight.
DEFINITIONS
YAW: is the oscillation around the long axix of
the bullet.
PRECESSION: is a circular Yawabout the center
of gravity which takes the shape of a
decreasing spiral.
Nutation: is a rotational movement in a small
circle which forms a rosette pattern like a
spinning top.

9/14/2014 33
Forces present in the medium



1- Air resistance
2- Gravity

9/14/2014 34
Curved path
Projectile
Follows..
Trajectory of bullet
Trajectory of bullet
9/14/2014 35
Tail wag phenomenon
Inside barrel projectile is
supported by walls of barrel
Entering new medium loses
balance due to air
resistance & force of gravity
Regains balance after
covering some distance
9/14/2014 36
Tail wag
Initial
tail wag
Intermediate
tail wag
Terminal
tail wag
Bullet through a glass
9/14/2014 37
Intermediate tail
wag
Secondary
misslies

Tail wag phenomenon
For pistol up to 60 yards
For Rifle up to 200 yards
9/14/2014 38
Medicolegal importance
Atypical firearm entry wounds
Terminal / Wound Ballistics
Mechanism of Wound production
Laceration & Crushing
Shock waves
Cavitation
9/14/2014 39
It is concerned with the effect of bullet on the
target at impact until it comes to rest
by Naseeb R. Awan
Mechanism of Wound production

INTERACTION BETWEEN THE FIRE BLAST AND PART STRUCK
FORCES IN THE FIRE - BLAST FACTORS IN THE PART STRUCK
PROJECTILE & ITS RESISTANCE OF THE TISSUE
DIAMETER DEPENDS UPON
SHAPE NATURE,
WEIGHT DESIGN &
RIGIDITY DENSITY
TERMINAL VELOCITY (MOST
IMPORTANT)
9/14/2014 40
Laceration & Crushing
Velocity is a key factor to the overall extent of gunshot
wounds
According to the kinetic energy equation: (kinetic energy =
mass/ 2 x velocity
2
) Doubling the mass doubles the energy,
however doubling the velocity quadruples the energy
Therefore a small-caliber bullet traveling at high speed can
produce a more extensive injury than larger caliber bullet
traveling at a lower speed

9/14/2014 41
Kinematics is the science of motion. In gunshot
wounds we can use this to determine the extent of
injury from the forces and motion involved.
Laceration & Crushing
. produced by the direct effect of bullet
1- Missile velocity
2- Shape & composition of
projectile or Frontal area
3- Angle of impact
4- Flight characteristics as
yaw, tumbling & nutation
5- Fragmentation

9/14/2014 42
LOW VELOCITY BULLET
a. PART STRUCK SOFT AND ELASTIC TISSUE
b. PUSHES & STRETCHES THE SKIN & UNDERLYING TISSUE.
c. ROTATES UPON ITS AXIS
d. INDENTATION IS PRODUCED
e. PERFORATION OF TISSUE
f. PASSAGE OF BULLET
g. ENERGY OF BULLET RADIATES LATERALLY
h. DAMAGE PROPORTIONATE TO DIAMETER OF THE BULLET
i. REPRESENTED BY THE PATH OR TRACK OF THE BULLET
9/14/2014 43
SHOCK WAVES
I. DEMONSTRATED ONLY BY HIGH SPEED PHOTOGRAPHY OR RADIOGRAPHY
II. IN HIGH VELOCITY BULLETS
III. TRACK IS FORCED THROGH SOLID TISSUE.
IV. MEDIUM IS COMPRESSED BY MISSILE IN FRONT OF IT
V. REGION OF COMPRESSION MOVES AS A SHOCK WAVE OF SPHERICAL FORM,
4800/FT/S
VI. CHANGES OF PRESSURE REMAINS FOR A MILLIONTH OF SECOND BUT MAY
REACH PEAK VALUE UP TO 100atm.
VII. So damage at a distance from wound track.
VIII. Solid tissues like Muscle, Liver, Spleen & brain are very susceptible.
IX. Conducted particularly well along tube filled tubes like arteries & veins to
cause damage at a distance.
9/14/2014 44
Shock waves
. generated in tissues by high velocity bullets, greater than
2,500/feet/sec
Last only for 15-25 microseconds
Are of high energy creating over 1000 lbs/sq inch of
pressure
Easily rupture gas filled organs
9/14/2014 45
Shock Waves
Types of cavitations

Temporary:
Permanent:
High velocity missile
Main destructive effect
Release of energy, absorbed by the local tissue.
Accelerated violently forwards & outwards.
Continue to move even after passage of missile.
A large cavity is produced (temporary cavity), reaches its maximum size,
have sub atmospheric pressure, collapses in a pulsatile fashion and
permanent cavity left.
Soft tissues pulped, blood vessels disrupted and bone may be shattered.
9/14/2014 46
Cavitation
. created by the bullets travelling at speeds > 1000 ft/sec
Size & shape depends upon the capacity of the bullet to disperse
energy in the surrounding tissues
Tissues are moved forward & laterally away from the bullet
Continues for few milliseconds after bullet has passed
This creates a cavity which sucks air in from entry & exit wounds & may
be 30 times more in diameter than that of the bullet
Permanent cavity if exists is much smaller than the temporary cavity
9/14/2014 47
M/L Importance of Wound
Ballistics
1- Recognition of Entry & Exit wounds
2- Distance of Fire
3- Direction of fire & Wound track
4- Relative position of weapon/victim & angle of fire
5- Cause of death
6- Manner of death
7- Identification of firearm
9/14/2014 48
Components of a Shot responsible for damage
1- Shot charge
(bullet/pallet)
2- Flame & heat
3- Hot explosive gases
4- Smoke
5- Wad
6- Unburnt gun powder
7- Grease from the barrel
9/14/2014 49
All these elements affect:
I. Body of the victim as signs & symptoms
II. At the place of strike or target produce
characteristic changes
Result is FIREARM WOUND COMPLEX
This has two components:
a. Wounding component
b. Non wounding component
9/14/2014 50
Firearm-wound complex has four parts:
1. An entry wound
2. A track with its direction
3. Place of resting of bullet or shot-charge.
4. Exit wound

9/14/2014 51
ENTRY WOUND
SINGLE HOLE:
SIZE : depends upon skin elasticity, tail wag, explosive
blast effect of gases so either proportionate to the
diameter of the bullet, SMALLER or much larger having
STELLATE SHAPE.
SHAPE: depending upon the angle of firearm with the
target. Circular, Oval, Elliptical, An elongated furrow.
Inverted margins. May be everted.
Collar of abrasion: shape depends upon the angle of
firearm with the target.


9/14/2014 52
9/14/2014 53
FLAME
9/14/2014 54
BURNING
9/14/2014 55
SMOKE
9/14/2014 56
Carbon particles
scattered on
HISTOLOGICAL
examination

9/14/2014 57
Burning: Few inches in case of
revolver & one foot in case of a
Shotgun
by Naseeb R. Awan
Blackening: Absent after one
yard
by Naseeb R. Awan
9/14/2014 58
TATTOOING (DUE TO UNBURNT GUNPOWDER
PARTICLES) Beyond 2 yards,
tattooing is not
present
by Naseeb R.
Awan
They pierce under the superficial skin layers causing
punctate abrasions of smaller blood vessels under the
skin
9/14/2014 59
Un-burnt gunpowder particles pierce the skin while blood
stains are washable
Tattooing Blood stains
Skin changes
Gross splitting: Seen in high velocity bullet & contact
wound of low velocity bullet . Tail wag/range/gas
penetration. BLOW BACK PHENOMENON
Bruising (at or around entry wound due to general tissue
trauma) MUZZLE IMPRINT, Gases of the blast ballooning
& bruising the skin/Vital reaction / Inflammatory reaction
Collar of Abrasion: Rub raw of the superficial skin layers
while projectile enters the skin. More prominent in rifled
firearms due to their rotational motion
9/14/2014 60
9/14/2014 61
5/3/2004
40
Tail wag phenomenon
Medicolegal importance
Atypical firearm entry wounds
Bigger entry wound
X-shaped entry wound
Key hole or slit like entry wound
Multiple entry wounds of a single fire
Skin deep / muscle deep wounds
9/14/2014 62
Key hole or Slit like entry wound
9/14/2014 63
Collar Of Abrasion
Classification of Firearm Rifled Entry wound
depending upon distance/range
9/14/2014 64
Contact entry
wound
Hard/Firm
contact
Loose contact
Close range:
Up to 2 yards
Near distant:
within six
inches
Intermediate
range:
1 2 yards
Distant range:
Beyond 2 yards
FEATURES OF ENTRY WOUND
FIRM CONTACT LOOSE CONTACT
Lacks exterior residue.
No imprints of components of
fire externally.
Burning, blackening, tattooing
present in the track or interior of
wound or on intervening bone.
Pinkish discoloration due to
CoHb.
Muzzle imprint on close
examination.
Entry wound of variable shape
with collar of abrasion.
As small gap between body &
weapon.
Circular defect.
Collar of abrasion.
Circular soot material.
Tattooing, blackning & burning
in the wound track.
No scorching, singeing
externally.
Muzzle imprint.
Pinkish discoloration
9/14/2014 65
FEATURES OF ENTRY WOUND
NEAR DISTANT INTERMEDIATE RANGE
Barrel is held close to skin in
the range of flame & smoke.
Central defect.
Collar of abrasion.
Inverted margins.
Burning, scorching,
singeing, blackening &
tattooing present.
Within 1 2 yard
Hole
Collar of abrasion.
Inverted margins.
Blackening fades.
Tattooing present
9/14/2014 66
FEATURES OF ENTRY WOUND:
DISTANT RANGE
Hole
Collar of Abrasion
Grease collar inside the collar of abrasion also
called smudge ring
No flame & gun powder effect.
9/14/2014 67
Contact Firearm Entry wound
Muzzle of firearm pressed hard on some hard
bony area as forehead / skull
Gases cant enter skull & escape from sides
causing lacerations in the scalp
Star shaped projections in scalp
Components of shot present inside skull in the
track
9/14/2014 68
Stellate Firearm wound
Close Range Firearm Entry wound
Examination of clothes is important
Burning, blackening, tattooing present
Collar of abrasion present
Grease collar / Dirt collar may be present
Margins may be inverted
Wad maybe present in the track in case of smooth bored
firearm
9/14/2014 69
Shotgun Cartridge

Construction:chamber primer/powder/wad/shot
Shot types Bird, Buck, Slugs
Pellets Rarely exit
Variable factors
Range
Gauge
Choke
HIGH ENERGY TRANSFER




9/14/2014 70

9/14/2014 71
Plastic WAD struck with the wall
Firearm Exit Wound
There may be no exit wound
May be multiple exit wounds of one entry wound due to
Secondary missiles
May be large typical exit wound with everted margins
No close range characteristics
Shored exit wound: Collar of abrasion present
9/14/2014 72
5/1/2004
25
Bullet through a glass
Intermediate tail
wag
Secondary
misslies
Intermediate tail
wag
Secondary
misslies
Shot gun wounds
Contact shotgun wound are most destructive
Bursting rupture of head is rule rather than
exception
Skull may be largely fragmented leading to
Egg-shell fractures
Scalp is extensively lacerated
9/14/2014 73
The unfavourable ballistic shape of shotgun pallets combined
With lack of stabilizing spin, causes a rapid fall-off in velocity &
Thus Kinetic energy by Naseeb R. Awan
9/14/2014 74
Contact Shotgun wound
Shotgun Entry wound complex
9/14/2014 75
Fanning
phenomenon
9/14/2014 76
Pallets traveling in a single mass & wad getting behind
Entry Wound
By contact to 2 ft birdshot
produces a single wound
By 3 ft there will be Rat-hole
type of entry wound
By 4 ft scattered satellite pallet
holes
By 10 ft there is great variation
in type of entry wound
The diameter of spread of
pallets on body in inches is
roughly equal to the distance
from muzzle in yards
Wad may travel upto 6 ft & may
be found in track of injury
within that distance
Biliard Ball Ricochetting
phenomenon: Important in
giving distance of fire
9/14/2014 77
Shot gun Firearm wounds
This cookie cutter type wound shows a few
separate pellet injuries forming as the distance increases.
This
is not a suicide.

9/14/2014 78
Loose contact shotgun wound and a larger, more
ragged exit wound.

9/14/2014 79
Biliard Ball Ricochetting
phenomenon
9/14/2014 80
Misguides
distance of fire
Important definitions
Bone of skull is dipoc (has 2 layers).
Table which is struck first by projectile is supported from
below so has comparatively small circular hole & clean
margins.
Table which is 2
nd
to be struck has no support so has a
bigger irregular hole & beveled margins.

M/L importance
Gives direction of fire

9/14/2014 81
Beveling of skull bone
9/14/2014 82
Blackening in the track
Beveled margins
Important definitions
Birdshot
Buckshot
Dustshot
Blank
ammunition
Dum dum
bullets

Size of pallet is 2-9
Pallets larger than size 9
Pallets smaller in size
Only powder no projectile present

Either non-jacketed or partially
jacketed. They may expand or flatten
on impact thus increasing energy
dissipation & tissue destruction
9/14/2014 83
Important definitions
Ballistic coefficient
Fragmentation

Embolised bullets

Swallowed bullets

Tandem bullets

Ricochetted bullet
Efficiency of a bullet in overcoming air resistance
Breaking up of a jacketed bullet through some
bone or non-jacketed bullet through soft tissues

Bullet gains access to blood circulation & carried
away to distant location
Bullet that enters GI tract & carried away by
peristalsis

Bullets remaining in barrel due to defect & then
come out subsequently one after the other

Bullet which deviates from its course by striking
an intermediate object
9/14/2014 84
DUM-DUM BULLET

A hollow point is an
expanding bullet that has a
pit or hollowed out shape in
its tip, generally intended to
cause the bullet to expand
upon entering a target in
order to decrease
penetration and disrupt more
tissue as it travels through
the target. It is also used for
controlled penetration,
where over-penetration
could cause collateral
damage (such as on an
aircraft).
9/14/2014 85
Tandem bullet
Tandem cartridge if used could result in
multiple entrance wounds in a single fire.
If the first bullet fails to leave the barrel and is
ejected by the subsequent fired bullets,The
bullets are ejected one before the other and
are called as tandem bullets.
9/14/2014 86
KENNEDY PHENOMENON
Surgical alteration or suturing of gunshot
wounds creates problem. in this situation the
evaluation of the wound whether it was an
entrance or exit wound becomes difficult.
This phenomenon is called as Kennedy
phenomenon.
9/14/2014 87
9/14/2014 88
BILLIARD BALL RECHOCHETTING
Diagnosing long-range injury based on the pattern of pellet spread is
difficult. When shotgun pellets are tightly clustered or widely spread
out, close-range injury or long-range injury (respectively) is usually
suspected. However, in close-range injuries, the billiard-ball effect may
cause considerable pellet spread.
16
When the tightly clustered group of
shot at close range contacts the skin, the pellets at the front of the
group are slowed. The pellets behind them in the group strike the
pellets in front, with an effect like a billiard-ball break. This causes much
more pellet spread in tissue than would be expected at close range. On
radiographs, particularly in trunk wounds, this effect can simulate the
pellet spread of a longer-range injury.
16
Correlate the physical
examination with the radiologic findings. If there is only one entrance
wound hole, it is a close-range injury. If the distribution of the multiple
skin entrance wounds is the same as the pellet spread on the
radiograph, the injury occurred at longer range.
9/14/2014 89
Gun Shot Wound in mouth
9/14/2014 90
Gun Shot Wound in mouth
9/14/2014 91
Multiple Firearm
Wounds
9/14/2014 92
Shotgun pellets 1
9/14/2014 93
Shotgun pellets 2
9/14/2014 94
Gun Shot Wound on Head
9/14/2014 95
Groin Gun Shot Wound
9/14/2014 96
Groin Gun Shot Wound
9/14/2014 97
Gun Shot Wound on hand
9/14/2014 98
Gun Shot Wound on hand in x-ray
9/14/2014 99
Gun Shot Wound on shoulder
9/14/2014 100
Firearm wounds are one type of wounds you may never
get hold on. Even 1000
th
case of your professional life
will bring another chapter of mystery & new learning
9/14/2014 101
THANKYOU !