BB and pellet guns--toys or deadly weapons?

Penetration capability of 0.177 (4.5 mm) air gun pellet and the characteristics of the entrance wound at various impact energies between 3.28 - 15.64 J on porcine skin. An experimental study

Air guns generate a large number of shot injuries, while pellets can produce life-threatening or lethal injuries by penetrating deep tissue. The assessment of air gun injuries include determining the direction and the distance of the shot, the type of arm, and the penetration capability of the pellet. Answering these questions can be challenging since air gun injuries have received less attention in scientific studies. This study aimed to determine skin and soft-tissue penetration capabilities and wound characteristics of air guns at different impact energies. Test shots were conducted on porcine tissue and ballistic gel with 0.177 caliber air guns from different shooting distances between impact energies of 3.28 and 15.71 J (111 m/s to 243.5 m/s). Entrance wound appearance, size, and penetration depth were compared. The penetration capabilities of the pellet with different impact energies are assessed and discussed. No difference was found in the entrance wound shape and appearance between shots from different distances and impact energy. The results indicate that 0.177 caliber air guns above 7.5 J of muzzle energy can easily penetrate deep into soft tissue, thus able to cause severe, life-threatening injuries. An air gun with a muzzle energy below 7.5 J muzzle energy can still cause severe injury up to 20-30 m as the projectile has enough energy to create several centimeter-deep penetrations.

Forensic assessment of a life-threatening penetrating abdominal air gun injury

Air guns are considered mostly harmless by the public opinion, but projectiles shot from common air guns can penetrate skin and thus able to cause severe, even life-threatening injury. The prevalence of air gun injuries is constantly high, but severe injuries occur rarely. Forensic evaluation of air gun injuries can be challenging since the shot wound characteristics produced by combustion in case of firearm injuries are missing. Despite these difficulties, the topic of air gun injuries is mostly overlooked in forensic literature, and there are no guidelines available which can help the assessment of specific cases. A case of an air gun injury is reported, where the projectile penetrated the abdominal wall and created multiple bowel injury. The complex assessment of all available information (macroscopic and microscopic appearance of entrance wound, types of injuries, CT findings, and crime scene reconstruction) helped to uncover the truth about the circumstances of the injury.

Spinal Gunshot Wound With an Air Rifle: A Case Report

Spinal gunshot injuries are one of the most serious injuries that can cause morbidity and mortality. We report a case of a nine-year-old boy, referred to our emergency department from another hospital, with lower limb weakness after being shot by an air gun in his back. After extensive investigation, it appeared that a foreign body representing the bullet was found in his spinal canal; the patient was taken to the operating room for surgical decompression and removal of foreign bodies. After that, the patient started to show partial improvement in his neurological deficits and is to be continued on physiotherapy.

Fatal cardiac injury sustained from an air gun: Case report with review of the literature

•

Air guns use compress air to cause bullet acceleration and can cause serious injury.

•

Cardiac injuries from air guns are rare, but can lead to cardiac tamponade/death.

•

Published cases of cardiac injuries from air guns most commonly occur in children.

Introduction

Traditionally promoted as “toy guns,” air guns have long been used by children and lack many regulatory guidelines compared to conventional firearms. However these weapons possess serious lethal potential and have led to numerous injuries and deaths.

Presentation of case

We describe a 21 year old man who sustained a penetrating cardiac wound from a pellet gun that led to cardiac tamponade and death. Post-mortem examination showed the pellet had penetrated the left ventricle and anterior esophagus with subsequent intraluminal migration into the stomach.

Discussion

Review of the literature identified 39 other cases of penetrating cardiac injuries from air guns. Sternotomy was the most frequently used surgical approach and the right and left ventricles were the most commonly affected chambers. Bullet embolization was the most frequently reported complication. Including our case, five deaths related to penetrating cardiac injury from air guns were identified.

Conclusions

This report highlights the seriousness of air guns and demonstrates a unique intra-thoracic injury.

Fatal injury by air gun: a case report

Background

The popularity of air weapons is increasing. They are often viewed as toys, rather than potentially lethal weapons. Regulations on purchase and ownership of air weapons differ from country to country. The majority of fatal and non-fatal air gun accidents involve children less than 16 years of age.

Case presentation

In this report, we present a fatal case resulting from an accident involving an air gun. An accident happened between two brothers aged 9 and 7 and was initially considered to be a traumatic wound inflicted by falling on a scooter handle. Upon the arrival of an experienced police inspector, the cause of child’s death was called into question and it was discovered that unlicensed, loaded air gun was left unattended in a backyard shed. It was later established that the cause of death was a fatal gunshot wound to the chest and a pointed lead pellet was found in the boy’s liver.

Conclusions

The public and governments should be advised that air guns can be dangerous weapons which may cause serious injuries and even death. We believe that air guns should be regulated by the same laws that apply to firearms.

Air gun wound: bihemispheric penetrating brain injury in a paediatric patient

Air guns are classified as low-velocity missiles and they usually considered safe and harmless. Despite that fact, air guns still can make serious or life-threatening injuries. Most of air gun injuries occur in paediatric population. A 2-year-old boy was shot in the forehead withan air gun accidentally. Skull radiography and non-contrast CT scan of the head were performed and showed penetrating bihemispheric brain injury from the left frontal to right occipital lobes at the level of the lateral ventricle with a metal-density foreign body at the right occipital. A projectile was successfully extracted via craniotomy, without complications. Air guns have the potential to cause fatal, life-threatening injury especially in children. Imaging is crucial for the evaluation of wound ballistics. Understanding about the mechanism of projectiles and wound ballistics is very helpful for radiologists to conceptualize these injuries when interpreting these cases. The role of radiology in ballistic wound cases is critical and important, both for clinical and forensic settings.

Model cannons causing lethal traumata

Model cannons are usually considered to be harmless toys; therefore no legal regulations are required. Nevertheless, suicidal intentions or playful experimentation can turn this toy into a lethal weapon. This paper describes two cases of misuse of model cannons, leading to severe injuries and consequently death: the first case was the result of a suicidal intention, where the cannon caused a bullet injury into the forehead with marked signs of close-firing and intensive brain damage. The second case was an accidental event, where the cannon induced an entry wound at the left chest wall with surrounding carbonization and a fatal rupture of the heart. Circumstances of the lethal situations and mechanisms of the cannons leading to fatal injuries including ballistic considerations are described. The report is supported by a thorough literature research.

The early management of gunshot wounds Part II: the abdomen, extremities and special situations

The management of gunshot wounds of the abdomen and extremities is evolving with centres who treat large volumes of such injuries tending to the application of a policy of selective non-operative management. This article discusses the management of gunshot wounds to the abdomen and extremities and reviews the evidence supporting these changing practices. Special situations such as wounding by shotguns or air rifles are also examined as are the special considerations needed when dealing with the gunshot injured pregnant women or in a child.

Experimental effect of shots caused by projectiles fired from air guns with kinetic energy below 17 J

Pursuant to the Polish Weapons and Ammunitions Law (Legal Gazette No 53/1999 item 549 with subsequent amendments), air guns with kinetic energy of the fired projectiles below 17 J are not regarded as weapons. The aim of the study was to assess the potential effect of shots caused by projectiles of various mass and structure fired from air guns with kinetic energy below 17 J on human soft tissues. As a model of soft tissue, we used 20% gelatin blocks. After shooting, we measured the depth of gelatin block penetration by pellets fired from various distances and compared these results with autopsy findings. The results demonstrated that examined pneumatic guns may cause serious injuries, including damage to the pleura, pericardium, liver, spleen, kidneys, femoral artery, and thoracic and abdominal aorta. Experiment shown that gelatin blocks do not reflect fully the properties of the human body.

Anesthesia for a thoracic BB gun injury

Pediatric anesthesiologists care for children with penetrating trauma from nonpowder (BB and pellet) guns. We present the case of a 9-year-old boy who required urgent median sternotomy for cardiac tamponade after sustaining a close-range BB gun injury to the chest. After summarizing the epidemiology of nonpowder gun injuries in children, we clarify the nomenclature, ballistics, and mechanisms of these guns, discuss the tendency to minimize these kinds of injuries, explain bullet embolization, and review (by body area) current clinical management issues.

Conventional radiographs: are they still the standard in localization of projectiles?

The penetration of air gun pellets in facial soft tissue can cause major problems during the removal of foreign bodies, although conventional radiography, computed tomography, image-guided surgical removal, and ultrasound have been applied to facilitate the procedure. It was the aim of the present case report to introduce a modified intraoperative method for the localization of air gun pellets, based on the use of radiopaque markers in conventional radiographs. A 66-year-old patient attempted to commit suicide by using an air gun. The pellet hit the right temporal region. A computed tomographic (CT) scan was acquired to localize the foreign body. The first attempt to remove the pellet through the penetrating wound failed. Because of a dislodgement of the pellet, the CT scan could no longer be used for the localization of the air gun pellet. As the air gun pellet was positioned under the zygomatic arch, ultrasound was unable to identify its position. Successful intraoperative localization of the projectile was performed after fixation of radiopaque markers to the skin in the region of the estimated localization, with conventional radiographs in 2 planes, acquired with a mobile dental x-ray device. Although the markers remained attached to the patient as reference makers, the air gun pellet was removed easily. The use of radiopaque markers in conventional radiographs in 2 planes allows fast, intraoperative localization of radiopaque foreign bodies within soft tissue. The procedure can be carried out with a conventional x-ray device that should be available in every oral and maxillofacial practice. The use of reference markers should be considered a standard procedure for the localization of radiopaque foreign bodies in the head and neck.

33 cases of airsoft gun pellet ocular injuries in Copenhagen, Denmark, 1998-2002

PURPOSE

To evaluate the incidence and ocular effects of blunt trauma due to injury from airsoft gun pellets.

METHODS

We conducted a non-comparative case series based on the files of 33 patients who suffered ocular injury from airsoft guns and were admitted to one university emergency eye clinic in Copenhagen during a 5-year period.

RESULTS

A total of 33 eyes in 33 patients were examined. Thirty male and three female patients were affected. Mean age was 13 years (range 3-49 years). Mean follow-up time was 6.5 days (range 1-540 days). On initial examination, we found: hyphaema (n = 28), corneal abrasion (n = 22), retinal oedema (n = 11), subconjunctival haemorrhage (n = 10), palpebral haemorrhage and/or oedema (n = 9), iris dialysis (n = 7), intraocular pressure (IOP) > 31 mmHg (n = 4), IOP < 9 mmHg (n = 4), vitreous haemorrhage (n = 2) and cataract (n = 1). One patient had brown corneal discoloration due to severe chronic hyphaema that required surgery. The final visual acuity was 1.0 in 20 patients and < or = 0.7 in five patients.

CONCLUSION

The airsoft gun trauma resulted in anterior and posterior segment ocular injuries that required acute medical intervention and for which some patients were hospitalized. Trauma mainly occurred in children and youths. A longterm risk of glaucoma is expected. Eye care professionals and parents as well as manufacturers of airsoft guns should advise participants to wear adequate protection when involved in this activity.

Shotgun shooting in northern India--a review (1980-1999)

Central Forensic Science Laboratory (CFSL), Chandigarh undertakes the examination of the crime cases of some northern states of India. The shooting cases of last two decades (1980-1999) involving shotguns were analysed in this laboratory. This paper consists of the study of 360 actual cases of shotguns for evaluation of various parameters, such as type of firearm, number of firearm and firing, location of wound, age, occupation, sex and caste of accused and victim, etc. Out of 360 cases, 253 (70%) were classified as homicidal, 68 (19%) accidental, 11 (3%) suicidal, 9 (2.5%) hunting and 19 (5.5%) cases of insufficient information including the cases of illegal possession of firearm. Single Barrel Breech Loading (SBBL) gun 144 (40%) was preferred over Single Barrel Muzzle Loading (SBML) 109 (30.3%), Double Barrel Breech Loading (DBBL) 72 (20%) and Double Barrel Muzzle Loading (DBML) gun 35 (9.7%). All the breechloader guns were of 12 bore. Muzzleloader gun were recovered only from the remote rural areas. Three hundred and thirty-one (92%) cases involved single, 22 (6%) double and 7 (2%) more than two shotgun. Majority of cases were found of single firing 288 (80%), followed by double 29 (8%) and multi-firing 18 (5%). Eleven (3%) cases were of misfiring and in 14 (4%) cases information was not available. Accidental and suicidal cases had only one firing. The mean age for male and female victim was 31 and 24 years, respectively. Occupationally, agriculture is predominating over business, service and security guards for accused and for victim agriculture followed by service, business, student and security guards are in the descending order. Caste wise the most aggressive community of Kshatriyas is predominating as accused and victim over lower cast people. Head (64%) being a vital part was chosen most frequently for committing suicide followed by body (36%). Service personnel committed maximum number of suicide.

Air-Gun Injuries: Initial Evaluation and Resultant Morbidity

Severity of injuries from air-powered weapons can be underappreciated. Transformation of these weapons into toys makes them available to children. Our experience reveals the underestimated injury severity and emphasizes need for prompt trauma evaluation. Retrospective chart review of children sustaining air-gun injuries and evaluated at a single, pediatric hospital from 1991 to 2002 was performed. Medical record numbers were retrieved from a trauma data base. Data included age, weapon type, firing distance, injury site, radiographic studies, operative intervention, length of stay, and long-term disability. Ocular injuries were excluded secondary to known severity. All other injuries and treatments are described. Thirty-four children, average age 10 years ± 3.3 years, sustained 35 injuries from 1991 through 2002. Twenty-one children required admission, 19 children required surgery, and 5 children experienced long-term disability. Average time to definitive care was 3 hours 12 minutes. Sites of injury included head, neck, chest, abdomen, and extremities. Average hospital stay was 4.3 days. In the pediatric population, air-gun injuries can be underestimated. Lack of collateral tissue damage makes wounds appear innocuous to unsuspecting medical personnel resulting in delayed care. During initial evaluation, injuries from air guns deserve the same respect as those caused by conventional firearms.

A Case of a BB-gun Pellet Injury to the Ethmoid Sinus in a Child

Injuries caused by BB and pellet guns remain common among children. These guns fire low-velocity missiles that can cause considerable harm when fired at close range. Most injuries occur in adolescents as a result of accidental or careless shooting. Such injuries to head and neck sites are common, second only to injuries to the extremities. We report the case of a 10-year-old girl who was accidentally shot by a BB gun. The BB pierced the skin of her right cheek, traversed the right maxillary sinus walls, and lodged at the junction of the right ethmoid sinus and septum. Preoperative radiology combined with endoscopic surgery techniques and instrumentation allowed us to precisely locate and remove the steel ball from the paranasal sinus while the patient was under general anesthesia. We review the scope of maxillofacial injuries caused by BB and pellet guns, and we discuss their presentation, diagnosis, and management. Although these guns are easily bought and sold as toys, they are weapons capable of causing significant injury.

Trends in BB/pellet gun injuries in children and teenagers in the United States, 1985-99

OBJECTIVE

To characterize national trends in non-fatal BB/pellet gun related injury rates for persons aged 19 years or younger in relation to trends in non-fatal and fatal firearm related injury rates and discuss these trends in light of injury prevention and violence prevention efforts.

SETTING

The National Electronic Injury Surveillance System (NEISS) includes approximately 100 hospitals with at least six beds that provide emergency services. These hospitals comprise a stratified probability sample of all US hospitals with emergency departments. The National Vital Statistics System (NVSS) is a complete census of all death certificates filed by states and is compiled annually.

METHODS

National data on BB/pellet gun related injuries and injury rates were examined along with fatal and non-fatal firearm related injuries and injury rates. Non-fatal injury data for all BB/pellet gun related injury cases from 1985 through 1999, and firearm related injury cases from 1993 through 1999 were obtained from hospital emergency department records using the NEISS. Firearm related deaths from 1985 through 1999 were obtained from the NVSS.

RESULTS

BB/pellet gun related injury rates increased from age 3 years to a peak at age 13 years and declined thereafter. In contrast, firearm related injury and death rates increased gradually until age 13 and then increased sharply until age 18 years. For persons aged 19 years and younger, BB/pellet gun related injury rates increased from the late 1980s until the early 1990s and then declined until 1999; these injury rates per 100 000 population were 24.0 in 1988, 32.8 in 1992, and 18.3 in 1999. This trend was similar to those for fatal and non-fatal firearm related injury rates per 100 000 which were 4.5 in 1985, 7.8 in 1993, and 4.3 in 1999 (fatal) and 38.6 in 1993 and 16.3 in 1999 (non-fatal). In 1999, an estimated 14 313 (95% confidence interval (CI) 12 025 to 16 601) cases with non-fatal BB/pellet gun injuries and an estimated 12 748 (95% CI 7881-17 615) cases with non-fatal firearm related injuries among persons aged 19 years and younger were treated in US hospital emergency departments.

CONCLUSIONS

BB/pellet gun related and firearm related injury rates show similar declines since the early 1990s. These declines coincide with a growing number of prevention efforts aimed at reducing injuries to children from unsupervised access to guns and from youth violence. Evaluations at the state and local level are needed to determine true associations.

Patterns and correlates of gun ownership among nonmetropolitan and rural middle school students

Examined prevalence of gun ownership and the links among gun ownership, reasons for gun ownership, and antisocial behavior in a sample of nonmetropolitan and rural middle school students. Participants completed the Questionnaire for Students (Olweus, 1995) and included 6,263 students from 36 elementary and middle schools, of whom most were African American (range = 46%-95% per school). Reasons for gun ownership were strongly associated with rates of antisocial behavior. Youths who owned guns for sporting reasons reported rates of antisocial behavior that were only slightly higher than those reported by youths who did not own guns. Youths who owned guns to gain respect or to frighten others reported extremely high rates of antisocial behavior. These high-risk adolescent gun owners were likely to come from families of high-risk gun owners, associate with friends who were high-risk gun owners, and engage in high rates of bullying behavior. Findings suggest that effective violence prevention programs must target high-risk youths, address risk factors that go beyond individual settings, and address a comprehensive array of risk factors.

Air gun dart injury in paranasal sinuses left alone

Patients with paranasal sinus foreign body are not commonly seen in otolaryngological practice and papers dealing with this issue are rare in the English literature. One case of penetrating sinus injury due to air gun dart is presented to illustrate the potentially serious consequences of air gun injuries. The clinical presentation, diagnostic pitfalls and the treatment aspects are discussed.

Pediatric nonpowder firearm injuries: outcomes in an urban pediatric setting

BACKGROUND

Approximately 32 000 nonpowder firearm injuries are reported annually with more than 60% occurring in the pediatric population. Case reports of serious and fatal injuries have been described; however, no large inclusive series have been published. We reviewed an 11-year experience of an urban pediatric emergency department to evaluate the circumstances, spectrum of injuries, and outcomes attributable to nonpowder firearms.

METHODS

A retrospective, descriptive case series of all children 18 years of age or younger evaluated at an urban children's hospital from January 1983 through December 1994 were eligible for study. Patients were identified using a computerized database, the National Electronic Injury Surveillance System, and the trauma registry in the department of surgery. Medical records were reviewed to collect demographic information, circumstances of injury, anatomic site and type of injury, treatment, and outcomes for nonpowder firearm injuries.

RESULTS

One hundred eighty patients were identified, and a complete data set was available for 166 (92%). The mean age was 12 +/- 3.7 years, 24% of children were <10 years old, and 71% of the children were male. Three patients returned with a second nonpowder firearm injury during the study period. Forty-nine percent of injuries were intentional and 44% of all injuries occurred during the summer and early fall months. The most common sites of injury were the extremity/buttocks (39%), head and neck (33%), thorax (13%), and eye (8%). Serious injuries included intracranial hemorrhage, cardiac right ventricle laceration, hyphema, and abdominal visceral injury (liver laceration, pancreatic laceration, intestinal perforation). The majority of wounds required local wound care, and the children (74%) were discharged from the emergency department. Of the patients admitted to the hospital (27%), 45% required operative intervention. There were no deaths. Seven percent (12/166) of patients sustained some functional deficit with 42% (5/12) the result of an ocular injury.

CONCLUSION

The majority of nonpowder firearm injuries are minor; however, the potential for serious injury should not be underestimated. Minor injuries can be treated with local wound care and tetanus prophylaxis, and patients can be discharged from the emergency department. Education of parents and children to the potential risks associated with these weapons is essential. Stricter regulations regarding ownership of nonpowder firearms and mandatory safety instruction should be considered.

Air-powered guns: too much firepower to be a toy

OBJECTIVE

This study reviews our experience and calls attention to the potential danger of air-powered guns.

DESIGN

Retrospective analysis.

MATERIALS AND METHODS

Review of patients with air-powered gun-injuries admitted to a Level I trauma center and air gun deaths reported to the United States Consumer Product Safety Commission over a 5-year period ending July 1994.

RESULTS

Sixteen children (median age 10) were admitted after sustaining BB or pellet gun injuries. Three children had cranial penetration; one remains severely brain impaired. One of two thoracic injuries required left ventriculorrhaphy. All five children sustaining abdominal wounds underwent laparotomy for enteric perforations; one was complicated by an intra-arterial pellet embolus. Three of five children with neck wounds had penetrating tracheal injury. Overall nine children required operative intervention. No deaths occurred in our series, but there were 33 air gun deaths reported to the United States Consumer Product Safety Commission during this period.

CONCLUSION

Our data demonstrate that injuries from air-powered guns should be treated in a manner similar to those from low velocity powder firearms. We can no longer continue to underestimate the potential for life-threatening injury from these weapons.

Air rifles--lethal weapons

Modern air rifles are very powerful and potentially dangerous, yet they are sold without a license because they are considered toys. We report on 16 patients who were shot with air rifles. Nine of these patients were treated in the last 3 years. Seven patients sustained injuries to the chest and upper back. The BB (ball bearing) penetrated the aorta of two patients, one of whom died. One of two patients shot in the abdomen had injuries to the iliac artery and the colon. Three patients were shot in the head and neck, three in the extremities, and one through the penis. Particularly alarming to us is the fact that nine patients had been shot intentionally after minor arguments with other children. The assailants were neighborhood children in seven cases, a friend in five, and a sibling in two.

Experimental thoracoabdominal airgun wounds in a porcine model

The Consumer Product Safety Commission estimates that there are 31,000 airgun injuries annually, 19,000 of which occur in children under 14 years of age. Case reports in the literature include 235 serious and nine lethal pediatric injuries. No experimental model of thoracoabdominal airgun pellet perforation exists. A 60-pound newly killed pig was selected as a model for pediatric airgun injuries. Two commonly available .177-caliber airguns were fired from point blank, 2.5 feet, and 5 feet. A chronograph was used to measure impact velocities for pellets fired at the already-killed pig. Autopsy study of organ wounding was completed. Perforation velocities with point-tip pellets were 407 ft/sec for the thoracic wall and 399 ft/sec for the abdomen. Of the 18 pellets shot at the chest, eight passed through the chest wall, causing 15 organ injuries. Eleven of the 18 pellets perforated the abdominal wall, producing 49 organ injuries.

CONCLUSION

Airguns create serious intracavitary organ injuries in a porcine model. Moreover, ballistic research is possible in unusual surroundings, such as a packing plant.

Air gun pellets in the sinuses

Three cases of penetrating sinus injuries due to air gun pellets are presented in order to illustrate the potentially serious consequences of air gun injuries. Primary surgery was performed in all cases. The clinical presentation, methods of accurate pre-operative localization and surgery are discussed.

The ongoing hazard of BB and pellet gun-related injuries in the United States

STUDY OBJECTIVE

To characterize BB and pellet gun-related injuries treated in US hospital emergency departments.

DESIGN

We obtained data through the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission and weighted them to obtain national estimates.

RESULTS

We estimate that from June 1, 1992, through May 31, 1993, 32,997 (95% confidence interval [CI], 27,823 to 38,171) people or 12.9 per 100,000 population (95% CI, 10.9 to 14.9) were treated for BB and pellet gun-related injuries. Of this total, 96% (31,547 [95% CI, 26,600 to 36,494]; 12.3 per 100,000 population [95% CI, 10.4 to 14.2]) sustained gunshot wounds. The incidence of BB and pellet gunshot wounds was highest among males (21.0 per 100,000 population [95% CI, 17.7 to 24.3]), children aged 10 through 14 years (71.4 per 100,000 population [95% CI, 57.4 to 85.4]), and blacks (14.6 per 100,000 population [95% CI, 10.3 to 18.9]). Boys aged 10 through 14 years had the highest risk of injury (121.1 per 100,000 population [95% CI, 95.0 to 147.2]). Although most patients (62%) were victims of unintentional shootings, 13.7% were victims of assault. Males aged 10 through 24 years (49.1% of assault cases) had the greatest risk of assault-related BB and pellet gunshot wounds.

CONCLUSION

BB and pellet gunshot injuries continue to represent a substantial public health problem, especially to children and adolescents. Although BB and pellet guns are designed and intended for recreational use and competitive sport, they are sometimes used to inflict harm, most often among teenagers aged 15 through 19 years. Intervention strategies must be developed and implemented to reduce unintentional shootings and assaults associated with BB and pellet guns.

Penetrating abdominal air gun injuries: pitfalls in recognition and management

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 gun-inflicted abdominal wounds. Finally, preventive strategies are discussed.

Thoracic BB injuries in pediatric patients

Penetrating thoracic injury from BB shot remains an innocuous event in most patients, but factors including location, proximity, gun type, and patient weight may identify groups at risk. The following cases demonstrate morbidity and mortality in two patients, and this experience may suggest the need for reassessment of this injury.

Air rifle pellet injury to the heart with retrograde caval migration

Great emphasis is placed on the lethality of modern high-powered street weapons, and their impact on mortality from firearm injuries. Presented is a case of an air rifle BB injury to the chest, resulting in a penetrating injury of the right heart, with apparent retrograde embolization to the inferior vena cava. Although no clinical evidence of pericardial tamponade was present 4 hours following injury, 150 mL of pericardial blood was encountered at median sternotomy, secondary to a right atrial appendage entry wound. This case exemplifies three important principles regarding penetrating chest trauma and air guns: (1) Modern air rifles, capable of muzzle velocities as high as 900 fps, are intrinsically lethal weapons; (2) missiles within the cardiovascular system have a propensity for embolization, and often follow an intuitively unexpected course; and (3) young healthy patients with potentially lethal penetrating cardiac injuries, particularly those caused by low velocity firearms, may appear stable and minimally injured in the emergency room. A strong suspicion of cardiac injury and prompt intervention should be extended to airgun injuries of the thorax.

Venous bullet embolism: a complication of airgun pellet injuries

Bullet emboli are an interesting but rare occurrence and their management when situated in the venous system remains controversial. Two cases of venous bullet embolism to the right heart are reported due to airgun pellet injuries. Both cases required bullet embolectomy using cardio-pulmonary bypass.

Pneumatic firearm injuries: trivial trauma or perilous pitfalls?

This report describes an injury due to a pneumatic firearm. Though powder firearm injuries are generally considered serious, pneumatic weapon injuries are often viewed as minor or insignificant trauma. Children and adolescents primarily wield these weapons contributing to their "harmless" aura. However, dramatic increases in muzzle and impact velocities have transformed the newer generation of pneumatic firearms into formidable weapons. Consequently, the literature is replete with increasing incidences of serious injury due to pneumatic weapons.

Air gun injuries in children

Air gun injuries occur frequently in children and are potentially lethal. Three cases of air gun injuries in children are described. Two children sustained air gun injuries to the neck that penetrated the platysma. Each had exploration of the wound. One had injury to the esophagus that was treated with external drainage; the other sustained no major injury to vital cervical structures. A third child received a penetrating injury to her right flank that did not appear to enter the peritoneal cavity. She was observed for 24 hours and released. After a six-month followup, all patients have remained free of complications. The emergency physician should be aware of the penetrating capabilities of these weapons, and they should be managed as would any other low-velocity gunshot wound.