Guns and coumadin don't mix

This is a patient who came in after reportedly shooting himself in the forehead with a 25-caliber handgun. He was reportedly taking coumadin, an agent that is used to keep the blood from clotting.


Incredibly, when he arrived in the emergency room he was alert and conversant with the ER staff. They saw the entrance wound on his forehead, but couldn't find an exit wound.

The first image they took was an x-ray of the skull.



The white thing just at the level of the nose is the bullet. The little arrow on the forehead is a marker that the emergency room put on the patient to show where the entrance wound was. It also shows the skull fracture that ensued from the bullet wound.

When he became unresponsive, they rushed the patient to the CT scanner to get a better idea of what was going on in his head. This is what they found initially on the "scout radiograph" - the initial image they take to plan where they will take "slices" with the CT scanner.





This is a side view of the skull. Again, the dot on the forehead shows where the bullet entered the head. The bright thing in about the middle of the head is the bullet, which is embedded in the soft tissues at the back of the patient's mouth. The dark oblong shapes in the middle of the head should not be there - those are indicative of air within the space that should be filled with brain or cerebrospinal fluid.




This is a slice through the patient's head at the level of the forehead sloping back just above the ears. The black dots throughout the head are collections of air that are moving around within his shattered skull. The white rounded area near the top of the image is clot and blood within the brain, marking the path the bullet took as it went down through his forehead, through his nasal cavity, and down into the soft tissues at the back of his mouth.





This image shows the exact path that the bullet took. It is a side view through the head showing the wound (at the upper left of the image) with the bone fragments traveling diagonally downward until you get to the bullet (the bright rectangle at the bottom center of the image).

Suffice to say, this was a non-survivable injury and the patient soon succumbed to increased intracranial pressure - probably from bleeding into the space that should be holding his brain. Gross!