A gunshot wound (GSW) is a form of physical trauma sustained from the discharge of arms or munitions. The most common forms of ballistic trauma stem from firearms used in armed conflicts, civilian sporting, recreational pursuits and criminal activity. Ballistic trauma can be fatal or cause long-term consequences.

The degree of tissue disruption caused by a projectile is related to the size of the temporary versus permanent cavity it creates as it passes through tissue. The extent of cavitation, in turn, is related to the following characteristics of the projectile:

- Kinetic energy: KE = 1/2"mv" (where "m" is mass and "v" is velocity). This helps to explain why wounds produced by missiles of higher mass and/or higher velocity produce greater tissue disruption than missiles of lower mass and velocity.

- Impulse: IMP = "mv". The impulse is working in a couple with kinetic energy, featuring the same characteristics

- Yaw

- Deformation

- Fragmentation

The immediate damaging effect of a gunshot wound is typically severe bleeding, and with it the potential for hypovolemic shock, a condition characterized by inadequate delivery of oxygen to vital organs. In the case of traumatic hypovolemic shock, this failure of adequate oxygen delivery is due to blood loss, as blood is the means of delivering oxygen to the body's constituent parts. Devastating effects can result when a bullet strikes a vital organ such as the heart or lungs, or damages a component of the central nervous system such as the spine or brain.

Common causes of death following gunshot injury include exsanguination, hypoxia caused by pneumothorax, catastrophic injury to the heart and larger blood vessels, and damage to the brain or central nervous system. Additionally, gunshot wounds typically involve a large degree of nearby tissue disruption and destruction due to the physical effects of the projectile. Non-fatal gunshot wounds frequently have severe and long-lasting effects, typically some form of major disfigurement and/or permanent disability.

Gunshot injuries can vary widely from case to case since the location of the injury can be in any part of the body, with wide variations in entry point. Also, the path and possible fragmentation of the bullet within the body is unpredictable. The study of the dynamics of bullets in gunshot injuries is called terminal ballistics.

As a rule, all gunshot wounds are considered medical emergencies that require immediate treatment. Hospitals are generally required to report all gunshot wounds to police.

Onset of symptoms may be after just a few minutes, but usually occurs after at least 20 minutes of free hanging. Typical symptoms are pallor, sweating, shortness of breath, blurred vision, dizziness, nausea, hypotension and numbness of the legs. Eventually it leads to fainting, which may result in death due to oxygen deprivation of the brain.

Traumatic brain injury (TBI) is an exchangeable word used for the word concussion. This term refers to a mild brain injury. This injury is a result due to a blow to the head that could make the person’s physical, cognitive, and emotional behaviors irregular. Symptoms may include clumsiness, fatigue, confusion, nausea, blurry vision, headaches, and others. Mild concussions are associated with sequelae. Severity is measured using various concussion grading systems.

A slightly greater injury is associated with both anterograde and retrograde amnesia (inability to remember events before or after the injury). The amount of time that the amnesia is present correlates with the severity of the injury. In all cases the patients develop postconcussion syndrome, which includes memory problems, dizziness, tiredness, sickness and depression. Cerebral concussion is the most common head injury seen in children.

Presentation varies according to the injury. Some patients with head trauma stabilize and other patients deteriorate. A patient may present with or without neurological deficit. Patients with concussion may have a history of seconds to minutes unconsciousness, then normal arousal. Disturbance of vision and equilibrium may also occur. Common symptoms of head injury include coma, confusion, drowsiness, personality change, seizures, nausea and vomiting, headache and a lucid interval, during which a patient appears conscious only to deteriorate later.

Symptoms of skull fracture can include:

- leaking cerebrospinal fluid (a clear fluid drainage from nose, mouth or ear) may be and is strongly indicative of basilar skull fracture and the tearing of sheaths surrounding the brain, which can lead to secondary brain infection.

- visible deformity or depression in the head or face; for example a sunken eye can indicate a maxillar fracture

- an eye that cannot move or is deviated to one side can indicate that a broken facial bone is pinching a nerve that innervates eye muscles

- wounds or bruises on the scalp or face.

- Basilar skull fractures, those that occur at the base of the skull, are associated with Battle's sign, a subcutaneous bleed over the mastoid, hemotympanum, and cerebrospinal fluid rhinorrhea and otorrhea.

Because brain injuries can be life-threatening, even people with apparently slight injuries, with no noticeable signs or complaints, require close observation; They have a chance for severe symptoms later on. The caretakers of those patients with mild trauma who are released from the hospital are frequently advised to rouse the patient several times during the next 12 to 24 hours to assess for worsening symptoms.

The Glasgow Coma Scale (GCS) is a tool for measuring degree of unconsciousness and is thus a useful tool for determining severity of injury. The Pediatric Glasgow Coma Scale is used in young children. The widely used PECARN Pediatric Head Injury/Trauma Algorithm helps physicians weigh risk-benefit of imaging in a clinical setting given multiple factors about the patient—including mechanism/location of injury, age of patient, and GCS score.

Injury is damage to the body caused by external force. This may be caused by accidents, falls, hits, weapons, and other causes. Major trauma is injury that has the potential to cause prolonged disability or death.

In 2013, 4.8 million people died from injuries, up from 4.3 million in 1990. More than 30% of these deaths were transport-related injuries. In 2013, 367,000 children under the age of five died from injuries, down from 766,000 in 1990. Injuries are the cause of 9% of all deaths, and are the sixth-leading cause of death in the world.

The World Health Organization (WHO) developed the International Classification of External Causes of Injury (ICECI). Under this system, injuries are classified by

- mechanism of injury;

- objects/substances producing injury;

- place of occurrence;

- activity when injured;

- the role of human intent;

and additional modules. These codes allow the identification of distributions of injuries in specific populations and case identification for more detailed research on causes and preventive efforts.

The United States Bureau of Labor Statistics developed the Occupational Injury and Illness Classification System (OIICS). Under this system injuries are classified by

- nature,

- part of body affected,

- source and secondary source, and

- event or exposure.

The OIICS was first published in 1992 and has been updated several times since.

The Orchard Sports Injury Classification System (OSICS) is used to classify injuries to enable research into specific sports injuries.

The most common cause is accidents in which the person remains motionless suspended in a harness for longer periods of time. Motionlessness may have several causes including fatigue, hypoglycemia, hypothermia or traumatic brain injury.

A liver injury, also known as liver laceration, is some form of trauma sustained to the liver. This can occur through either a blunt force such as a car accident, or a penetrating foreign object such as a knife. Liver injuries constitute 5% of all traumas, making it the most common abdominal injury. Generally nonoperative management and observation is all that is required for a full recovery.

The primary symptom, hemorrhage, presents differently depending on the degree of injury, with the symptoms of major hemorrhage, shock, abdominal pain, and distention being clinically obvious. Minor hemorrhage often presents as upper left quadrant pain. Patients with unexplained left upper quadrant pain, particularly if there is evidence of hypovolemia or shock, are generally inquired regarding any recent trauma.

The primary concern in any splenic trauma is internal hemorrhage, though the exact amount of hemorrhage may be small or large, depending on the nature and degree of injury. Small or minor injuries often heal spontaneously, especially in children. Larger injuries hemorrhage extensively, often causing hemorrhagic shock. A splenic hematoma sometimes ruptures, usually in the first few days, although rupture can occur from hours to even months after injury.

Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues (such symptoms can occur in the absence of fractures as well). Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising. Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Asymmetry can suggest facial fractures or damage to nerves. People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin. With Le Fort fractures, the midface may move relative to the rest of the face or skull.

Liver injuries are classified on a Roman numeral scale with I being the least severe, to VI being the most severe. Generally any injury ≥III requires surgery.

Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures.

Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe. Depending on the type of facial injury, treatment may include bandaging and suturing of open wounds, administration of ice, antibiotics and pain killers, moving bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be necessary for other injuries such as traumatic brain injury, which commonly accompany severe facial trauma.

In developed countries, the leading cause of facial trauma used to be motor vehicle accidents, but this mechanism has been replaced by interpersonal violence; however auto accidents still predominate as the cause in developing countries and are still a major cause elsewhere. Thus prevention efforts include awareness campaigns to educate the public about safety measures such as seat belts and motorcycle helmets, and laws to prevent drunk and unsafe driving. Other causes of facial trauma include falls, industrial accidents, and sports injuries.

Blast-related ocular trauma comprises a specialized group of penetrating and blunt force injuries to the eye and its structure caused by the detonation of explosive materials. The incidence of ocular trauma due to blast forces has increased dramatically with the introduction of new explosives technology into modern warfare. The availability of these volatile materials, coupled with the tactics of contemporary terrorism, has caused a rise in the number of homemade bombs capable of extreme physical harm.

Birth trauma (BT) refers to damage of the tissues and organs of a newly delivered child, often as a result of physical pressure or trauma during childbirth. The term also encompasses the long term consequences, often of a cognitive nature, of damage to the brain or cranium. Medical study of birth trauma dates to the 16th century, and the morphological consequences of mishandled delivery are described in Renaissance-era medical literature. Birth injury occupies a unique area of concern and study in the medical canon. In ICD-10 "birth trauma" occupied 49 individual codes (P10-Р15).

However, there are often clear distinctions to be made between brain damage caused by birth trauma and that induced by intrauterine asphyxia. It is also crucial to distinguish between "birth trauma" and "birth injury". Birth injuries encompass any systemic damages incurred during delivery (hypoxic, toxic, biochemical, infection factors, etc.), but "birth trauma" focuses largely on mechanical damage. Caput succedaneum, subcutaneous hemorrhages, small subperiostal hemorrhages, hemorrhages along the displacements of cranial bones, intradural bleedings, subcapsular haematomas of liver, are among the more commonly reported birth injuries. Birth trauma, on the other hand, encompasses the enduring side effects of physical birth injuries, including the ensuing compensatory and adaptive mechanisms and the development of pathological processes (pathogenesis) after the damage.

The majority of blast-related ocular injuries occur in soldiers who present with other life-threatening injuries that require immediate intervention. Current Combat Support Hospital (CSH) protocol requires the surgical stabilization of any life-threatening injuries, as well as hemodynamic stability, prior to initial eye evaluation and surgical repair. Therefore, initiation of emergency ophthalmic care often occurs hours after injury. Initial examination by a military ophthalmologist begins with gross examination of each eye and orbital. 73-82% of all ocular injuries resulting from mine explosions are due to fragmentation of shrapnel upon detonation, so gross anatomical inspection by penlight may not rule out open globe injury. Harlan JB, Pieramici DJ. Evaluation of patients with ocular trauma. Ophthalmol Clin North Am. 2002; 15(2):153-61./ref> Computerized tomography (CT) may detect foreign matter and aid the clinician in determining the presence of an open-globe injury.

Testicular trauma is an injury to one or both testicles. Types of injuries include blunt, penetrating and degloving.

Because the testes are located within the scrotum, which hangs outside of the body, they do not have the protection of muscles and bones. This makes it easier for a testes to be struck, hit, kicked or crushed, which occurs most often during contact sports. Testicles can be protected by wearing athletic cups during sports.

Trauma to the testes can cause severe pain, bruising, swelling, and/or in severe cases even possible infertility. In most cases, the testes—which is spongy—can absorb some impact without serious damage. A rare type of testicular trauma, called testicular rupture, occurs when the testicle receives a direct blow or is squeezed against the hard bones of the pelvis. This injury can cause blood to leak into the scrotum and possibly even infertility and other complications. In severe cases, surgery to repair the rupture—and thus save the testicle—may be necessary.

In at least one case, testicular trauma was reported as the cause of a patient developing Systemic inflammatory response syndrome (SIRS) despite otherwise minor trauma.

Breath sounds on the side of the rupture may be diminished, respiratory distress may be present, and the chest or abdomen may be painful. Orthopnea, dyspnea which occurs when lying flat, may also occur, and coughing is another sign. In people with herniation of abdominal organs, signs of intestinal blockage or sepsis in the abdomen may be present. Bowel sounds may be heard in the chest, and shoulder or epigastric pain may be present. When the injury is not noticed right away, the main symptoms are those that indicate bowel obstruction.

A pancreatic injury is some form of trauma sustained by the pancreas. The injury can be sustained through either blunt forces, such as a motor vehicle accident, or penetrative forces, such as that of a gunshot wound. The pancreas is one of the least commonly injured organs in abdominal trauma.

Virtually all organ systems experience a progressive decline in function as a result of the aging process. One example is a decline in circulatory system function caused in part by thickening of the cardiac muscle. This can lead to congestive heart failure or pulmonary edema.

Atrophy of the brain begins to accelerate at around seventy years of age, which leads to a significant reduction in brain mass. Since the skull does not decrease in size with the brain, there is significant space between the two when this occurs which puts the elderly at a higher risk of a subdural hematoma after sustaining a closed head injury. The reduction of brain size can lead to issues with eyesight, cognition and hearing.

Vaginal trauma can occur when something is inserted into the vagina, for example, a sharp object, causing penetrating trauma.

The diagnosis of this form of injury can be challenging because of the pancreas' location inside the abdomen. The use of ultrasound can reveal fluid around the site of injury. Computed tomography (CT) can also be utilized as a non-invasive diagnostic tool, but its reliability is low; one retrospective case review found that computed tomography had either failed to find injuries or had underestimated the severity of injury in more than half of 17 pancreatic injury patients. Serum amylase has also been shown to be of limited diagnostic utility within the first three hours following injury. Management of a pancreatic injury can be difficult because other abdominal organs, such as the liver, usually have sustained trauma as well. Several common symptoms manifest hours after the injury such as tachycardia, abdominal distension, and midepigastric tenderness. Indications for surgical intervention include: peritonitis based on physical examination; hypotension in combination with a positive focussed assessment with sonography (ultrasound) for trauma (FAST); and pancreatic duct disruption based on the results of thin-cut computed tomography or endoscopic retrograde cholangiopancreatography (ERCP). Commonly, a laparotomy is done in order to directly visualize the injury, and generally this approach is the most accurate diagnostic method.

Vulvar trauma is more common in prepubertal children due to small labial fat pads and more physical activity. Adults are more protected. Though some injuries are serious, most are accidental minor blunt traumas. The most common type of injury is a straddle injury, which can be incurred through normal activities like bicycle riding. Due to the vascularity of the vulva, it may form a large hematoma when injured. The vulva can also be injured through sexual assault. Vulvar trauma can occur concurrently with vaginal trauma, especially if a sharp object is involved.

Diaphragmatic rupture (also called diaphragmatic injury or tear) is a tear of the diaphragm, the muscle across the bottom of the ribcage that plays a crucial role in respiration. Most commonly, acquired diaphragmatic tears result from physical trauma. Diaphragmatic rupture can result from blunt or penetrating trauma and occurs in about 5% of cases of severe blunt trauma to the trunk.

Diagnostic techniques include X-ray, computed tomography, and surgical techniques such as laparotomy. Diagnosis is often difficult because signs may not show up on X-ray, or signs that do show up appear similar to other conditions. Signs and symptoms included chest and abdominal pain, difficulty breathing, and decreased lung sounds. When a tear is discovered, surgery is needed to repair it.

Injuries to the diaphragm are usually accompanied by other injuries, and they indicate that more severe injury may have occurred. The outcome often depends more on associated injuries than on the diaphragmatic injury itself. Since the pressure is higher in the abdominal cavity than the chest cavity, rupture of the diaphragm is almost always associated with herniation of abdominal organs into the chest cavity, which is called a traumatic diaphragmatic hernia. This herniation can interfere with breathing, and blood supply can be cut off to organs that herniate through the diaphragm, damaging them.