CSI: WhiteCoat #2
Posted by WhiteCoat on May 5, 2008
Everyone seemed to like CSI: WhiteCoat #1 … so here’s another one.
A patient is rushed to your emergency department with a gunshot wound to the chest. Despite your best efforts, he is unable to be resuscitated and dies. The paramedics report that he was found in the back of an alley after being shot in a drive-by shooting while playing craps with some friends.
Police visit your emergency department to make a positive ID, stating that they have a suspect in custody who was a known gang member and who was seen speeding away from the scene. They found a .38 caliber revolver in the car and believe it to be the murder weapon.
What can you tell the detectives based on the appearance of the patient’s hand?
Answer is in the comments section.
WhiteCoat said
If the patient was shot at the back of an alley, it wasn’t a drive-by shooting.
Secondary effects from gunshot wounds can be divided into four categories: contact wounds, close-range wounds, intermediate-range wounds, and long-range wounds.
When a gun is held against the skin and fired, the bullet penetrating the skin is accompanied by all the byproducts of gunpowder combustion including hot gases, soot, and unburned gunpowder. The resulting contact wound often appears burned or singed around the edges and soot is usually distributed in a tight circumference around the wound edges and within the wound itself. Sometimes the hot gases will track under the skin and cause the surrounding tissues to blow outward, causing irregular tears in the skin surface.
Close-range wounds are usually 12 inches or less and typically show the deposition of soot either on the wound or on the clothing surrounding the wound. Soot appears as a fairly confluent black discoloration to the skin or clothing while tattooing due to impact from flecks of unburned gunpowder appears as multiple small black marks (like this patient had). Soot can be removed with wound debridement or cleansing while tattooing cannot.
Gunshots from a distance of approximately 12 to 36 inches will produce a characteristic tattooing as noted in this patient and are classified as intermediate-range wounds. The distance between the gun and skin required to produce tattooing depends upon the caliber of the bullet, gun characteristics, degree at which the gun was pointed toward the victim, and any objects between the barrel of the gun and the victim’s skin. For example, a higher-powered gun with a long muzzle may produce tattooing from a longer distance while a person wearing a heavy coat who is shot at close range may have no skin tattooing at all.
Long-range wounds are generally from more than 36 inches and the bullet is the only projectile coming in contact with the victim. There is no accurate way to judge the distance from which a long-range wound was inflicted. Note that bullets fired from a long distance can ricochet or hit other objects (such as glass, brick, or concrete), causing them to fragment, become projectiles, and create “pseudo-tattooing.”
In this case, the police were alerted to the presence of the tattooing on the hand of the victim. When police questioned the victim’s friends further, the friends admitted that they were not playing craps in the back of the alley, but were playing with a loaded gun when it accidentally went off.
TK said
These are powder burns. This means he was shot a very close range – likely by another card player. Not a drive-by.
crankyprof said
In addition to the powder burns, that looks like a hammer-pinch on the hand. Did patient try to grab the barrel of the gun as it was being fired?
We actually thought that the larger mark on the hand was made by the bullet. He wouldn’t have been able to have a hammer pinch on the side of one finger and still have the tattooing on the backs of his other fingers – the fingers had to be 12-36 inches from the muzzle of the gun to get that pattern (unless there was more than one bullet fired)
Skye said
my first thought before reading this is that it appears the patient had grabbed the barrel at the time gun was fired.
William the Coroner said
This is an intermediate range wound–I would estimate range of fire from 24 to 6 inches, on the higher end. No soot, so not under 6″, and the tattoo pattern looks fairly well spread, but you need to test fire the weapon.
This looks like the hand was the intermediate target, between the chest and the muzzle, perhaps in a “defensive” posture–the victim tried to knock the bullet away (which doesn’t work)
Donna said
defensive wound with stippling, (powder burns/tattooing), not a drive by, his boy walked up to him and shot him, or he walked out to the car, either way, close contact, within a foot I’d say, just off hand without shooting the gun.
Donna said
p.s., give us more, this is fun!
Wish I had more. I only have one more and I’ll probably save that one for a boring day when I don’t have anything to post.
rogue medic said
Was he grabbing for the gun to “play” with it himself or did somebody point the gun at him and shoot him intentionally? If his hand was trying to deflect the gun, or bullet, he may have felt threatened.
I’m not sure the circumstances behind the shooting. All that I knew at the time was that it wasn’t a drive-by.
This Guy said
Whitecoat said: “If the patient was shot at the back of an alley, it wasn’t a drive-by shooting,” but the original post read: “The paramedics report that he was found in the back of an alley after being shot in a drive-by shooting while playing craps with some friends.”
Medics are saying he was *found* in the back of the alley, not necessarily *shot* there. But then again, they said he was shot “while playing craps”, which is more likely to be happening more toward the back of the alley than near the street.
Unless, of course, it was a very short alley…
Tour de Derby, Battery ball, and a lab coat « Sitting Pugs: Sports Movies said
[...] of medical examiners, I came across the following WordPress entry entitled “CSI: WhiteCoat #2” over at White Coat Rants. Check it out if you want to learn about gunshot wounds. [...]
doug said
It looks like he was skin popping. The larger leison could be an abcess. I think it was a drug deal gone bad.
sadnezz said
I don’t think this is a drive-by shooting. The hand wound seems to be injured by a nearby person. I think this is what happened: The patient probably got into an argument with someone. Out of anger, the other person pulled out a gun and pointed at the patient. The patient tried to grab the gun away from the other person, and during the struggle, he got shot on the hand (because looking at the wound, it seems unlikely that the other person intentionally wanted to shoot at that spot). Afterwards, the other person shot the patient on the chest and the patient died from this wound and not from the wound on his hand.
OnlineSnitch.com » CSI: WhiteCoat said
[...] to guess what happened to this patient who was [...]
Bassel Deeb said
It would be better to see the intrance wound in the chest. What seems in the picture is not a powder tattooing as it is light and assymetrical. It is a stippling or pseudo tattooing. It may be a result of ricocheting bullet.