Citation

Antonucci MU. Ann. Intern Med. 2019; 171(4): 304-305.

Affiliation

Medical University of South Carolina, Charleston, South Carolina (M.U.A.).

Copyright

(Copyright © 2019, American College of Physicians)

DOI

10.7326/L19-0210

PMID

31426068

Abstract

With the recent mass shootings in Thousand Oaks, California, and the Pittsburgh Tree of Life Synagogue adding to the increasing number of gun-related deaths in the United States, physicians promoting guidelines to reduce firearm-related violence (1) have been instructed by the National Rifle Association to “stay in their lane.” Taichman and colleagues' editorial (2) reflects a powerful refusal to be silenced and counters the National Rifle Association's tweet with both strong evidence and common sense. Data released since the publication of this editorial reveal that a record number of school shootings took place in 2018 (3), which further highlights the urgency of this issue. Against this backdrop, and contrary to its initial goal, the National Rifle Association's suggestion has motivated physicians across specialties to examine their lane and identify ways to combat escalating gun violence.

As a neuroradiologist, my lane traverses behind the scenes. I am spatially removed from patients and indirectly evaluate them through images. Clinical colleagues (who directly interact with patients) typically have a more complete overview of specific issues, but the extent of damage from a bullet is a notable exception. Although I am spared such emotional tasks as conveying prognostic information to the families of victims, I have a more vivid first look at the pathologic characteristics of ballistic trajectories. On clinical examination, superficial skin laceration and hematoma around a scalp entry wound (and, if present, exit wound) belie the more substantial intracranial findings seen on medical imaging. These can include skull and metallic fragments within brain tissue, resultant hemorrhage in and damage to eloquent cortex and white-matter tracts, edema, and herniation.

In my lane, the prevalence of gun violence is alarmingly apparent. For example, over a particularly taxing call weekend ...

Language: en