- Email: [email protected]
Safety of Imaging Exploding Bullets With Ultrasound
INJURY PREVENTION/ORIGINAL
CONTRIBUTION
afety of Imaging Exploding Bullets With Ultrasound From the Department of Emergency Medicine, Kaiser Permanente Medical Center, Santa Rosa, California*; the Bureau of Forensic Services, California Criminalistics Institute, Sacramento, Calif~rnia¢; and the Department of Radiology', University of California, Davis, California.~
Dan Schlager, MD*
Study objective: To evaluate the safety of using ultrasound to
Torrey Johnson, MS*
image exploding bullets that have not detonated.
Russ McFall, MD §
Receivedfor publication March 22, i995. Revisions received August25, 1995 and January 22, 1996. Accepted for publication March 5, 1996. Copyright © by the American College of Emergency Physicians.
AUGUST 1996
28:2 ANNALS OF EMERGENCY MEDICINE
Methods: We evaluated various types of exploding bullets using ultrasonography at various depths with various transducers and using standard radiography. Results: None of the unexploded bullets subjected to ultrasonography or standard radiography exploded. Conclusion: Our results suggest that evaluation of exploding bullets with ultrasonography is safe. [Schlager D, Johnson 7-, McFall R: Safety of imaging exploding bullets with ultrasound. Ann EmergMedAugust1996;28:183187.]
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EXPLODING BULLETS 5chlager et al
ii
INTRODUCTION
Ultrasound is now frequently used in emergency departments to evaluate trauma. >1o Ultrasound emits considerable energy, and although its effect on exploding bullets has never been studied, some believe this energy could be enough to detonate a bullet, causing harm to patient and physician. 11 Exploding bullets usually have a cavity in the tip filled with explosive materials designed to maximize the bullet's energy and effect. They are intended to detonate on impact, creating a larger wound than that caused by a standard bullet. Exploding bullets have several types of ignition systems. The Devastator (Bingham Limited) contains a small capsule of a primary explosive (such as lead azide); Velex (Velex Cartridge Company) and Exploder bullets (Bingham Limited) have a cavity containing black powder or a similar pyrotechnic mixture that is ignited by a percussion cap or primer sealing the open end of the cavity. The "homemade" exploding bullet relies on the normal primer and powder in the .22 blank cartridge. In this study we tested the effect of standard diagnostic ultrasound on a variety of exploding bullets and evaluated the safety of this imaging technique for patient and physician. MATERIALS AND METHODS
We imaged four types of exploding bullets: (1) Devastator bullets in .22 short, .22 long riP[e, and .22 magnum calibers; (2) Velex in 9-mm parabellum caliber; (3) Exploder Figure 1. Ultrasound image, made with a 7.5-MHzprobe, of a Devastator cartridge with an unfired exploding bullet. Note comet-tail artifact.
184
in 9-ram parabellum caliber; and (4) homemade exploding bullets made from PMC Ultramags in .38 special caliber (Poongsan Metal Manufacturing Company Limited, Seoul, South Korea) and Winchester .22 short blank cartridges. For sonography, the bullets were embedded in 10% ballistic gelatin. Photography was then used to record the images (Figures 1 and 2). All imaging lasted for at least 30 seconds, and each bullet was imaged with 10 cycles of exposure for 5 minutes. We also fired samples of each variety of bullet into the gelatin (250A ordnance type; Knox and Kind Company) to demonstrate the effect of exploding bullets on human tissue. We wanted to ensure that the bullets would function as designed and that we would not be basing our assumptions on defective lots of bullets. The 10% gelatin, prepared according to the method of Fackler and Malinowski 13, has been found suitable for duplicating the reaction of human soft tissue during the passage of a missile, t4 We tested the gelatin's properties by firing. 17caliber BBs into the gelatin. The BBs penetrated a mean of 10.5 cm when fired at an average velocity of 601 feet/second. Velocities were recorded with an Oehler chronograph. All bullets exploded. Unexploded bullets (still in the cartridge) from the same package as the exploded bullets were then placed in gel at depths of 1 inch or 3 inches and imaged with a Damon portable ultrasound unit and a 7.5-MHz and a 5MHz transducer. The bullets were identified on the ultrasound screen and imaged for at least 30 seconds. The cubes of gel were then taken to the University of California Figure 2,
Ultrasound, with a 7.5-MHz probe, of a Devastator cartridge.
ANNALS OF EMERGENCY MEDICINE
28:2
AUGUST 1996
EXPLODING BULLETS 5chlager et al
at Davis, where they were subjected without incident to standard radiography. The Damon ScanMate ultrasound system is a portable unit measuring 7.3 cm high x 21 cm wide x 24.5 cm deep. It comprises a 5.7-cm diagonal display cathode ray tube and an end-viewing probe in which the crystal mechanically oscillates through a maximum of 80 degrees. We used 5.0-MHz and. 7.5-MHz probes. The system is powered by direct current voltage from rechargeable nickel-cadmium batteries or art AC adapter. Voltage is +6.9 VDC at 1.5 A and -6.9 VDC at -1.5 A. Current is 1.5 A. RESULTS
None of the exploding-tip bullets was detonated by ultrasound imaging or standard radiography. We obtained 50 ultrasound and radiographic images without incident. On ultrasound, the unfired bullets had a characteristic comettail appearance (Figure 1). Explosive bullets (except the homemade PMC type) also show the characteristic pattern depicted in the gelatin blocks: multiple fragmented pieces of bullet metal near the surface of the wound. This same pattern would be demonstrated on radiographic imaging because the multiple metal fragments would be seen near the surface. Undetonated exploding pistol bullets and conventional pistol bullets penetrate much deeper into a wound, and usually do not have multiple fragmented particles. ~5 DISCUSSION
The characteristic comet-tail effect has been noted in previous studies of metallic foreign bodies. ~6-~s Devastator
bullets, according to the manufacturer, have relatively high stopping power and transfer maximum energy to the target without deeply penetrating it (Figures 3-5). These bullets were used (in .22 long rifle caliber 19,2°) in the 1981 assassination attempt against President Ronald Reagan. However, the bullet that struck Reagan did not explode on impact; it is believed to have ricocheted off the president's armored limousine. ~~ These bullets may not cause more severe injuries than those resulting from nonexploding bullets of similar mass and velocity is because they do not penetrate as deeply as other bullets and therefore miss vital organs. However, these bullets do cause an unusually large entrance deficit in the skin, with extensive tissue extrusion and projectile fragmentation, is:9 In the manufacture of Devastator bullets, a hole about the diameter of the hollow-point cavity is drilled in the tip of the bullet. An aluminum cylinder--filled with an explosive mixture and its open end sealed--is then inserted in this hole. The cylinder is inserted with the sealed end toward the base of the bullet. The other end of the cylinder is recessed a few hundredths of an inch~ RDX explosive was originally used in the cylinder, but it has been replaced with lead azide. Lead azide was used in the bullet with which President Reagan was shot. 21 Exploding rifle bullets have been described as far back as the early 19th century. They were used by Union and Confederate forces during the Civil War. 21 Alteration of bullets to make then: more effective in producing fatal or incapacitating wounds can be traced back to the British military campaigns in India, where bullets were physically altered to fragment after impact. This modification was
Figure 3.
Devastator cartridge in original packaging.
AUGUST 1996
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Schlager et al
reportedly used in the village of Dum-Dum, so the modified bullets became known as dumdum bullets. 11,12 More recently, attempts have been made to drill bullets so cyanide might be inserted. The rebirth of exploding bullets was noted in the early 1980s, when medical examiners in Miami, Minneapolis, and Baltimore reported the characteristic wounding effects of handmade exploding bullets. 13,~8,22 Before the attempted assassination of President Reagan in 1981, exploding bullets were commercially available in calibers ranging from .22 to .45. Their availability is now more restricted. Previous research has shown that Devastator bullets only detonate reliably when fired into substrate at an angle of 90 degrees33 This finding helps explain why these bullets did not explode in the assassination attempt and why the possibility exists of unexpectedly encountering an unexploded bullet in the examination of a patient with penetrating trauma.
Our study was limited in that we only used one type of ultrasound machine, with 5.0-MHz and 7.5-MHz transducers. Nonetheless, because the US Food and Drug Administration has mandated a maximum level of intensity for diagnostic ultrasound equipment sold in the United States, we believe our machine generated a representative intensity and energy level for standard diagnostic ultrasound imaging. 23 This study is the first to demonstrate the safety of using ultrasound imaging to evaluate penetrating trauma that may have been caused by an undetonated exploding bullet. In this setting, routine ultrasonography or radiography does not produce the energy required to detonate these bullets and is safe for diagnostic use. REFERENCES 1. SchlagerD, LazzareschiG, Whitten D, et al: A prospectivestudy of ultrasonographyin the ED by emergencyphysicians.Am J EmergMarl1994;12:185-189. 2. Colucciello SA: Blunt abdominal trauma. EmergClin NorthAm 1993;11:107-123.
Figure 4. Three .22-caliber short Devastator bullets that exploded on impact with ordnance gelatin, showing fragmentation and residue in the permanent cavity.
3. Luks FI, LemiraA, St-Vii D, et ah Blunt abdominal trauma in children: The practical value of ultrasonography. J Trauma1993;34:607-61O; discussion 610-611. 4. Waning JV: Evaluationof ultrasound, lavage,and computedtomographyin blunt abdominal trauma. SurgEndosc1989;3:152-158. 5. GrE)essnarR, Mentges B, DQberC, et ah Sonographyversus peritoneal lavagein blunt abdominal trauma. J Trauma1989;29:242-244. 6. SchwartzM, Weaver F, Yellin A, et ah The utility of color flaw Dopplerexamination in penetrating extremity arterial trauma. Am Surg1993;59:375-378. 7. FrankRG, GerardPS, FeldhamerL: Serial sonographicevaluationof "buckshot colic" following a penetrating gunshotwoun& UrolRadial 1992;14:172-176. 8. Brathwaite CEM,Weiss RL, Baldino WA, et ah Multichamber gunshotwounds of the heart: The utility of transesophagealechocardiography.Chest1992;101:287-288. 9. Mclntyre RCJr, Moore EE, ReadRR, et ah Transesophagealechocardiographyin the evaluation of a transmediastinalgunshot wound: Casereport. J Trauma1994;36:125-127. 10. Xie SW, Picard MH: Two-dimensional and color Doppler echocardiographicdiagnosis of penetrating missile wounds of the heart: Chroniccomplicationsfrom intracardiaccourse of a bullet. JAm Sac Echocardiogr1992;5:81-84. 11. EckertWG: Exploding bullets: A hazardto the victim, physician, and investigator[editorial]. Am J ForensicMad Pathol1981;2:103-104. 12. FacklerML: Gunshotwound review. Ann EmergMad 1996;29:194-203. 13. FacklerML, Malinowski JA: Ordnancegelatin for ballistic studies. Am JForensicMedPathol 1988;9:218-219. 14. FacklerML, Malinowski JA: The wound profile: A visual method for quantifying gunshot wound components.J Trauma1985;25:522- 529. 15. Jesselsan AR, Johnson AC, Washington WD, et ah A study of .22 caliber rimfire exploding bullets: Effects in ordnancegelatin. J ForensicSci 1985;30:760-772. 16. Schlager O, SandersAB, Wiggins D, et ah Ultrasound for the detection of foreign bodies. Ann EmergMed1991;2:189-191. 17. Goading GAW, HardimanT, Sumers M, et ah Sonographyof the hand and foot in foreign body detection. J UltrasoundMeal1987;6:441-447. 18. Ziskin MC, Thickman DI, GoldenbergNJ, et ah The comet tail artifact. J UltrasoundMad 1982;1:1-7. 19. Clark MA, Smith TD, FisherRS: Russian roulette with exploding bullets: A case report. Am J ForensicMed Pathol 1981;2:167-169. 20. Ballistic data: Exploderammunition. Norcross,Georgia: Bingham,Limited, 1980.
1 86
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EXPLODING BULLETS Schlage~ et al
21. Tate LG, DiMaia VJM, Davis JH: Rebirth of exploding ammunition: A report of six human fatalities. J ForensicSci1981;26:636-644. 22. AmatuzioJC, Coe Jh Homicide by Exploderammunition. Am J ForensicMed Patho/ 1981;2:111-113. 23. Revised510(k)diagnostic ultrasound guidancefor 1993. Rockville, Maryland: Centerfor Devices and Radiological Health, US Departmentof Health and Human Services, 1993.
George Kass, ForensicAmmunition Service, Okemos, Michigan, providedcartridges used in this study. Gelatin was prepared by the California Highway Patrol Academy technical staff. Tha Medical Editing Department, Kaiser FoundationResearch Institute, providededitorial assistance.
Reprint no. 47/1/74141 Address for reprints: Dan Schlager, MD Department of EmergencyMedicine Kaiser PermanenteMedical Center 401 BicentennialWay Santa Rosa, California95403-2192
Figure 5. Fragments of three •22-caliber ,;hort Devastator i)ullets after extracl:ion from ordnance ge!atin.
AUGUST 1996
D e v a s t a t o r - .22 short
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@
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CONTRIBUTION
afety of Imaging Exploding Bullets With Ultrasound From the Department of Emergency Medicine, Kaiser Permanente Medical Center, Santa Rosa, California*; the Bureau of Forensic Services, California Criminalistics Institute, Sacramento, Calif~rnia¢; and the Department of Radiology', University of California, Davis, California.~
Dan Schlager, MD*
Study objective: To evaluate the safety of using ultrasound to
Torrey Johnson, MS*
image exploding bullets that have not detonated.
Russ McFall, MD §
Receivedfor publication March 22, i995. Revisions received August25, 1995 and January 22, 1996. Accepted for publication March 5, 1996. Copyright © by the American College of Emergency Physicians.
AUGUST 1996
28:2 ANNALS OF EMERGENCY MEDICINE
Methods: We evaluated various types of exploding bullets using ultrasonography at various depths with various transducers and using standard radiography. Results: None of the unexploded bullets subjected to ultrasonography or standard radiography exploded. Conclusion: Our results suggest that evaluation of exploding bullets with ultrasonography is safe. [Schlager D, Johnson 7-, McFall R: Safety of imaging exploding bullets with ultrasound. Ann EmergMedAugust1996;28:183187.]
I 83
EXPLODING BULLETS 5chlager et al
ii
INTRODUCTION
Ultrasound is now frequently used in emergency departments to evaluate trauma. >1o Ultrasound emits considerable energy, and although its effect on exploding bullets has never been studied, some believe this energy could be enough to detonate a bullet, causing harm to patient and physician. 11 Exploding bullets usually have a cavity in the tip filled with explosive materials designed to maximize the bullet's energy and effect. They are intended to detonate on impact, creating a larger wound than that caused by a standard bullet. Exploding bullets have several types of ignition systems. The Devastator (Bingham Limited) contains a small capsule of a primary explosive (such as lead azide); Velex (Velex Cartridge Company) and Exploder bullets (Bingham Limited) have a cavity containing black powder or a similar pyrotechnic mixture that is ignited by a percussion cap or primer sealing the open end of the cavity. The "homemade" exploding bullet relies on the normal primer and powder in the .22 blank cartridge. In this study we tested the effect of standard diagnostic ultrasound on a variety of exploding bullets and evaluated the safety of this imaging technique for patient and physician. MATERIALS AND METHODS
We imaged four types of exploding bullets: (1) Devastator bullets in .22 short, .22 long riP[e, and .22 magnum calibers; (2) Velex in 9-mm parabellum caliber; (3) Exploder Figure 1. Ultrasound image, made with a 7.5-MHzprobe, of a Devastator cartridge with an unfired exploding bullet. Note comet-tail artifact.
184
in 9-ram parabellum caliber; and (4) homemade exploding bullets made from PMC Ultramags in .38 special caliber (Poongsan Metal Manufacturing Company Limited, Seoul, South Korea) and Winchester .22 short blank cartridges. For sonography, the bullets were embedded in 10% ballistic gelatin. Photography was then used to record the images (Figures 1 and 2). All imaging lasted for at least 30 seconds, and each bullet was imaged with 10 cycles of exposure for 5 minutes. We also fired samples of each variety of bullet into the gelatin (250A ordnance type; Knox and Kind Company) to demonstrate the effect of exploding bullets on human tissue. We wanted to ensure that the bullets would function as designed and that we would not be basing our assumptions on defective lots of bullets. The 10% gelatin, prepared according to the method of Fackler and Malinowski 13, has been found suitable for duplicating the reaction of human soft tissue during the passage of a missile, t4 We tested the gelatin's properties by firing. 17caliber BBs into the gelatin. The BBs penetrated a mean of 10.5 cm when fired at an average velocity of 601 feet/second. Velocities were recorded with an Oehler chronograph. All bullets exploded. Unexploded bullets (still in the cartridge) from the same package as the exploded bullets were then placed in gel at depths of 1 inch or 3 inches and imaged with a Damon portable ultrasound unit and a 7.5-MHz and a 5MHz transducer. The bullets were identified on the ultrasound screen and imaged for at least 30 seconds. The cubes of gel were then taken to the University of California Figure 2,
Ultrasound, with a 7.5-MHz probe, of a Devastator cartridge.
ANNALS OF EMERGENCY MEDICINE
28:2
AUGUST 1996
EXPLODING BULLETS 5chlager et al
at Davis, where they were subjected without incident to standard radiography. The Damon ScanMate ultrasound system is a portable unit measuring 7.3 cm high x 21 cm wide x 24.5 cm deep. It comprises a 5.7-cm diagonal display cathode ray tube and an end-viewing probe in which the crystal mechanically oscillates through a maximum of 80 degrees. We used 5.0-MHz and. 7.5-MHz probes. The system is powered by direct current voltage from rechargeable nickel-cadmium batteries or art AC adapter. Voltage is +6.9 VDC at 1.5 A and -6.9 VDC at -1.5 A. Current is 1.5 A. RESULTS
None of the exploding-tip bullets was detonated by ultrasound imaging or standard radiography. We obtained 50 ultrasound and radiographic images without incident. On ultrasound, the unfired bullets had a characteristic comettail appearance (Figure 1). Explosive bullets (except the homemade PMC type) also show the characteristic pattern depicted in the gelatin blocks: multiple fragmented pieces of bullet metal near the surface of the wound. This same pattern would be demonstrated on radiographic imaging because the multiple metal fragments would be seen near the surface. Undetonated exploding pistol bullets and conventional pistol bullets penetrate much deeper into a wound, and usually do not have multiple fragmented particles. ~5 DISCUSSION
The characteristic comet-tail effect has been noted in previous studies of metallic foreign bodies. ~6-~s Devastator
bullets, according to the manufacturer, have relatively high stopping power and transfer maximum energy to the target without deeply penetrating it (Figures 3-5). These bullets were used (in .22 long rifle caliber 19,2°) in the 1981 assassination attempt against President Ronald Reagan. However, the bullet that struck Reagan did not explode on impact; it is believed to have ricocheted off the president's armored limousine. ~~ These bullets may not cause more severe injuries than those resulting from nonexploding bullets of similar mass and velocity is because they do not penetrate as deeply as other bullets and therefore miss vital organs. However, these bullets do cause an unusually large entrance deficit in the skin, with extensive tissue extrusion and projectile fragmentation, is:9 In the manufacture of Devastator bullets, a hole about the diameter of the hollow-point cavity is drilled in the tip of the bullet. An aluminum cylinder--filled with an explosive mixture and its open end sealed--is then inserted in this hole. The cylinder is inserted with the sealed end toward the base of the bullet. The other end of the cylinder is recessed a few hundredths of an inch~ RDX explosive was originally used in the cylinder, but it has been replaced with lead azide. Lead azide was used in the bullet with which President Reagan was shot. 21 Exploding rifle bullets have been described as far back as the early 19th century. They were used by Union and Confederate forces during the Civil War. 21 Alteration of bullets to make then: more effective in producing fatal or incapacitating wounds can be traced back to the British military campaigns in India, where bullets were physically altered to fragment after impact. This modification was
Figure 3.
Devastator cartridge in original packaging.
AUGUST 1996
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ANNALS OF EMERGENCY MEDICINE
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E X P L O D I N G BULLETS
Schlager et al
reportedly used in the village of Dum-Dum, so the modified bullets became known as dumdum bullets. 11,12 More recently, attempts have been made to drill bullets so cyanide might be inserted. The rebirth of exploding bullets was noted in the early 1980s, when medical examiners in Miami, Minneapolis, and Baltimore reported the characteristic wounding effects of handmade exploding bullets. 13,~8,22 Before the attempted assassination of President Reagan in 1981, exploding bullets were commercially available in calibers ranging from .22 to .45. Their availability is now more restricted. Previous research has shown that Devastator bullets only detonate reliably when fired into substrate at an angle of 90 degrees33 This finding helps explain why these bullets did not explode in the assassination attempt and why the possibility exists of unexpectedly encountering an unexploded bullet in the examination of a patient with penetrating trauma.
Our study was limited in that we only used one type of ultrasound machine, with 5.0-MHz and 7.5-MHz transducers. Nonetheless, because the US Food and Drug Administration has mandated a maximum level of intensity for diagnostic ultrasound equipment sold in the United States, we believe our machine generated a representative intensity and energy level for standard diagnostic ultrasound imaging. 23 This study is the first to demonstrate the safety of using ultrasound imaging to evaluate penetrating trauma that may have been caused by an undetonated exploding bullet. In this setting, routine ultrasonography or radiography does not produce the energy required to detonate these bullets and is safe for diagnostic use. REFERENCES 1. SchlagerD, LazzareschiG, Whitten D, et al: A prospectivestudy of ultrasonographyin the ED by emergencyphysicians.Am J EmergMarl1994;12:185-189. 2. Colucciello SA: Blunt abdominal trauma. EmergClin NorthAm 1993;11:107-123.
Figure 4. Three .22-caliber short Devastator bullets that exploded on impact with ordnance gelatin, showing fragmentation and residue in the permanent cavity.
3. Luks FI, LemiraA, St-Vii D, et ah Blunt abdominal trauma in children: The practical value of ultrasonography. J Trauma1993;34:607-61O; discussion 610-611. 4. Waning JV: Evaluationof ultrasound, lavage,and computedtomographyin blunt abdominal trauma. SurgEndosc1989;3:152-158. 5. GrE)essnarR, Mentges B, DQberC, et ah Sonographyversus peritoneal lavagein blunt abdominal trauma. J Trauma1989;29:242-244. 6. SchwartzM, Weaver F, Yellin A, et ah The utility of color flaw Dopplerexamination in penetrating extremity arterial trauma. Am Surg1993;59:375-378. 7. FrankRG, GerardPS, FeldhamerL: Serial sonographicevaluationof "buckshot colic" following a penetrating gunshotwoun& UrolRadial 1992;14:172-176. 8. Brathwaite CEM,Weiss RL, Baldino WA, et ah Multichamber gunshotwounds of the heart: The utility of transesophagealechocardiography.Chest1992;101:287-288. 9. Mclntyre RCJr, Moore EE, ReadRR, et ah Transesophagealechocardiographyin the evaluation of a transmediastinalgunshot wound: Casereport. J Trauma1994;36:125-127. 10. Xie SW, Picard MH: Two-dimensional and color Doppler echocardiographicdiagnosis of penetrating missile wounds of the heart: Chroniccomplicationsfrom intracardiaccourse of a bullet. JAm Sac Echocardiogr1992;5:81-84. 11. EckertWG: Exploding bullets: A hazardto the victim, physician, and investigator[editorial]. Am J ForensicMad Pathol1981;2:103-104. 12. FacklerML: Gunshotwound review. Ann EmergMad 1996;29:194-203. 13. FacklerML, Malinowski JA: Ordnancegelatin for ballistic studies. Am JForensicMedPathol 1988;9:218-219. 14. FacklerML, Malinowski JA: The wound profile: A visual method for quantifying gunshot wound components.J Trauma1985;25:522- 529. 15. Jesselsan AR, Johnson AC, Washington WD, et ah A study of .22 caliber rimfire exploding bullets: Effects in ordnancegelatin. J ForensicSci 1985;30:760-772. 16. Schlager O, SandersAB, Wiggins D, et ah Ultrasound for the detection of foreign bodies. Ann EmergMed1991;2:189-191. 17. Goading GAW, HardimanT, Sumers M, et ah Sonographyof the hand and foot in foreign body detection. J UltrasoundMeal1987;6:441-447. 18. Ziskin MC, Thickman DI, GoldenbergNJ, et ah The comet tail artifact. J UltrasoundMad 1982;1:1-7. 19. Clark MA, Smith TD, FisherRS: Russian roulette with exploding bullets: A case report. Am J ForensicMed Pathol 1981;2:167-169. 20. Ballistic data: Exploderammunition. Norcross,Georgia: Bingham,Limited, 1980.
1 86
ANNALS OF EMERGENCY MEDICINE
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EXPLODING BULLETS Schlage~ et al
21. Tate LG, DiMaia VJM, Davis JH: Rebirth of exploding ammunition: A report of six human fatalities. J ForensicSci1981;26:636-644. 22. AmatuzioJC, Coe Jh Homicide by Exploderammunition. Am J ForensicMed Patho/ 1981;2:111-113. 23. Revised510(k)diagnostic ultrasound guidancefor 1993. Rockville, Maryland: Centerfor Devices and Radiological Health, US Departmentof Health and Human Services, 1993.
George Kass, ForensicAmmunition Service, Okemos, Michigan, providedcartridges used in this study. Gelatin was prepared by the California Highway Patrol Academy technical staff. Tha Medical Editing Department, Kaiser FoundationResearch Institute, providededitorial assistance.
Reprint no. 47/1/74141 Address for reprints: Dan Schlager, MD Department of EmergencyMedicine Kaiser PermanenteMedical Center 401 BicentennialWay Santa Rosa, California95403-2192
Figure 5. Fragments of three •22-caliber ,;hort Devastator i)ullets after extracl:ion from ordnance ge!atin.
AUGUST 1996
D e v a s t a t o r - .22 short
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