Soldier Suicide with a Firearm: A Case Report with an Approach to Hemorrhagic Shock Control in the Emergency Department
Abstract
Military personnel face a heightened risk of suicide due to firearm accessibility. Bullet impacts can cause significant tissue damage and bleeding, which varies depending on the affected area. This report details a case of a 20-year-old Iranian Baluch soldier who was admitted to the emergency room with hemorrhagic shock after suicide with a firearm. The bullet damaged his mandible, tongue, and maxilla, exited from his forehead, and damaged his nose. In hemorrhagic shock, prioritize blood products over isotonic fluids; consider norepinephrine if hemodynamics remain unstable.
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[10] David JS, Spann C, Marcotte G, Reynaud B, Fontaine O, Lefèvre M, et al. Haemorrhagic shock, therapeutic management. Ann Fr Anesth Reanim. 2013; 32(7-8):497-503.
[11] Petros S. Trauma-Induced Coagulopathy. Hamostaseologie. 2019; 39(1):20-7.
[12] Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, et al. Trauma-induced coagulopathy. Nat Rev Dis Primers. 2022; 8(1):25.
[13] Rudloff E, Hopper K. Crystalloid and Colloid Compositions and Their Impact. Front Vet Sci. 2022; 9:878702.
[14] Gillissen A, van den Akker T, Caram-Deelder C, Henriquez DDCA, Bloemenkamp KWM, van Roosmalen JJM, et al. Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study. BMC Pregnancy Childbirth. 2018; 18(1):398.
[15] Fage N, Asfar P, Radermacher P, Demiselle J. Norepinephrine and Vasopressin in Hemorrhagic Shock: A Focus on Renal Hemodynamics. Int J Mol Sci. 2023; 24(4):4103.
[2] Hoyt T, Duffy V. Implementing firearms restriction for preventing US Army suicide. Mil Psychol. 2015; 27(6):384-90.
[3] Anisi J, Majdian M, Mirzamani SM. The factors associated with suicide ideation in Iranian soldiers. Iran J Psychiatry. 2010; 5(3):97-101.
[4] Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018; 378(4):370-9.
[5] Eastridge BJ, Holcomb JB, Shackelford S. Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury. Transfusion. 2019; 59 Suppl 2:1423-8.
[6] Markl-Le Levé A, Haller I, Bachler M. Fluid management in hemorrhagic shock. Curr Opin Anaesthesiol. 2025; 38(3):316-22.
[7] Vishwanathan K, Chhajwani S, Gupta A, Vaishya R. Evaluation and management of haemorrhagic shock in polytrauma: Clinical practice guidelines. J Clin Orthop Trauma. 2020; 13:106-15.
[8] Bouglé A, Harrois A, Duranteau J. Resuscitative strategies in traumatic hemorrhagic shock. Ann Intensive Care. 2013; 3(1):1.
[9] Jacob M, Kumar P. The challenge in management of hemorrhagic shock in trauma. Med J Armed Forces India. 2014; 70(2):163-9.
[10] David JS, Spann C, Marcotte G, Reynaud B, Fontaine O, Lefèvre M, et al. Haemorrhagic shock, therapeutic management. Ann Fr Anesth Reanim. 2013; 32(7-8):497-503.
[11] Petros S. Trauma-Induced Coagulopathy. Hamostaseologie. 2019; 39(1):20-7.
[12] Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, et al. Trauma-induced coagulopathy. Nat Rev Dis Primers. 2022; 8(1):25.
[13] Rudloff E, Hopper K. Crystalloid and Colloid Compositions and Their Impact. Front Vet Sci. 2022; 9:878702.
[14] Gillissen A, van den Akker T, Caram-Deelder C, Henriquez DDCA, Bloemenkamp KWM, van Roosmalen JJM, et al. Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study. BMC Pregnancy Childbirth. 2018; 18(1):398.
[15] Fage N, Asfar P, Radermacher P, Demiselle J. Norepinephrine and Vasopressin in Hemorrhagic Shock: A Focus on Renal Hemodynamics. Int J Mol Sci. 2023; 24(4):4103.
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| Section | Case Report(s) | |
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| Suicide Firearm Hemorrhagic shock Case report | ||
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How to Cite
1.
Rastegari Najafabadi H, Keykha A. Soldier Suicide with a Firearm: A Case Report with an Approach to Hemorrhagic Shock Control in the Emergency Department. Arch Anesth & Crit Care. 2026;.
