A Level I trauma alert gunshot wound to the head is paged out by EMS and they are at the back door of the ambulance bay with a 32-year-old man. Per EMS report, the man was shot in a drive-by shooting. The patient is being ventilated by bag-valve mask. He has a Glasgow Coma Scale score of 7. He has an obvious gunshot wound to his left temple and the crown of his head, with brain matter exposed. Upon your assessment you also notice some stippling. He is tachycardic and hypertensive, with bilateral breath sounds and good distal pulses. What is meant by stippling?

Rationale: A. This describes tissue being drawn inward, which is not the definition of stippling. Stippling is related to surface skin findings from a firearm discharge, not tissue movement into the wound. B. Cavitation refers to the temporary cavity created by the bullet as it passes through tissue, causing internal damage. This is a separate ballistic concept and not related to stippling. C. An exit wound is where the bullet leaves the body and is typically larger and more irregular than the entrance wound. Stippling is associated with the entrance wound, not the exit wound. D. Stippling (also called powder tattooing) occurs when unburnt gunpowder and other residues from the firearm are driven into the skin. This indicates a close-range or intermediate-range gunshot wound, and the pattern can help estimate the distance between the firearm and the victim at the time of injury.