It plays like Russian roulette, shoot yourself, or the dealer. There are a random amount of blank rounds in the shotgun, and a random amount of live rounds. If you were to shoot yourself with a blank, the dealer will have to skip their next turn. You can use the handcuff item to skip the dealers turn, you can smoke to gain one extra life, you can drink a beer can to get rid of the current round in the gun, you can saw off the top of the shotgun to do double damage. You start with 2 hitpoints.