First off, thanks for posting a new case S/S.
At the EMT-B / CLS level...
- Return fire; eliminate the threat.
- Palpate / expose wound / look for secondary injury
- Instruct pt to hold still, possibly lie down (METT-TC - cervical immobilization; philly collar is coming)
- Depending on what I'm carrying, either insert a lubed (to seal) child-size ET-tube (small NPA?) through thyroid cartilage to secure airway OR tape kerlix to entry site w/ inspection/change of dressing q. 5m (absorb blood)
- Apply philly collar
- Evac - Urgent Surgical
What I'm thinking:
To have not exited the neck, projectile is a fragment, a ricochet, or lodged in the C-spine. The first two options provide a high risk of additional damage with movement d/t sharp edges and unknown location within the neck, while the third may be the most dangerous with potential for spinal cord injury either directly, d/t bone / bullet fragments or swelling. Airway has to be controlled. A lubed tube through the point of injury will provide a seal against additional bleeding into the airway as well as provide a measure of control against tissue swelling - situational intubation of a conscious casualty is a no-no at my level and doesn't seem to be indicated for anyone outside the hospital unless he codes. The alternative - kerlix taped to the injury site - will absorb the majority of the fluid (preventing it from entering the airway) while not causing the sub-cut air referred to previously. Philly collar is a necessity d/t injury site (civ. doctrine would also dictate backboarding, though that doesn't seem realistic for the situation).
I'm looking to learn, so please tell me if / how badly I've gone wrong...