Quote:
Originally Posted by Doc Dutch
OK. This is a graphic account but is true. I almost did not relate this topic and images as some might not take this seriously but it is a very serious case. You must work through this exercise and go through the thought process. It is an excellent teaching case.
There is an IED explosion in Afghanistan while a team is returning to a FOB. The bottom of the MRAP is burned and rumbled but has not been breached. Fortunately, after a quick count and status check everyone is fine in the motor vehicle and convoy except the 22 year old technical sergeant with blood on his anterior ABU's pants. The blood came from somewhere (right?) and no one else is injured. One of the guys in the MRAP noted the blood as the TS is so wired by his near death IED experience he does not feel any pain (adrenaline/catecholamine surge). The astute combat medic immediately lays the TS down on the ground and cuts away his pants. The TS has sustained a penetrating injury from his own handgun. He refused to use a side belt holster in theater for his 9mm and he insisted in tucking the 9 mm in his belt with the safety off as he felt it was easier to level the 9 mm if needed. The 9mm discharged with the detonation and he was struck. The bullet entered the top of the penile shaft and exited from his perineum. He is immediately evacuated to Bagram AFB Medical Center. The patient keeps asking, "Are you going to cut my junk off ? Be honest with me, please. I haven't had kids yet, Please tell me the truth, doc!" (true story and you will be asked this question)
To the medics, what do you do first? What are your priorities? What do you need to consider? What do you tell the patient about an amputation?
To the physicians, where do you start? What do you do? What are your priorities? Let us just state that during this rotation at Bagram there is no urologist. So, what are you going to do? What is your algorithm?
I am posting images, however, this is for this website only as a medical teaching case. The photos have no identifying features and are HIPPA compliant. Please remember this is sensitive information but should be discussed for all providing combat casualty care in the field or at a medical center. It will happen. Be prepared.
DD
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One last thing, as I am leaving call for today. I will be back tomorrow to discuss what was done and how to deal with these injuries. Please relate what you would do for this patient and the work-up/care. I will be back to tell you what was done and see if anyone would have done something else or different.
Thank you,
DD