Quote:
Originally Posted by Priest
First and foremost, treat the pt. Don't mention amputation, stick with what you know. I'd have no idea what type of internal damage has actually been done, could only be out of "the game" for a few weeks for all I know. Convince him that he needs to calm down in order to prevent any further damage to himself. Get him talking as much as you can about something other than the obvious.
Then, assuming that the rapid trauma exam turns up no other wounds (superficial or signs of head injury) I'd suspect a possible pubic symphysis fracture, so I'd be wary of any log rolls. I would try and stop any hemorrhaging if present (I wouldn't suspect any major arterial involvement due to the anatomy.) I wouldn't be worried much about any tumbling due to the skin contact of the muzzle at the time of discharge.
As far as meds, I would establish IV access, most likely restraining the pt during this process. I would push Phenergan and morphine for pain. Standard war wound therapy would call for Rocephin as well.
Concerns would be for urethral tears, some suspensory ligament damage, and nerve damage.
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Yes . . . treat the patient and do not get engrossed by the nature or what the wound looks like. Agree. Do not mention amputation as that is likely not an issue as the majority of the appendage is there. I might recommend IV benzos or pain meds at this time to get him to relax as this is fairly benign despite a 9 mm going through penis which would concern any male and would be painful.
There were no other wounds (except a damaged ego) on initial evaluation. He was imaged with a Ct scan with IV and rectal contrast. Fortunately no fracture and no vascular injury but the penis is a vascular structure. The bleeding had stopped so no need to repair Bucks fascia in this setting just a simple wash out and bandage. Dressings were xeroform and gauze bunched up and held in place with a simple sling (can use burn netting or scrotal support. IV access is critical and part of the ABCDE's and it is what the medic did initially and a second one in the ED. He did get antibiotics and his tetanus was already up o date. Urethral tears are important and must be ruled out with a retrograde urethrogram. I have images to show. Nerve damage is a long term concern but the suspensory ligaments would not preclude ultimate function.
More to follow as per below . . .
DD