Quote:
Originally Posted by Trapper John
Dx: Hypovolemic shock caused by GSW L mid thorax. Rx: Seal exit wound. Start IV Dextran/NS wide open. Drive to Level 2 trauma center. Watch for tension peumo en route. May need a chest tube. Assist breathing with ambu bag and O2.
Manner of Injury: This is not a self-inflicted wound! Suspect that this is related to the stand-off. Patient may be an under-cover DEA or local LEO. Gun is probably his. Carefully bag gun for evidence. Burns on fingers and mouth suggest torture prior to attempted assassination. Keep the potpourri as evidence along with the bagged gun.
Call in the GSW to the Level 2 trauma center (thoracic surgeon on duty). Have them prep an OR immediately. Watch for cardiac arrest en route.
After thought: Don't know if it's permitted in civilian practice, but if this guy were my patient I would try to clamp the bleeders through the exit wound before sealing the chest...
...Question: Can you describe his heart sounds? I'm curious about the JVD distention and suspect cardiac tamponade. The force of the bullet may have damaged the myocardium. Obviously missed the heart or we wouldn't be discussing the case. I suspect the shooter was using a low velocity low caliber round. Don't know if I would attempt to treat cardiac tamponade in a moving vehicle on a rural road though. So the question is sort of moot.
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I was thinking the burns on the mouth and fingers were from a meth pipe, not torture. This guy's likely a user IMO and this was possibly a deal gone bad.
I also worry about tamponade causing the JVD as well as a hemothorax causing the left-sided breath sound abnormalities. Volume expanders may make this worse, but this guy is clearly cyanotic so I would consider supplemental oxygren, but I wouldn't bag him due to concerns about the integrity of his thoracic cavity. My response is to get this guy to a trauma center most ricky-tick!
I'm not a trauma/field guy so my knowledge of field medicine is quite limited. I enjoy reading these scenarios and hearing how they are stabilized prior to coming to the hospital.
Thanks Sdiver!
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"The dignity of man is not shattered in a single blow, but slowly softened, bent, and eventually neutered. Men are seldom forced to act, but are constantly restrained from acting. Such power does not destroy outright, but prevents genuine existence. It does not tyrannize immediately, but it dampens, weakens, and ultimately suffocates, until the entire population is reduced to nothing better than a flock of timid, uninspired animals, of which the government is shepherd." - Alexis de Tocqueville
Last edited by PedOncoDoc; 05-31-2013 at 05:55.
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