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Tue, 26 Mar 2002 11:08:24 -0300

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    This is a very interesting recent case and I'd like to know the =
opinion of the Surgeons of the List. At the end I can send the photos if =
anybody wants.
    A 19 years old male patient entered in the ER  last monday ( =
2002/03/28 ), in shock, with 2 gunshot wounds  ( 10-20 min before =
admission ); one gunshot wound in the LEFT posterior axilar line ( 9th =
intercostal space ) and another gunshot wound in the left upper =
abdominal quadrant. No exit wounds . Vital signs: BP 70/30, P 140, RR =
32, GCS 14. The auscultation revealed breath sounds decreased  on the =
RIGHT hemithorax and he had abdominal pain. We obtained a  chest film =
that demonstrated the bullet in the RIGHT hemithorax and fluid/blood =
density  all over the RIGHT side, nothing wrong was seen at the LEFT =
hemithorax and there was NO widened mediastinum .  The abdominal film ( =
AP ) demonstrated a bullet in the projection of  L4. After rapid =
administration of 3000ml of IV fluids ( Ringer ) there was no increase =
in his blood pressure and the patient was sent to the operation room. =
Clear yellow urine was obtained at the urinary catheter .
    What would you do?=20

    Marcos Reis,  MD  Trauma Surgeon
    Jo=E3o XXII Hospital - Trauma Center - Belo Horizonte, Brazil =20

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<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; This is a very =
interesting=20
recent case and I'd like to know the opinion of the Surgeons of the =
List. At the=20
end I can send the photos if anybody wants.</FONT><FONT face=3DArial=20
size=3D2></FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; A 19 years old male =
patient=20
entered in the ER&nbsp; last monday ( 2002/03/28 ), in shock, with 2 =
gunshot=20
wounds&nbsp; ( 10-20 min before admission ); one gunshot wound in the =
LEFT=20
posterior axilar line ( 9th intercostal space ) and another gunshot =
wound in the=20
left upper abdominal quadrant. No exit wounds . Vital signs: BP 70/30, P =
140, RR=20
32, GCS 14. The auscultation revealed breath sounds decreased&nbsp; on =
the RIGHT=20
hemithorax and he had abdominal pain. We obtained a&nbsp; chest film =
that=20
demonstrated the bullet in the RIGHT hemithorax and fluid/blood =
density&nbsp;=20
all over the RIGHT side, nothing wrong was seen at the LEFT hemithorax =
and there=20
was NO widened mediastinum .&nbsp; The abdominal film ( AP ) =
demonstrated a=20
bullet in the projection of&nbsp; L4. After rapid administration of =
3000ml of IV=20
fluids ( Ringer ) there was no increase in his blood pressure and the =
patient=20
was sent to the operation room. Clear yellow urine was obtained at the =
urinary=20
catheter .</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; What would you do? =
</FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp;&nbsp; Marcos Reis,&nbsp; =
MD&nbsp;=20
Trauma Surgeon</FONT></DIV>
<DIV><FONT face=3DArial size=3D2>&nbsp;&nbsp; &nbsp;Jo=E3o XXII Hospital =
- Trauma=20
Center - Belo Horizonte, Brazil&nbsp; </FONT></DIV></BODY></HTML>

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