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A new interesting case for you...

trauma-list@trauma.org trauma-list@trauma.org
Wed, 27 Mar 2002 19:20:05 EST 

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In a message dated 3/27/2002 6:21:29 PM Eastern Standard Time, 
trauma1@uol.com.br writes:


> 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? 
> 

Right chest tube and midline laparotomy--fix the intra-abdominal injuries, 
then judge the need for operation on the chest by chest tube output.  While 
in the abdomen, a quick look in the pericardium thru a subxyphoid 
pericardiotomy could exclude cardiac injury.
ERF

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<HTML><FONT FACE=arial,helvetica><FONT  COLOR="#0000ff" SIZE=2 FAMILY="SCRIPT" FACE="Comic Sans MS" LANG="0"><B>In a message dated 3/27/2002 6:21:29 PM Eastern Standard Time, trauma1@uol.com.br writes:<BR>
<BR>
</FONT><FONT  COLOR="#000000" style="BACKGROUND-COLOR: #ffffff" SIZE=2 FAMILY="SANSSERIF" FACE="Arial" LANG="0"></B><BR>
<BLOCKQUOTE TYPE=CITE style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px">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&nbsp; on the RIGHT hemithorax and he had abdominal pain. We obtained a&nbsp; chest film that demonstrated the bullet in the RIGHT hemithorax and fluid/blood density&nbsp; all over the RIGHT side, nothing wrong was seen at the LEFT hemithorax and there was NO widened mediastinum .&nbsp; The abdominal film ( AP ) demonstrated a bullet in the projection of&nbsp; 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 .</FONT><FONT  COLOR="#000000" style="BACKGROUND-COLOR: #ffffff" SIZE=3 FAMILY="SANSSERIF" FACE="Arial" LANG="0"><BR>
</FONT><FONT  COLOR="#000000" style="BACKGROUND-COLOR: #ffffff" SIZE=2 FAMILY="SANSSERIF" FACE="Arial" LANG="0">&nbsp;&nbsp;&nbsp; What would you do? </FONT><FONT  COLOR="#000000" style="BACKGROUND-COLOR: #ffffff" SIZE=3 FAMILY="SANSSERIF" FACE="Arial" LANG="0"><BR>
</BLOCKQUOTE><BR>
</FONT><FONT  COLOR="#0000ff" style="BACKGROUND-COLOR: #ffffff" SIZE=2 FAMILY="SCRIPT" FACE="Comic Sans MS" LANG="0"><B><BR>
Right chest tube and midline laparotomy--fix the intra-abdominal injuries, then judge the need for operation on the chest by chest tube output.&nbsp; While in the abdomen, a quick look in the pericardium thru a subxyphoid pericardiotomy could exclude cardiac injury.<BR>
ERF</B></FONT></HTML>

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