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Thu, 28 Mar 2002 00:11:27 -0500

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Chest tube on Right, think hard about one on the left. ECHO the heart=20
and off to the OR for a Lap +/- a t-cotomy depending on the output of=20
the chest tube
Ron Simon
JAcobi MEdical Center
Bronx, NY
PS some will not be happy with a 3 liter resuscitation while standing=20
around.

Marcos Reis wrote:

>     This is a very interesting recent case and I'd like to know the=20
> opinion of the Surgeons of the List. At the end I can send the photos=20
> if anybody wants.
>
>     A 19 years old male patient entered in the ER  last monday (=20
> 2002/03/28 ), in shock, with 2 gunshot wounds  ( 10-20 min before=20
> admission ); one gunshot wound in the LEFT posterior axilar line ( 9th=20
> intercostal space ) and another gunshot wound in the left upper=20
> abdominal quadrant. No exit wounds . Vital signs: BP 70/30, P 140, RR=20
> 32, GCS 14. The auscultation revealed breath sounds decreased  on the=20
> RIGHT hemithorax and he had abdominal pain. We obtained a  chest film=20
> that demonstrated the bullet in the RIGHT hemithorax and fluid/blood=20
> density  all over the RIGHT side, nothing wrong was seen at the LEFT=20
> hemithorax and there was NO widened mediastinum .  The abdominal film=20
> ( AP ) demonstrated a bullet in the projection of  L4. After rapid=20
> administration of 3000ml of IV fluids ( Ringer ) there was no increase=20
> in his blood pressure and the patient was sent to the operation room.=20
> 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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Chest tube on Right, think hard about one on the left. ECHO the heart and
off to the OR for a Lap +/- a t-cotomy depending on the output of the chest
tube<br>
Ron Simon<br>
JAcobi MEdical Center<br>
Bronx, NY<br>
PS some will not be happy with a 3 liter resuscitation while standing around.<br>
<br>
Marcos Reis wrote:<br>
<blockquote type="cite" cite="mid:003501c1d4cf$da228a20$5694e3c8@marcos">
  <meta content="MSHTML 5.00.2614.3500" name="GENERATOR">
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  <div><font face="Arial" size="2">&nbsp;&nbsp;&nbsp; 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.</font></div>
  <div><font face="Arial" size="2">&nbsp;&nbsp;&nbsp; A 19 years old male patient  entered
in the ER&nbsp; last monday ( 2002/03/28 ), in shock, with 2 gunshot  wounds&nbsp;
( 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&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></div>
  <div><font face="Arial" size="2">&nbsp;&nbsp;&nbsp; What would you do? </font></div>
  <div>&nbsp;</div>
  <div><font face="Arial" size="2">&nbsp;&nbsp;&nbsp; Marcos Reis,&nbsp; MD&nbsp;  Trauma Surgeon</font></div>
  <div><font face="Arial" size="2">&nbsp;&nbsp; &nbsp;Jo&atilde;o XXII Hospital - Trauma  Center
- Belo Horizonte, Brazil&nbsp; </font></div>
  </blockquote>
  <br>
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