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Thu, 28 Mar 2002 16:11:35 +0200 (IST)

Rt Chest tube, midline laparotomy. If output from CT is high, and no
abdominal source, consider Rt thoracotomy.  After bleeding controled you
can look for esophageal injury.

WTP?

Avi=20

On Tue, 26 Mar 2002, Marcos Reis wrote:

>     This is a very interesting recent case and I'd like to know the opini=
on 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 ) a=
nd another gunshot wound in the left upper abdominal quadrant. No exit woun=
ds . 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=
=2E We obtained a  chest film that demonstrated the bullet in the RIGHT hem=
ithorax and fluid/blood density  all over the RIGHT side, nothing wrong was=
 seen at the LEFT hemithorax and there was NO widened mediastinum .  The ab=
dominal film ( AP ) demonstrated a bullet in the projection of  L4. After r=
apid administration of 3000ml of IV fluids ( Ringer ) there was no increase=
 in his blood pressure and the patient was sent to the operation room. Clea=
r yellow urine was obtained at the urinary catheter .
>     What would you do?=20
>=20
>     Marcos Reis,  MD  Trauma Surgeon
>     Jo=E3o XXII Hospital - Trauma Center - Belo Horizonte, Brazil =20
>=20

=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=
=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=
=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D=3D
Aviel Roy-Shapira, M.D.              Soroka University Hospital &
Dept. of Surgery A. and              Ben-Gurion University Medical School=
=20
the Critical Care Unit               POB 151, Beer Sheva, Israel
=20
email:avir@bgumail.bgu.ac.il         Fax:972-7-6403260 voice:972-7-6403390

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