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GSW to abdomen

Varcelotti MD, Jorge trauma-list@trauma.org
Sun, 6 Apr 2003 06:32:44 -0400


Damage control. Stop bleeding, Isolate contaminants (bowel). Quick
interposition shunt to iliac artery. Ligature vein. Packing if necessary.
Take patient to the ICU . Continue resuscitation, rewarming, correct
coagulopathy. Take patient back to the OR and now proceed with the definite
repairs, resections, ostomies.
Jorge

> -----Original Message-----
> From:	azonic75 [SMTP:azonic75@yahoo.com]
> Sent:	Saturday, April 05, 2003 8:39 PM
> To:	trauma-list@trauma.org
> Subject:	GSW to abdomen
> 
> Would like some feedback/wisdom/criticism regarding a
> recent case....
> 
> 26 y/o male presents with multiple GSW, one to the
> left chest mid axillary line 9th ICS, another on the
> left just below the costal margin. Combative in ED,
> intubated, left chest tube placed with minimal output,
> HR 140, SBP 60. Taken to OR where laparotomy reveals
> ~2L blood in belly, 6 SB enterotomies, enterotomy in
> transverse colon near the splenic flexture, injury to
> distal left iliac vein and artery and diaphragmatic
> injury. 
> 
> We performed a colonic resection with ostomy, resected
> the area of SB with the enterotomies (~2 feet) and
> made one anastomosis. Iliac injuries were repaired
> after  obtaining proximal control at the aorta and
> distally with compression
> 
> As expected pt became cold, acidotic, coagulopathic
> and eventually arrested
> 
> What may have been done differently? At what point
> would you apply damage control principles? The
> vascular injuries did not appear amenable to
> packing....Any thoughts?
> 
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