Gunshot wound to chest

• Previous message: Gunshot wound to chest
• Next message: Gunshot wound to chest
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

Hi John, Why the time of incident to A&E 45 minutes? Problems on scene or
problems getting to incident?

> 1. What on scene interventions/packaging would you consider appropriate
> (resuscitation room interventional skills are available at the scene)?

LOAD AND GO. FiO2 0.98 via non-rebreather, Review airway constantly with a
view for suction.
IF any delay on scene because of reasons beyond your control introduce at
least two wide bore IVI (while you still got a vein) otherwise do it in the
ambulance.
Monitor ECG and BP.
Pass ASHICE to A&E.

> 2. Should the nearest hospital be bypassed?

Yes, IF the facilities and team at the other hospital are better. Definitive
care is not any old A&E (ED) it has to be good enough to get the patient
into surgery within 10 minutes or less of coming through the doors.


> 3. What investigations/interventions would be appropriate in the ED?

Determine by auscultation the underlying trauma to chest (i.e. tension
pneumothorax etc)
Perform RSI
Confirm IV placement, if none - IV at this time consider venous cutdown.
Administer type O when available
Consider Cardiac Tamponade - ?pericardiocentisis... High Index of Suspicion
here with raised JVP and only central pulses
Chest, head, c-spine, abdominal films
12 lead ECG
BP
Do not wait for x-rays to come back, they can catch up with the patient in
theatres.
Bloods for U, E, FBC and x-match -
GO TO SURGERY.


> 4. When/where would you anaesthetise this patient?

EARLY - In the A&E Dept if the paramedic could not do it en-route.


> 5. What would be your surgical approach when delivering definitive care?

Outside of my knowledge base - sorry.



Mike Bjarkoy
Falmouth.UK.

• Previous message: Gunshot wound to chest
• Next message: Gunshot wound to chest
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]