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Gunshot wound to chestMichael Bjarkoy email@example.com
Thu, 19 Jun 2003 23:37:44 +0100
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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.