unique penetrating injury

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A 37 YO man is brought in by EMS after sustaining multiple gunshot wounds. He 
has a GCS of 7 with a possible blown pupil, absent right breath sounds, blood 
in his mouth and adequate blood pressure. He is a  difficult intubation and 
requires cricothyroidotomy. He gets a right chest tube.He is hyper capneic, 
adequately oxygenated and acidotic with base deficiit of -7. 
 
Examination shows three penetrations: one to the lip with no exit wound, an 
entry in the LEFT anterior infraclavicular area and one to the thigh. There is 
no major bleeding, or hematomas. 
 
Chest xray  shows opacities consistent with aspiration, ( likely of blood 
from the mouth), a widened mediastinum and a bullet in the RIGHT supraclavicular 
region, with minimal hemothorax. Other portable xrays showed a bullet in the 
thigh with no fracture and no other bullets in the torso.
 
How to proceed
 
sal sclafani
 



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