List Archives

Sat Aug 11 17:34:26 BST 2007

The penetrating injury is one we see quite often in Houston, as it is  
described.   The problem here is that there are multiple entries and  bullets, and a 
lot of potential assumptions, and a lot of  traps.    He obviously has:  

1.    Mediastinal traverse at Zone 1 of the neck,  probably aortic arch or 
innominate artery.
2.    Hemothorax
3.    Some potential element of CNS problem
4.    Something going on in the hip
5.    He apparently is already intubated

His threat to life right now is the thoracic outlet injury and whatever is  
going on in the head.    

I would desire an arch arteriogram, mainly as a road map.   I  would NOT want 
a CTA unless the quality is very good and then I would consider  the 
possiblity of being mislead by VOMIT.   I would want an  arteriogram to consider 
aortic arch abnormalities, particularilly a common  takeoff of the left carotid and 
innominate artery from the same  origin.    

I would want to minimize the time prior to cutting his chest and I would  
plan a mediansternotomy with a RIGHT neck or supraclavicular extension,  
depending on what I found.  I would be concerned that there may be a  trachea injury.  

After the median sternotomy, I would NOT get into the hematoma until I had  
exposed distal innominate and right common carotid, and the aortic  arch.  

Nice case, and I await the next shoe to fall as is common in cases that Sal  
or me present to this group.

k

************************************** Get a sneak peek of the all-new AOL at 
http://discover.aol.com/memed/aolcom30tour

List Archives

For your convenience, find the Trauma List Archive Below

unique penetrating injury