unique penetrating injury

• Previous message: unique penetrating injury
• Next message: unique penetrating injury
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

Sal

Item 1: Find the possible missing bullet, or the exit wound! (?Lip entry)

Safe Assumption: Transmediastinal bullet in chest. - If stable CT Chest, while you're there CT neck with CTA, as screening, also do contrast swallow - proceed to surgery if needed, or to endovascular therapy if you have the means. The "blown pupil" is likely to be a vascular injury.

Regards
Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302



-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of SJASMD at aol.com
Sent: Saturday, August 11, 2007 5:01 PM
To: trauma-list at trauma.org
Subject: unique penetrating injury


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
 



************************************** Get a sneak peek of the all-new AOL at 
http://discover.aol.com/memed/aolcom30tour
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

• Previous message: unique penetrating injury
• Next message: unique penetrating injury
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]