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Fri Aug 31 05:23:40 BST 2007

lurking mode off
replying from a place where we don't see too many gunshot injuries.

bullet appears to be overlying R 9th rib just adjacent to vertebral column + mod haemothorax

ABC seem to be under control  so

R ICC  and watch output  - thoracotomy as per EMST (ACLS) guidelines
Secondary survey (exclude neurology)
surgical consult  (general or cardiothoracic - No dedicated trauma surgeons in my part of the world)
iv x2, Xmatch, O2, etc
further imaging as per Surgeons request - CT

Waiting to see what happens next....

regards

Andrew Mitchell MBBS
(far north) queensland
Australia

----- Original Message ----- 
From: <SJASMD at aol.com>
To: <trauma-list at trauma.org>
Cc: <sclafans at nychhc.org>
Sent: Friday, August 31, 2007 12:47 PM
Subject: GSW TO RIGHT CHEST. WHAT IS THE WORKUP OF THIS CASE

We seem to be having a run of interesting gunshot wounds of the chest at  our
hospital. I have been in disagreement with the management of many of them
and look to this site to give me a reality check. Here is another chest  case.

This case is a 35 year old male who sustained a single gunshot wound of the
right chest posterolaterally with no exit wound. He presented alert, but
short of breath . On exam he was normotensive and diminished breath  sounds in the
right chest.. There was an entry wound in the postero lateral area  of his
right thorax around the seventh intercostal space. but no exit  wound.

He was sent for a chest xray which i share with you.

next step?

sal

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GSW TO RIGHT CHEST. WHAT IS THE WORKUP OF THIS CASE