List Archives

Fri Aug 31 05:33:49 BST 2007

This one just in.  Your management?

40-something male hijacking victim brought in off the street by
companions with transaxial GSW to the neck.  Entry at left mandible
with ramus fracture; exit just anterior to right external auditory
meatus.  On arrival in our resus unit the patient is making gurgling
attempts at respiration and has rapid weak radial pulse.  GCS 6 with
equal reacuve pupils; restless; moving all limbs.

1) Do you immobilise c-spine?

We commenced with RSI...

2) What drugs?
3) Endotracheal or surgical airway?

...and established bilateral large IV's.  Initial BP was 71/33, HR
130.  Rapid infusion of Ringer's Lactate (1500ml) brought BP to 96
systolic but spurting arterial bleeding from the exit wound.

4) Oversew, foley's tamponade, pack or just a pressure dressing?
5) What BP should we target? Permissive hypotension or normotension?

Patient continues to be restless.

6)Sedation?
7) Analgesia?

The patient was stabilised to the point at which doom was not
immediately impending.  A plain chest film confirmed our tube
placement and demonstrated aspiration (presumed blood).  Orogastric
tube in situ; urinary catheter drained 300ml.  No other injuries on
survey.

What's the next step?
What imaging are you wanting?
What interventions do you plan?

I'll let you know what we did when some reponses come in.

Ross.

-- 
_____________________
Ross Hofmeyr
MBChB (Stell) ATLS ACLS
wildmedic at gmail.com
ross at wildmedix.com
www.wildmedix.com

List Archives

For your convenience, find the Trauma List Archive Below

Next GSW case...