Next GSW case...

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Wow.  Somebody wanted this guy to die suffering.

1) Do you immobilise c-spine?
-- Of course.  What's the down side -- providing you don't get all
fretful over it?

We commenced with RSI...

2) What drugs?
-- Sux and etomidate?

3) Endotracheal or surgical airway?
-- Any port in a storm.  Don't see why you wouldn't attempt a
conventional ETT in the near term.  

4) Oversew, foley's tamponade, pack or just a pressure dressing?
-- You forgot tourniquet!
-- But seriously... press on the squirter and make haste to image the
vessels.  Easy for me to say; I'm a nurse with a desk.

5) What BP should we target? Permissive hypotension or normotension?
-- If you can't get past #4, this becomes academic pretty quick.
Abandon the numbers and aim for signs of central perfusion.

Patient continues to be restless.

6)Sedation?
-- Propofol?
7) Analgesia?
-- Fentanyl?

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?
-- Angio, damage control, CT to r/o spine or brain inj.
-- ENT, OMFS, etc.

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
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