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Fri Aug 31 13:47:06 BST 2007

Something like ninety per cent of penetrating chest trauma is treated
with a single chest tube.  Start there.  He's got a pneumo on the right.

Question is, do you wait for a CXR given his history, or insert the tube
first and save on the extra film?

I'm doubtful that the little circle in his mediastinum is a bullet.
Doesn't look dense enough, and it's too symmetrical.  Looks more like a
button (or a spent casing, end-on).  And so as to prove conclusively
that I have no aptitude for radiology: his stomach silhouette looks odd
to me.  Any chance the trajectory was downward?

No doctor, me.  And the world is better for it.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of SJASMD at aol.com
Sent: Thursday, August 30, 2007 10:47 PM
To: trauma-list at trauma.org
Cc: sclafans at nychhc.org
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