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Fri Aug 31 14:22:53 BST 2007

This is a transaxial, trans mediastinal GSW.  Big problem.  I am concerned about r bronchus, trachea, and esophagus.   Also of concern is thoracic duct.  I am less concerned about vessels at this point but I might after the next test.   I would do a chest and neck CT for trajectory.   I would consider esophagogram and oi would use barium, and would decide on vascular evaluation based on trajectory although I would not object to a CTA as part of Ct.    I do believe this pt has either R brobchus, trachea, or upper esophageal injury.   If either of these exist and the other is not dx pre op, I would scope the other tube.    If I have already made a dx of airway or gullet injury by imaging, I would not scope him

K
Sent via BlackBerry by AT&T

-----Original Message-----
From: SJASMD at aol.com

Date: Fri, 31 Aug 2007 08:46:14 
To:trauma-list at trauma.org
Subject: Re: GSW TO RIGHT CHEST. bullet found in left neck

Chest tube placed, 500 ml of blood drained. Still stable

repeat chest xray attached showed persistent hemothorax and BOTH  FILMS  
showed left sided subcutaneous emphysema . Not shown, the top of the  second chest 
film showed a bullet in Zone II on the LEFT.

 In a message dated 8/31/2007 5:58:50 A.M. W. Europe Daylight Time,  
wildmedic at gmail.com writes:

I'm in  the same boat as K in both regards - I'm on my mobile and can't
see the  bullet, and would do nothing else immediately other than put
in a chest  drain, repeat XR and monitor carefully.

I'm sure there's more to  come...

Ross.

On 31/08/2007, kmattox at aol.com  <kmattox at aol.com> wrote:
> I'm on BB.  Quality of image on BB  not crisp.  I do not see bullet.   Would
> put in chest  tube and reassess.   Depending onwhere bullet is and amount  
of
> blood out of ct. I might do nothing else
>
>  K
>
>
> Sent via BlackBerry by AT&T
>
>  -----Original Message-----
> From: SJASMD at aol.com
>
> Date:  Thu, 30 Aug 2007 22:47:22
> 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. bullet found in left neck