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Futility in penetrating (GSW) brain injury?

Karim Brohi karimbrohi at gmail.com
Wed Dec 8 22:47:19 GMT 2010


Caesar

Resuscitate.  2 reasons:
1. This is still potentially a survivable injury.  If the injury is frontal
or occipital then meaningful survival is possible. At least get the CT.
 Even if unsurvivable the CT scan helps in end-of-life care discussions.

2. He has the potential to be a very valuable organ donor and until his and
the family's wishes become clear he should be supported as such (unless
directive/family are not found in a reasonable time frame).

Karim

On Wed, Dec 8, 2010 at 20:16, caesar ursic <cmursic at gmail.com> wrote:

> *Hypothetical patient*:
>
> Young male, self-inflicted (i.e. suicide) GSW to head. Intubated by
> paramedics en route.
>
> Arrival to ER: Entrance and exit wound to head (i.e. bi-hemispheric
> injury).  BP 60 mm Hg systolic, hear rate 130/min, bleeding from bullet
> holes.
> GCS is 3T.  No other visible signs of injury.
>
> *Options*:
> 1. Resuscitate (i.e. give blood products, activate massive transfusion
> protocol, try to get BP up)  CT brain, call neurosurgery.
>
> OR
>
> 2. Comfort measures only (eg: IV morphine and midazolam, speak to family,
> etc).
>
> Which one?  Or maybe something else enirely?
>
> Thanks.
>
> C Ursic, MD
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