Thread: GSW to chest
View Single Post
Old 01-25-2009, 12:54   #4
shr7
Asset
 
Join Date: Dec 2007
Location: Pittsburgh PA
Posts: 50
For the first time, I'll try to give one a go. I'll probably leave out enough stuff so that this will go on for a while, though.

1) I see an entrance wound on the left shoulder and an exit wound on the left upper arm. I do not see an exit wound from the posterior chest GSW, so I am thinking the bullet is still somewhere in the chest. I would be extra cautious when moving the patient.

2) Not so sure about this one. I would grab a CBC, looking at the Hgb/Hct, maybe the WBC depending how long ago he was shot. Grab a chest Xray, looking for the bullet, or a pneumo/hemothorax. Not sure about necessity of a CT scan. Would it be helpful in looking for early signs of cardiac tamponade? CT of the arm help in determining amount of damage? I'll hook him up to a 12-lead, closely monitor his ECG. I would keep monitoring his BP, HR, and RR looking for changes that might be indicative of pneumothorax, tamponade, or compartment syndrome/hypovolemic shock.

3) I would first look at the chest. Listen for breath and heart sounds. This is where I might find cardiac tamponade or pneuomothorax. Percuss on the chest, looking for fluid build-up. Look for even rise and fall of the chest. Monitor for trouble breathing, cyanosis of the fingertips and lips, JVD, tracheal deviation. Also keep monitoring for signs of shock like a fall in BP, cool, clammy skin, confusion, lethargy, and tachycardia. Depending on where the wound is, also check for muscle control of the chest, abdomen and extremities, looking for spinal cord damage. Keep an eye out for damage, maybe peek below the sheets looking for priapism, urinary or fecal incontinence.

For the arm, I would take a radial pulse and check reflexes below the wound, looking for damage to a major artery or nerve. Not sure what else there.

4) All I know is what I've been taught in CLS class, so I'm not sure what to do in a hospital setting. I'd start some oral empiric antibiotics. Broader spectrum, maybe Augmentin? Not too worried about enterics or anaerobes unless we find the bullet somewhere in the gut. Take a wound culture prior to initiation of therapy, adjust as necessary. make sure and get an allergy history as well as immunization history to determine necessity of tetanus immunization.

Chest injury may need a trip to the OR, and placement of a chest tube, but I don't know anything about that.

5) I'm worried about the lungs, the heart, and the spinal cord. Also, about the break in the skin and chance of infection.

I'm sure I left out a lot of stuff, and included a lot of unnecessary stuff, but I would love to learn more.

SR

EDIT: But now that I look at the picture again, I'm not so sure that my answer to #1 is correct. Maybe I am not looking at the picture correctly. Haven't seen any GSW before so I don't really know what entry/exit wounds look like.

Last edited by shr7; 01-25-2009 at 12:59.
shr7 is offline   Reply With Quote