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Originally Posted by desertmedic
First thought is a tegaderm or similar occlusive dressing to seal the wound. Is there an exit wound? Would be prepared to intubate or cric. C-spine control would be nice but not necessarily plausible in this setting. Undecided on pain meds weighing Px level vs. anticipated level of respiratory distress. An access line or two would be nice depending on time/present location, if volume replacement is needed going with hypotensive resuscitation. Just my thoughts,
Desertmedic, NREMT-P
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No second wound (i.e. potential exit). Pain tolerable and descried as midline as well as to the right and 'behind' the trachea. Palpation of wound area puts the hole through the thyroid cartilage, no palpable hematoma, bullet, etc.
Patient awake, alert, still in the fight since evac not for 30 minutes.
So, Desertmedic, you placed an occlusive dressing and his neck begins to develop subcutaneous air and he doesn't like the full feeling he's getting and rips off your dressing....feels better without it he says. He lets you start a 16G IV site but no way to hook him up to IVF right now, he's not in distress, just pissed he's been shot, not light headed, not any more tachycardic than you are.
What is happening and what do we do for the next 30 minutes.
ss