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It was a lot of fun indeed.
Next we quickly prepped the right chest and slid in a chest tube while in the ED. It put out about 300 cc of blood and had a persistent airleak (no surprise) but the blood output stopped there and throught the remainder of his hospital ICU course. We pulled it three to four days later once on H20 seal and the airleak had stopped. Covering the chest wound with bandages slowed the airleak but not completely.
CXR showed a partially collapsed lung before the chest tube and an ETT in place. No blood in the left chest on X-ray. No widened mediastinum. After the right chest tube was placed, the right lung had come up nearly to normal, but again the right chest tube had a small airleak.
Yes, started blood right out of the refrigerator in the trauma bay - two units with an increase in the SBP into the low 90's and a heart rate finally dipped into the 120's to 110's.
FAST was negative by report by the EM physicians(resident) but poor PI and quality control (the images were not perfect). So, I had another plan . . .
Left arm BP was checked and was eqaul to the right arm BP. The bleeding in the left axilla looked non-pusatile (a persistent ooze), just a dark and constant bloody oozing. When we looked into the left axilla wound temporarily in the trauma bay, we did not see an arterial or large venous injury, i.e. no huge gush or torrent of blood.
So, off to the OR we went . . . (my favorite place in the world!)
Any thoughts on how to attack these lacerations/explorations? Which order would you go after these lacerations? Explore the neck vessels on the right? Pericardial window? Explore the left axilla? Right chest wall next to the mediastinum?
Looking back, this was a great case and wonderful mental exercise. I hope my residents appreciated it as much as I loved doing it with them.
Thanks,
Dutch Matthews
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