Quote:
Originally Posted by Doc Dutch
Agree with usual priorities. There was some blood loss en route (about a unit of blood but the bleeding stopped by arrival. Subsequent wash-out was necessary but little bleeding was encountered. Did not stitch up the wound and left it open as did not want to trap infection (did give antibiotics). Sphincter tone was normal with rectal examination. No blood was seen at the meatus and keeping careful watch to not cross contaminate, the blood was soaked up and pressure held to the perineal wound with the rectal examination. There was no blood found on rectal exam. The patient was hemodynamically stable at all times.
He was hemodynamically stable, pelvis films will be shown below. We did not need to explore as it turned out because the CT with IV and rectal contrast and delays were negative. We did need a retrograde urethrogram (RUG) however to assure the urethra was okay. An indwelling Foley can be passed only after the RUG and no urologist was needed. The CT helped us in regards to looking at the bone fragments, vascular injuries and soft tissues including the bowel.
The Bobbitt case (replant of the penis) has been repeated many times in the US. Most of the urogenital trauma in war zones are not simple lacerations or simple amputations and are more in line with severe debulking trauma or complete loss of the penis and/or testicles. Blast injuries with the directed force straight into the groin can be devastating and typically nothing to replant and unfortunately just debridement and dressing changes. His outcome is actually favorable in the case.
DD
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Fun fact: Bangkok leads the world in penile re-attachment sx. Beware of pissing off your Thai dictionary.
Doc, I'm curious about the specifics of the MOI. Do you happen to know exactly where the pistol was tucked? Was the hammer cocked?
It's SOP on many if not most teams to leave the safety off when carrying the M9. If the hammer was not cocked, the blast would had to have racked the slide to the rear in order for the hammer to fall on the firing pin. I'm not asking to be critical, but to be safe.