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Dx: Hypovolemic shock caused by GSW L mid thorax. Rx: Seal exit wound. Start IV Dextran/NS wide open. Drive to Level 2 trauma center. Watch for tension peumo en route. May need a chest tube. Assist breathing with ambu bag and O2.
Manner of Injury: This is not a self-inflicted wound! Suspect that this is related to the stand-off. Patient may be an under-cover DEA or local LEO. Gun is probably his. Carefully bag gun for evidence. Burns on fingers and mouth suggest torture prior to attempted assassination. Keep the potpourri as evidence along with the bagged gun.
Call in the GSW to the Level 2 trauma center (thoracic surgeon on duty). Have them prep an OR immediately. Watch for cardiac arrest en route.
After thought: Don't know if it's permitted in civilian practice, but if this guy were my patient I would try to clamp the bleeders through the exit wound before sealing the chest.
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Honor Above All Else
Last edited by Trapper John; 05-31-2013 at 05:26.
Reason: added after thought
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