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GSW vs Pentrating chest wound


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13 replies to this topic

#6 chbare

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Posted 01 September 2010 - 11:03 PM

If the stabbing is really developing JVD, then we have to assume tamponade. Especially when we consider the location of the injury. This patient may quickly transition to a moribund state.

Take care,
chbare.
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#7 Happiness

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Posted 01 September 2010 - 11:09 PM

Pretty tough one.

Im sending the SW first with the notification of going right behind them with the GSW.

#2 is already showing signs of a pnumo and A comes before C.

Wow I think that is the simpilest answer I have ever given here ;)
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#8 chbare

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Posted 01 September 2010 - 11:14 PM

It's not a pneumothorax that concerns me. In fact, that would be much preferred over what we must suspect.

Take care,
chbare.
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#9 jjd

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Posted 02 September 2010 - 08:20 AM

So the general consensus at the moment is that the SW be transported first based on.... raised JVD, pneumo and the possibility of a tamponade based on the wounds location? Firemedic made a good point that the wound is directly in the same location that a needle decompressionn would be done at. What alternatives do we have to relieve the tension? Would an occlusive dressing make the slightest difference to someone who is already presenting with raised JVD, which as we know present in the late stages of a tension pnuemo.

Sorry if this is a mundane scenario, i'm relatively new to ems and believe participating in a few scenarios would benefit me. The reason i posted this particular scenario is that i have a friend who is a new intern at a provincial hospital. She had a similiar situation although the decision she had to make was more along the lines of who would be admitted to surgery first (only one functioning operating room). In the end she decided to go with the GSW. Her decision was based solely on the fact that it was a gunshot vs stabbing and a GSW is generally considered higher priority then a stabbing. (she is not entirely sure her decision was the correct one)

I understand her line of thinking but i can't help but think that a penetrating chest wound may pose more of a risk then a low calibre bullet into the abdo. Yes there is the possibility of substantial blood loss and the fact that there is no exit wound makes me wonder what the bullet ricochet off and what else may potentially be damaged.
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#10 Richard B the EMT

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Posted 02 September 2010 - 02:47 PM

I understand her line of thinking but i can't help but think that a penetrating chest wound may pose more of a risk then a low calibre bullet into the abdo. Yes there is the possibility of substantial blood loss and the fact that there is no exit wound makes me wonder what the bullet ricochet off and what else may potentially be damaged.

First off, welcome to our world, where craziness is the norm.
In addition to internal bleeding from the GSW, there is the issue of dynamics from the bullet impact. With that in mind, the policies of NY State DoH, and the FDNY EMS Command, have the patient being long back board immobilized, in addition to trying to stop the bleeding. That may have been one of the concerns addressed by your intern friend, in making the decision to do the surgery on the GSW prior to the stab wound injury.
As to which patient should be transported first, local protocols, personnel training, and experience, will be involved in the decision.
Just as a mention: due to the dynamics of receiving a GSW, the body part will be kicked kind of hard. Soft Body Armor, the so-called "Bullet-Proof" vest (I say so called, because with the right ammunition, it will be penetrated, like a 22 caliber through my EMS design T-Shirts) spreads the impact area to absorb the shock, hence the lack of body penetration. LEOs (Law Enforcement Officers) who have been shot in the armor have described it as like being hit with a 20 pound sledgehammer.

Edited by Richard B the EMT, 02 September 2010 - 02:55 PM.

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