Ace844 Posted June 8, 2006 Share Posted June 8, 2006 I did not indicate we need the ICP or CPP only the pulse pressure to decide degree of shock Difference between systolic and diastolic = pulse pressure. When this narrows we can quickly determine that a patient is compensating for volume loss. Yes, the MAP would be nice to know, as would the pressures you describe, but for the quick and simple, just use the pulse pressure and use the fluid of choice (NS, LR, diesel) to maintain it. I agree and understand what your saying. I just wanted to make sure I wasn't 'losing it' for a sec. Another benefit to the pulse pressures in this scenario would be to cover your index of suspicion for 'Tamponade' in this instance as well... Thanks, ACE844 Link to comment Share on other sites More sharing options...
chbare Posted June 8, 2006 Author Share Posted June 8, 2006 Good conversation everybody. It just so happens that you have a cool guy ambulance that blocks out all background noise. The heart sounds are not muffled and the lungs are clear throughout all of the lobes. The BGL is 102. You notice blood on the floor of the ambulance however. Take care, chbare. Link to comment Share on other sites More sharing options...
AZCEP Posted June 9, 2006 Share Posted June 9, 2006 Finish the exposure to find the hole we missed. Plug it accordingly. I don't suppose this ambulance is "cool-guy" enough to have a radioilogy department included. Link to comment Share on other sites More sharing options...
Asysin2leads Posted June 9, 2006 Share Posted June 9, 2006 Okay, so the guy took a GSW to the chest and his lungs are clear with equal expansion and no accessory muscle use? Did he happen to be wearing a shirt with a big 'S' stitched on the front? Or did the bullet bounce off the pleuritic lining? Link to comment Share on other sites More sharing options...
chbare Posted June 9, 2006 Author Share Posted June 9, 2006 AZCEP, you cut the rest of his clothing off and note that the pants and several layers of long johns are blood soaked. You find a small wound to the anterior aspect of the patients left knee. The wound is just inferior to the patella. You also note a larger profusely bleeding wound to the posterior aspect of the knee. You are able to stop the bleeding with direct pressure and elevation. A pressure dressing is applied and no further bleeding is noted. You are correct, all of chbare's ambulances in the land of Oz are the epitome of cool guy. Take care, chbare. Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 9, 2006 Share Posted June 9, 2006 Okay, so the guy took a GSW to the chest and his lungs are clear with equal expansion and no accessory muscle use? Did he happen to be wearing a shirt with a big 'S' stitched on the front? Or did the bullet bounce off the pleuritic lining? Chest GSW was right at the sternum. Blood from the left axilla. Deflection off the sternum maybe? Link to comment Share on other sites More sharing options...
chbare Posted June 9, 2006 Author Share Posted June 9, 2006 This was a pretty unusual case. Here is the story. The guy was a few days out of prison and ran into a few people that did not like him. I believe it was related to a drug debt. His friends attempted to knee cap him and shot him in the area of his knee. In addition, he took a round to the chest. The bullet that hit him in the chest contoured the third rib and exited out of his axilla. Unfortunately, the bullet intended to knee cap him went through his leg and tore through the popliteal artery. Ballistics is a strange thing. Take care, chbare. Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 9, 2006 Share Posted June 9, 2006 Amen. I believe it was Rid who gave a story not long ago about someone who was shot in the leg, the bullet hitting and entering the femoral artery, traveling the body and lodging somewhere in the brain... Great case CB... Link to comment Share on other sites More sharing options...
chbare Posted June 9, 2006 Author Share Posted June 9, 2006 PRPGfirerescuetech, there are no rules when it comes to ballistics. I am glad you enjoyed the scenario. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted June 9, 2006 Share Posted June 9, 2006 Amen. I believe it was Rid who gave a story not long ago about someone who was shot in the leg, the bullet hitting and entering the femoral artery, traveling the body and lodging somewhere in the brain... Great case CB... What's the anatomy that made this possible? Link to comment Share on other sites More sharing options...
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