35 Year Old Female with a Gunshot Wound Essay

1704 Words Dec 10th, 2011 7 Pages
-Number of shots heart; type of gun used; position of pt when shot; distance of the pt from the gun. History should be gathered from the pt, available eye-witnesses, and emergency medical service providers
Does the patient have intra or extraperitoneal bleeding that requires surgical intervention?
Does the patient have peritoneal contamination requiring washout and repair of a hollow viscus?
Penetrating injuries with any hemodynamic instability and/or signs of intraperitoneal injury are treated operatively at the outset of management
-GSWs most often injure the small bowel followed by the colon and liver
Clinical thinking
Does the patient have an adequate airway, and ability to protect it?
Is the patient breathing? Is oxygenation
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HISTORY • Need to ascertain the mechanism of the injury: damage inflicted by a low-velocity handgun is far different from the cavitating blast effect exerted by high-velocity hunting projectile. • AMPLE(allergies, meds, past medical hx; last meal; events leading to presentation) • Past medical hx provided by the patient or family may provide insight to observed physiology: for example, beta blockade may mask the tachycardia of stage II shock.

Physical Exam • A GSW to the abdomen is always explored. • Pay attn to the signs of abdominal penetration and try to reconstruct the path of injury • Be skeptical of apparent injuries: two holes aligned on a patient do not necessarily indicate entrance and exit wounds. • Does the patient have abdominal pain? Is the patient tachycardic and hypotensive because of peritoneal hemorrhage? Are respirations labored b/c of a distended abdomen and limitation to diaphragmatic excursions or because of a missed pneumothorax. • Check the NG tube after insertion: bloody nasogastric effluent? • Rectal examination may reveal blood w/in the bowel lumen. • Is the foley catheter draining blood tinged urine? • Whereas all of these findings may corroborate the need for laparotomy, hemodynamic

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