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GSW to the chest.

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A 19 y/o male walked into the ER with a single GSW to the left chest.
AB: talking and answering questions, obeys commands
GCS: 15
Skin was cool, diaphoretic, and pallor.
Trauma sweep revealed small diameter GSW entry in the superior chest and larger diameter GSW through the back and superior to the scapula. No other wounds revealed via blood/trauma sweep.
Pt was negative for: JVD and tracheal deviation.
EKG: sinus tach
S
A - NKA
M - none
P - none
L - “I don’t remember.”
E - “walking home”
Ultrasound: no for tapenade, blood in cavities or pneumo.
IV access was two pressure bags with NS initiated along with 15L NRB, occlusive dressings using large tegaderm and 4x4 and petroleum dressing utilizing chest seal venting on chest side. vitals stable throughout except very tachypneic at 32 RPM. Being an adolescent and pallor appearance, an aggressive fluid resuscitation was used until imaging revealed no other immediate life threats. One unit of O- blood was used and approx 2L of saline using pressure bag. Pain management was fentanyl in 50mcg doses totaling 100mcg.
No neuromuscular deficits or vascular abnormalities in extremities.
Trauma surgeon arrived at an assessment that the patient was stable and did not need immediate surgery. The patient went to a tele unit for over watch.

• first two X-rays and CT done in ED. Third X-ray (4th pic) done 6h after the second.
  ** orange arrow depicts GSW. Blue for bullet frag and green for gaseous space.

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