Gunshot wound to the chest. Bullet was fired from an AK47 fr | Figure 1

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Gunshot Wound to the Chest

Gunshot wound to the chest. Bullet was fired from an AK47 from a range of approx 500m. Fortunately the bullet had lost a lot of its velocity by the time it impacted the casualty and punched a neat hole through them causing a simple pneumothorax. Entrance wound was the posterior shoulder with exit at the anterior chest. Clinically the patient had significant surgical emphysema on the injured side (seen on x-ray) and was desaturating to 85% on room air, correcting well with oxygen. Treatment was surgical clean out of wound, closure and chest tube. Link to full case study will be in comments.

Patient Cases

Case 1

EMS called to a 45yoF stabbed and finds the patient seated, distressed, tachypneic with a single stab wound superior to L clavicle with slight JVD visible and c/o SOB and chest pain. Initial VS: RR44, HR 120, SpO2 76% (Room air), BP 115/74. 3 way dressing, NRB Oxygen. On loading into ambulance RR ↑ to 60, very distressed, ↑ JVD, SpO2 ↓ 60%. Needle thoracentesis with 14G performed, immediate relief with RR decreasing, SpO2 ↑ to 90%. IV access TKVO, pre-alert trauma centre, rapid transport. Stable en-route. Significant swelling to L chest, with increasing subQ emphysema. On follow up patient had Left haemopneumo and right sided pneumo.

Case 2

48yo male, 6 gunshot wounds, 2 of which to the upper abdomen, L side hemothorax, chest tube inserted in trauma room, L radius fracture d/t thru and thru bullet, but solid VS and GCS of 15 throughout! Impressive #emergency #trauma #traumanursing #GSW

Case 3

Gunshot wound, 50 caliber bullet, cause only hemopneumothorax and scapula fracture.

Case 4

assault, tension pneumothorax, look how subtle the pneumo is on CXR, but the surgical emphysema and clinical findings (tender left thoracic wall) warrant CT. LESSON: Palpate that chest in a trauma setting!

Trending Cases

Case 5

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

Case 6

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Case 7

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Case 8

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?