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Involved in a fight (John Wick: Chapter 2)

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Involved in a fight (John Wick: Chapter 2)

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timestamp 2:05-2:32

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John Wick: Chapter 2 (2017) - Pencil Kill Scene (6/10) | Movieclips

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open wound to the trachea about the size of a pencil

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open wound to the trachea about the size of a pencil

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penetrating #2 pencil on the posterior side of his neck

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penetrating #2 pencil on the posterior side of his neck

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En route, the receiving facility will be called as soon as possible so that adequate resources will be available upon our arrival. I will tell them we are en route with a trauma alert of a middle aged male involved in a fight who is alert and has a GCS of 15. He has a GSW to the upper right chest, penetrating injury to the trachea and an impaled pencil in the posterior neck. I would run through treatments, last set of vitals and approximate time of arrival. Once arrived, the receiving team will receive a more detailed assessment and history.

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My first priority with this patient is management of the ABC's. I first want to make sure the airway is open and the patient is breathing at an adequate rate. If the pencil in his posterior neck is occluding the airway, it should be removed. If not, it should be bandaged and stabilized. Next I want to check for any life threatening bleeding, such as from the gunshot or the pencil stabbing. If bleeding is major it should be controlled with an occlusive bandage. Take first set of vitals

Lastly, spinal motion restrictions are indicated for this patient because of the direct would to his neck and high MOI. Based on given info, this pt will be transported to the closest level 1 Trauma facility as soon as ABC's are managed.

En route, the patients clothes will be cut to exposed injured areas. Bilateral large bores IV's will be established. The gunshot wound will be inspected to try and locate an entrance and exit. I also want to try and determine the type of gun used as well as the type of bullet. Hypovolemic shock will be highly considered due to blood loss and the potential for internal bleeding. The patient will be placed on 15 liters on a NRB, a fluid bolus of 500ml should be given IV and the patient will be kept warm with blankets and the ambulances heater. Vitals will be assessed every 5 mins to the hospital.

The patients SAMPLE history will try to be obtained given his condition.

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The patient was involved in a fight inside of a well populated office/cafe. Scene safety is a major concern at this point. PD should be notified. The patient in a middle aged male who was involved in a fight with multiple injuries. He is alert and oriented and has a GCS of 15. He had been shot in the upper right chest, stabbed by a pencil in the trachea, and had been stabbed by that same pencil in the posterior neck, but it was left in place.

The closest Trauma 1 facility is 10 mins away and there is a Trauma 2 about 7 mins away.

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This would be a red/resuscitation level case, we will likely need a trauma room, a physician, 1 to 2 nurses and a tech for our personnel

supplies I anticipate needing include, 1-2 liter NS, labs tubes including cbc and type and screen, xray with personnel to obtain it, bandages, possible needs for intubation and/or thoracotomy in case of hemothorax

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I would want to ask the paramedic team if they have obtained a sample history if possible. Information on vitals trends en route and mentation changes are important as well. Any medications given

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Mechanism of Injury is penetrating trauma

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Excellent case!

Regarding the gunshot, I noticed we didn't see any checking for a pneumothorax. However, considering that the patient was able to get back up and continue fighting immediately after being shot, and the nature of his profession, my guess would be that he was wearing body armor. Even if this is the case, bruises and broken bones are a possibility.

Regarding room equipment, a blood transfuser should also be prepped and ready to go. Many models take some time consuming setup or need time to prep the heaters.

Great work both of you!