4022- Gunshot wound victim by Lynzie Lancaster

lynzielancaster — 2025-05-26 21:29:55 UTC

EMS

2025-06-03 04:39:16 UTC

EMS responded to East Beach in Santa Barbara for a reported GSW. Law enforcement was already on scene and had secured the scene, making it safe for EMS to enter. As we approached, we noticed one patient lying supine in the sand appearing conscious but in obvious distress. We introduced ourselves to the patient and began our primary assessment. Henry was alert but anxious and clutching the left side of his chest. Pt stated he had been shot by someone. We observed a single GSW to the upper left chest with a moderate amount of blood spurting from it. Pt was speaking in short sentences and his breath sounds were diminished on the left side with asymmetrical chest rise. We then immediately put an occlusive dressing over the wound and assumed possible open pneumothorax. We then gave oxygen at 15LPM NRB. Skin was pale, cool, and diaphoretic with weak, thready radial pulses. After performing a rapid head to toe assessment we concluded that the GSW was the only wound. Pt first set of vitals were: HR 122, BP 88/54, RR 28 and shallow, SpO₂ 89% on oxygen, and a GCS of 14 (confused but oriented). We then established 2 large bore IVs, one in each AC, and initiated a NS bolus at 500ml to start. Pt respiratory status then began to decline and his breathing became labored, we noted jugular venous distention and worsening hypotension. We reassessed his dressing and noted no changes. We then performed a needle decompression in the second intercostal space, midclavicular line on the left. Almost immediately, respiratory effort and BP stabilized. We continued to monitor vitals, placed him on a cardiac monitor, and applied warm blankets. He was in significant pain so once his BP stabilized, we administered 50 mcg of fentanyl. Given the severity of his injuries and the risk of further decompensation, I classified him as a Priority 1 trauma and contacted Santa Barbara Cottage Hospital—a Level I Trauma Center—via radio, giving an early alert: “Inbound GSW to upper left chest, needle decompression performed, improved but unstable vitals. ETA 8 minutes.” We loaded Henry into the ambulance and continued care en route, reassessing every five minutes.

Arrival to ED

lynzielancaster — 2025-06-05 00:07:24 UTC

Personnel

ED physician
RT
At least 2 RN's
X-ray tech
Trauma surgery notified

Supplies:

Suction and intubation at bedside
Chest tube insertion supplies
fluid warmer
dressings
blood products ready
Cardiac monitors & defibrillator
Needle decompression kit
EKG machine
portable CT or X-ray

Additional information

Any signs of worsening respiratory status
Post-needle decompression status, is chest rise symmetrical now?
Patients pain level post 50 mcg fentanyl

Mechanism of injury

Penetrating trauma: GSW to upper left chest

Thank you for your notification we are preparing the trauma team for the patient's arrival.

Follow Up Post Arrival

2025-06-09 15:32:27 UTC

After the needle decompression in the field, patient's respiratory status immediately improved, symmetrical chest rise and fall can be observed. Upon arriving to the ED, no signs of respiratory decline, chest rise and fall is still adequate. After the 50mcg of fentanyl was given, pain was reassessed and was much lower than before. Pt continued to show signs of anxiety and pain throughout the transport, so an additional 25mcg of fentanyl was given after reassessing BP. With 75 mcg of fentanyl on board, patient has minimal pain and anxiety with a stable BP. Thank you for taking our patient!