My epic padlet by clara white

Case Study With Paramedics

elinaclarawhite03 — 2024-06-09 11:59:16 UTC

A 32-year-old male called Adam was involved in a fight with another male on the street outside of the bar. The altercation ended with the victim sustaining a gunshot wound to the abdomen, a laceration on the forehead, and generalized bruising; there is blood on the victim’s abdomen region and the face. The victim is lying on the street and barely follows verbal commands. The altercation occurred at 0200 am, on the 24th, in Ogden; it was a random fight; the individuals were drunk. The victim was with his girlfriend, who called 911. There are two level II Trauma centers near the place of incidence. The first is McKay-Dee Hospital, which is 3.5 miles away, and the second is Ogden Regional Medical Center, located 5.0 miles away. These Trauma centers can care for a gunshot wound; they have 24 general surgeons, anesthesiology, emergency medicine, radiology, and critical care; they both have a helicopter to airlift the patients to the level I trauma center. The Nearest level I Trauma Center is 41 miles away.

EMS report

mitchellstanding — 2024-07-03 19:13:00 UTC

Scene size up:

After police have ensured the scene is safe we will evaluate the patient.

I would ensure there was no massive bleeding. There could be substantial bleeding from the gunshot wound depending on if it hit an organ like the liver or the spleen, or a major blood vessel.

I would evaluate the airway and breathing, both of which seem unimpaired, indicating that his diaphragm was spared. I would get an IV started as soon as possible to administer a fluid bolus.

I would evaluate the patient’s mental status, which appears blunted currently. The patient is likely in a lot of pain, so I would administer Fentanyl.

As both hospitals are capable of providing care for this patient, we will go to whichever hospital the patient prefers, or if the patient is unable to respond, most likely to McKay Dee, as it is closer.

EMS report

This is EMS unit 446, calling with report. I have John Doe, a 35-year-old male with an abdominal gunshot wound to the right upper quadrant. According to bystandard report, the gunshot occurred after an altercation at a bar approximately 15 minutes ago. Upon arrival to the scene, the patient was found conscious and alert, but was acting a bit confused, so I gave him a GCS of 14. I’m not sure if his confusion is due to being drunk or being a bit shocky.

Vital signs are as follows:

BP 95/45

HR 110

RR 24

Spo2 98% on room air.

On physical examination, the patient appears generally alert and is breathing easily. The abdominal entry wound is approximately 1 cm in diameter. We have not seen an exit wound yet. The abdominal wound was bleeding profusely, and there was estimated blood loss of 200 on scene. We put a sterile dressing on the entry wound. We’re giving an NS bolus to support pressure currently. The patient also has a head laceration, but he is not sure when that happened. He is acting a little confused, which could be from his injuries or the alcohol. We put him in a C collar since we are unsure if he hit his head and on the spine board.

I also noted abrasions to his chest. There are some old bruises on his abdomen and he has a left black eye, but these appear to be old wounds.

We have one 18 gauge iv in his left arm, but have been unable to establish a second line. I’m going to give him 50 mcg of fentanyl to try and get his pain under control.

We are approximately 4 minutes out.

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Respond to the Paramedic

elinaclarawhite03 — 2024-07-04 09:04:33 UTC

Thank you, EMS Unit 446, for the report and the prompt initial intervention to the patient. I have the room ready for the patient, two nurses, a Trauma surgeon and general surgeon, an anesthesiologist, and phlebotomy for labs and start a second IV. I have notified the radiology technician for imaging to see if the bullet can be removed and to identify the damaged tissues and organs and the extend of the damage, as well as to rule out spinal cord injury.

A 1000 bag of NS is primed for fluid resuscitation, vasopressors, a unit of O-negative PRBC is ready for use, pain medications, and sterile dressing for the wound before surgery. A five-lead telemetry continuously monitors blood pressure, heart rate, and oxygen saturation.

I have a few questions for additional information. Is it a close-range wound? what is the shape of the wound? Did the patient state to have any known allergies and their severity? Did the patient state the number and type of alcohol consumed and any street drugs? Did the patient state to have any medical condition going on?

Gunshot injury is the result of Kinetic energy.

Response to nurse

mitchellstanding — 2024-07-05 17:04:07 UTC

Range:

Witnesses on scene describe that the shooter had backed up about seven to ten feet before turning and shooting as the patient started pursuing.

Wound:

The entry wound is a 1 cm diameter hole.

Let me ask about allergies....

Patient denies allergies.

Previous medical conditions:

Patient states that he is a type one diabetic.

Alcohol and drugs: Patient is unsure of how much he drank, can only state quite a bit. He says he's been drinking pretty heavily over the last month. Denies drug use.