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EM Forum Case #169 "I’m not stopping; I’ve just been shot!"
by Charlene Irvin Babcock
 

Medical

Triage notifies you that a male is driving to the hospital after being shot. The police called it in as they saw him speeding down side streets and running stop signs. The cop pulled up next to the car with his police lights and sirens on. The car would not pull over. The guy yelled out the window that he had just been shot and he’s driving to the hospital. The cop pulled ahead and ran lights and sirens all the way to get him there quickly.

A stretcher is waiting at the ambulance bay, and the man jumps out of the car and hops onto the stretcher. He is quickly wheeled into the resuscitation suite.

Quick history reveals he was by his open trunk, heard some gunshots, felt 2 stinging him (one in buttocks and one in the side). He looked down as blood began soaking his shirt, and he jumped into the car to get to the hospital.

You’ve asked for the usual six things that sick people get: IV, oxygen, monitor, a set of vital signs, undress the patient and draw some blood.

Primary survey revealed airway and breathing intact (he was speaking full sentences), but he did describe feeling short of breath. Capillary refill is slow, and you can barely feel a femoral pulse. A GSW is noted in the right flank, and pressure is applied to the bleeding site. He has a rigid abdomen. He is moving all extremities normally, and mentation is normal.

Vital signs: Systolic Blood pressure 85, pulse 140, RR28.

Questions:

  1. What IV fluids do you order? How much?
  2. What is permissive hypotension, and what blood pressure goal is ideal?
  3. How do you calculate Mean Arterial Pressure?
  4. What is the average cost to society for every patient suffering a firearm related injury that survives? What about if they die?


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