NYMedic828
Forum Deputy Chief
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had this call about a week ago now and its been bugging me.
Story:
41 y/o male, found supine on ground post gunshot to left chest. Patient was working under his car when someone walked up and shot him at close range. Called in by a bystander no further info could be obtained on-scene.
When my partner and I arrived, the BLS unit had already begun CPR and c-spine.
Assessment:
-Pulseleness Apneic.
-Single GSW to left chest, roughly one inch inferior and medial to the the left nipple.
-No exit wound
-Absolutely no blood from the wound or anywhere for that matter.
-Possible non-tension hemo-pnuemothorax to left side.
-Idioventricular PEA on the monitor at a rate of <20 complexes per min.
Since CPR was already started, in the NYC 911 system, you must continue until a physician takes over either via telemetry or hospital and takes responsibility for pronouncement.
We ran it as a PEA arrest,
EJ to the left jugular, giving vasopressin followed by Q5 epi.
Tubed the patient no problem, frothy pink secretions in tube (hence hemo-pnuemo)
CPR throughout.
We gave a notification to the trauma hospital and upon arrival they took over CPR for about 3 minutes until the trauma surgeon walked in gave the "We're done here" look once he saw where the wound was and they called it.
My question is, would you have arrived on-scene and began CPR, or would you call it an obvious death and write up a pronouncement on-scene, leaving the crime-scene in tact as well.
The shirt had burn marks on it, the wound had no bleeding leading me to believe immediate cessation of blood flow. The bullet was directly in the anatomical location of the left ventricle and probably went through to the left lung.
What would you have done if you were first on-scene?
Story:
41 y/o male, found supine on ground post gunshot to left chest. Patient was working under his car when someone walked up and shot him at close range. Called in by a bystander no further info could be obtained on-scene.
When my partner and I arrived, the BLS unit had already begun CPR and c-spine.
Assessment:
-Pulseleness Apneic.
-Single GSW to left chest, roughly one inch inferior and medial to the the left nipple.
-No exit wound
-Absolutely no blood from the wound or anywhere for that matter.
-Possible non-tension hemo-pnuemothorax to left side.
-Idioventricular PEA on the monitor at a rate of <20 complexes per min.
Since CPR was already started, in the NYC 911 system, you must continue until a physician takes over either via telemetry or hospital and takes responsibility for pronouncement.
We ran it as a PEA arrest,
EJ to the left jugular, giving vasopressin followed by Q5 epi.
Tubed the patient no problem, frothy pink secretions in tube (hence hemo-pnuemo)
CPR throughout.
We gave a notification to the trauma hospital and upon arrival they took over CPR for about 3 minutes until the trauma surgeon walked in gave the "We're done here" look once he saw where the wound was and they called it.
My question is, would you have arrived on-scene and began CPR, or would you call it an obvious death and write up a pronouncement on-scene, leaving the crime-scene in tact as well.
The shirt had burn marks on it, the wound had no bleeding leading me to believe immediate cessation of blood flow. The bullet was directly in the anatomical location of the left ventricle and probably went through to the left lung.
What would you have done if you were first on-scene?
