Hypothetical question(s): GSW to Large Toe

OK - My GSW anecdote: I've seen a subject shot in the "lower back" (read... below waistline) have a bullet lodged against the base of the femoral head be discharged with Tylenol #3 within 6-8 hours of ED arrival by ambulance. The trauma surgeon and the orthopedist did not feel the patient needed surgery, as they felt that pulling out the bullet was fine where it was, and that removing it ran greater risks.

I would think that a good, fast bullet, at close range, could do serious damage to the toe and bone, and IMHO (EMT with 1 year college A&P) there is a decent possibilty of some form of amputation...if the shot hit at the right place and shattered/removed bone. Because the great toe (big toe) is VERY important for balance and movement, if it were missing, the subject would likely have trouble walking without assistance.

Additionally - if it is being amputated, that is likely to become major surgery, perhaps general anesthesia, and involve a longer hospital stay. At some point, PD will decide that they want to know WHAT happened... and when they feel he's not being honest, then he might find himself in custody.
 
I might have to toe the company line here.

Guy would probably lose the toe. Morphine would probably not be given in the field unless it can be confirmed to be the only injury.
 
I might have to toe the company line here.

Guy would probably lose the toe. Morphine would probably not be given in the field unless it can be confirmed to be the only injury.

I would have no problem of giving an analgesic, Morphine, Fentanyl, Dilaudid. I hope you are not referring that Morphine be held because of the "masking" the symptoms myth. Most physicians/surgeons educated in the past few decades understand pain control can be given for abdominal pain and others within reason and still be able to perform a thorough examination.

R/r 911
 
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I would have no problem of giving an analgesic, Morphine, Fentanyl, Dilaudid. I hope you are not referring that Morphine be held because of the "masking" the symptoms myth. Most physicians/surgeons educated in the past few decades understand pain control can be given for abdominal pain and others within reason and still be able to perform a thorough examination.

R/r 911

It is in our protocols for that reason. As soon as they examine the pt, the pt gets an analgesic. I could always ask medical control.
 
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