Priority intervention?

E tank

Caution: Paralyzing Agent
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Brain Teaser time:

Had a guy with 4 self inflicted bullet wounds in his belly. .38 special. One in each quadrant, pretty symmetrical pattern. No exit wounds on his back. No bullets visible on KUB, AP chest or lower extremity films. Negative FAST.

What happened?
 

Akulahawk

EMT-P/ED RN
Community Leader
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Brain Teaser time:

Had a guy with 4 self inflicted bullet wounds in his belly. .38 special. One in each quadrant, pretty symmetrical pattern. No exit wounds on his back. No bullets visible on KUB, AP chest or lower extremity films. Negative FAST.

What happened?
He lost a fight with an industrial-size staple remover.
 

Akulahawk

EMT-P/ED RN
Community Leader
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Brain Teaser time:

Had a guy with 4 self inflicted bullet wounds in his belly. .38 special. One in each quadrant, pretty symmetrical pattern. No exit wounds on his back. No bullets visible on KUB, AP chest or lower extremity films. Negative FAST.

What happened?
If the patient was a bit portly (shall we say?), I suspect the revolver discharged twice, with the bullets travelling through the abdomen and exiting without impacting (literally) any organs.
 

E tank

Caution: Paralyzing Agent
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If the patient was a bit portly (shall we say?), I suspect the revolver discharged twice, with the bullets travelling through the abdomen and exiting without impacting (literally) any organs.
Exactly...He actually grabbed a handful of fat and shot across his belly...twice. Surgeon figured it out pretty quickly by running a probe through the holes. The guy was shocked he had been figured out so fast.
 

Akulahawk

EMT-P/ED RN
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Nope...he was really shot with a .38. That does remind me of the guy that was seeking sexual gratification with a belt sander though...
I imagine he was a bit raw after that...
Exactly...He actually grabbed a handful of fat and shot across his belly...twice. Surgeon figured it out pretty quickly by running a probe through the holes. The guy was shocked he had been figured out so fast.
While I've never had a patient like that, nor have I heard of such a patient until now, given the findings that you typed, I pretty much figured out what happened and it took me longer to type it up than to figure out. Let me guess, he also had unilateral signs of perhaps muzzle contact with his abdomen? He may have also had some very minor wounds from debris spitting out of the cylinder gap.
 

E tank

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Let me guess, he also had unilateral signs of perhaps muzzle contact with his abdomen? He may have also had some very minor wounds from debris spitting out of the cylinder gap.
Smart guy, you are....all the above...I guess. That was around 27 years ago. He might have been wearing a clown suit too, I don't remember.
 

Akulahawk

EMT-P/ED RN
Community Leader
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Smart guy, you are....all the above...I guess. That was around 27 years ago. He might have been wearing a clown suit too, I don't remember.
I don't consider myself to be that smart... I just used the data you provided and my knowledge of firearms and figured the rest out. The cylinder gap wounds would have probably been either overlooked or been written off as some minor abrasions or some similar thing. Guy likely had some more spectacular wounds on the entry side just due to either direct or very close to direct muzzle contact with the body.
 

Jim37F

Forum Deputy Chief
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This reminds me of a story from Band of Brothers, guy gets shot in his 4th point of contact.. 1 bullet, 4 holes....
 

phideux

Forum Captain
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A buddy of mine playing quick draw with a 45 Colt, luckily he was sort of bow-legged. Just as he cleared leather, Bang. Bullet went in his upper thigh came out above the knee went into the calf came out just above the ankle. Left a hell of a mark.
 

E tank

Caution: Paralyzing Agent
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I don't consider myself to be that smart... I just used the data you provided and my knowledge of firearms and figured the rest out. The cylinder gap wounds would have probably been either overlooked or been written off as some minor abrasions or some similar thing. Guy likely had some more spectacular wounds on the entry side just due to either direct or very close to direct muzzle contact with the body.
Now that I stretch my memory and think about it, after it was established that these where through and through across the abdominal fat/fascia, the powder burns around the right hand wounds magically became visible to everyone for the "Aha" moment.
 

LaAranda

Forum Probie
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Interesting hearing others' experiences treating GSWs. As a half-time paramedic (straight nights) in a large but not particularly dangerous American city, I personally run about two a year. The hospital (L1) I work at receives probably one or two a week. There are two other hospitals in town that also receive major trauma.
 

Medic27

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BSI ofc, Scene Safety ofc, Spinal Stablization /Full Trauma assessment

1.) ABC's Airway, Breathing, Circulation
2.) Direct pressure
3.) 15 liters non-rebreather, initiate shock management elevation of feet, and ensuring warmth
3.) Contact hospital and notify the ED you are inbound with a priority patient.
 

bakertaylor28

Forum Lieutenant
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Interesting hearing others' experiences treating GSWs. As a half-time paramedic (straight nights) in a large but not particularly dangerous American city, I personally run about two a year. The hospital (L1) I work at receives probably one or two a week. There are two other hospitals in town that also receive major trauma.
Only Two a year? Lucky you. I once went two weeks seeing nothing but heroin overdoses, GSWs, and a couple Psych Hobos. Its about the only time in history I can imagine one praying for the powers that be to move someone's STEMI up two weeks, oh, and praying to and/or for Madonna to get hit by a MAC truck.
 

bakertaylor28

Forum Lieutenant
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What? I know some people have their kinks, but for ****s sake....
Does not necessarily mean what you think it means. I've seen people use a belt sander and how should I say....attach a apparatus to the motor without how should we say considering the sheer velocity involved, resulting in significant rectal trauma.
 

Tigger

Dodges Pucks
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Only Two a year? Lucky you. I once went two weeks seeing nothing but heroin overdoses, GSWs, and a couple Psych Hobos. Its about the only time in history I can imagine one praying for the powers that be to move someone's STEMI up two weeks, oh, and praying to and/or for Madonna to get hit by a MAC truck.
 

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