Treating GSW to the head

Would you have worked it? (Just because I saw this cool poll feature!)

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samiam

samiam

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Hey guys quick question for all of you, I was thinking about a case that came in a few years ago and as I learn more I have been re-evaluating and looking at things differently then when I did not have as much knowledge being firehosed into my head.

Had a Level 1 trauma come in to a top ER in a city that sees a frequent gun shots. Patient comes in via ambulance, medics are doing compressions and bagging, ET tube in place on a scrawny caucasian male. The doc rushes over looks at something and then kinda stops for a second and gets a weird look on her face. He tells the medics that we got it from here. As I walk over I see the patient had a single GSW dead center of the forehead. Probably the size of a sharpie. I look at him and he looks at me and points towards the back of his head. I have on a pair of gloves and kinda look/stick my hand back there. Lets just leave it as there was no back there. No skull at all.

Would you have worked this and why? Any ideas why the medics who brought the patient in did? All I can think of is that maybe in the beginning there was some residual pulse and they just load and go and thats that.
 
most likely not...thats a case of call base and get order to terminate. what was his rhythm? even with a pulse i would call, due to the fact that the part of the brain that controls HR isnt affected, hes still brain dead. I suppose if he was a donor then sure...
 
I dont have any more info then that, It was a while ago so I dont remember if I saw a rythm strip or not. Also I dont think he was a donor because we bagged him up. I was thinking about that after I posted, It is possible the medics did not know that.
 
Lol no. If the exit wound did that much damage to blow out the whole back of skull, I can pretty much guarantee the brain is no longer functioning. Medics probably didn't do a good trauma assessment and just threw him in back of box.
 
I agree with everyone else. Call and pronounce. The only way I could see working that is if he somehow had pulses on scene.

As far as I'm concerned, the EKG doesn't matter. It's not like your going to accomplish anything working him before his sinus tach devolves into asystole.
 
Call base and then pronounce the patient.
 
I wouldn't even need to call to determine the patient wasn't viable. Just take a look and leave them there
 
Evisceration of the heart, lungs, or brain is one of our criteria to determine death in the field. Pulseless and apneic? Even as a basic I wouldn't have to start CPR in that case (If the patient did have pulses upon our arrival, than that'd be a different story)
 
That i think is why the doctor gave me a deer in the headlight look wondering what they were doing. I guess that goes to show you how important it is to do a full survey. Granted we dont know what happened in the ambulance or at scene so I will not be making any judgments about the crew. I know that group works hard.
 
We would just call it here. It is in our guidelines not to even begin CPR on a patient like that. If we transported that we probably would get a QI flag.
 
If he had a pulse I'd try. Wouldn't be the first time we try to save organs. I remember a suicide by shotgun our team managed to keep alive for organs. Face and frontal lobe were on the ceiling, but the doc managed to intubate him and get him to the hospital.

Disclaimer: Here everyone is considered a donor unless they explicitly state that they refuse to donate so we always work our *** off to try and at least keep organs viable.
 
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