Question

On a hot Saturday summer night, three male teenagers/young adults are at a friend’s house for a house party. As they are leaving the house around 1 a.m., a vehicle drives by and starts shooting at them and the house. One male is shot in the head, another male is able to run away and call 911, and the third is shot in the torso. Upon the arrival of emergency medical personnel at the scene, the team finds two victims. The first victim is found to be shot in the head and has no vital signs or signs of life. He is declared dead at the scene. The second victim is found to have two gunshot wounds. The EMS team quickly stabilizes, packages, and starts to transport the patient to the nearest trauma center.
Prehospital EMS consultation to the level I hospital emergency department (ED) and trauma center:
19-year-old male with a gunshot wound to the right shoulder and lower back
Vital signs:
Heart rate: 120 bpm
Blood pressure: 120/60 mm Hg
Respiratory rate: 24 breaths/minute
Pulse oximetry: 90% on room air, 98% on 100% nonrebreather (NRB) mask
GCS: 15
IV: 18 g left antecubital
ETA: 2 minutes
Upon arrival to the trauma bay, the patient is sitting up and yelling that he cannot breathe. VSs: HR = 130 bpm, BP = 100/55 mm Hg, RR = 30, SpO₂ 98% on 100% NRB. There is a single gunshot wound to the right shoulder and a single gunshot wound to the right upper quadrant of the abdomen, no other wounds. On assessment, there are minimal breath sounds on the right, positive breath sounds on the left. The trachea is midline. The prehospital providers had performed a needle decompression to the right chest to release accumulated air due to a pneumothorax ……
The 19-year-old gunshot victim is still complaining of shortness of breath. A needle decompression was done in the field to release air because of the pneumothorax, preventing a tension pneumothorax. Initial assessment confirms minimal breath sounds on the right.  Upon further assessment, patient has a wound to the right lower back, which is tender to palpation. Current VSs: HR 135 bpm, BP 90/50 mm Hg, RR 22 breaths/minute, O₂ 99% with 100% NRB mask in place, temperature 97.7°F (36.5°C). A FAST examination is performed and is positive. The operating room (OR) is alerted and the patient is prepared to go to the OR STAT. In the OR, the the bleeding is controlled. The patient is moved to the ICU where he begins to stabilize.
In addition to the trauma surgeon and nurse, what other members of the team are essential at the bedside in this patient’s care?  What function will each provide in the care of this patient.  What interventions would you anticipate occurring in the first 15 minutes after the patient's arrival?

Answer 1

In addition to the trauma surgeon and nurse , there should be a respiratory physiotherapist,radiologist intensivist who could manage the patient to recover at the earliest by proper reapiratory physio exercise .

Doctors have the responsibility of closely monitoring the physiological status and parameters and deciding the accurate treatment. Nurse stay back with patient 24×7 and play the liason coordinating the team and providing accurate treatment as informed by the critical care team. Respiratory physiotherapist help patient to regain the health by repiratory physio exercise.radiology team help to accurately diagnose the recovery stage from timely X-ray or CT scan.

The emergency team should identify the site of injury and since upper thorax has been gun shot, and by auscultation as minimal breath sound without gurgling, could have suspected pneumothorax and performed a needle decompression at the earliest in right side within 15 min after patients arrival .