Question

You are working a night shift in the emergency department (ED) when the security staff yells for help at the ED entrance. As you grab a pair of gloves and race to the entrance you find a young adult white male lying on the pavement of the drive, unconscious and bleeding from his torso. He does not respond to verbal or painful stimuli but he has respirations of approximately 14 breaths/min and a weak and thready pulse of 120bpm. Two more staff members appear with a stretcher and a backboard and as the team log rolls the patient onto the backboard you see tears in his shirt where the bleeding is coming from. The patient is taken into the emergency department into a trauma bay where trauma assessments and interventions are employed.

Upon examination you find that the patient has a blue discoloration with an abrasion to the left forehead above the left eye. It measures 5cm x 3cm. Swelling and a 3cm x 1cm abrasion is noted to the bridge of the nose with epistaxis. Three torso wounds are noted that line up with the tears in the shirt. He is bleeding heavily from the largest…it appears with smooth edges and appears deep. A constant ooze of blood is flowing. It is found on the right lateral chest mid axillary line at the 4^th rib 3cm x 2cm x 5cm deep. A 3cm x 2cm x 2cm wound is found at the mid clavicular line, 2^nd rib above nipple on the right side. A linear cut is noted lateral to the right nipple 4cm x 2cm x 1/2cm deep. Bleeding is controlled by provider and a metal fragment pulled from the wound. A large amount of dried blood covers the patient’s torso. The palm of the right hand has two linear cuts that are parallel and 4cm x 2cm and 4 1/2cm x 2cm.

The patient is taken to surgery and planned to transfer to the ICU.

No information has accompanied this patient other than another ED patient stating that as they were walking in they saw a dark car open the passenger door and the patient fell out.

What should be done with the metal fragment removed from the victim’s wound?

Answer 1

The injury of this person doesn't seems to be a natural accident rather than a harm caused by others.This case comes necessitates cops enquiry.The metal fragment removed from the victim's wound should be sent for forensic investigation. This will enable to provide a clear knowledge on the type of metal and the cause for victim's injury.