GSW TO RIGHT CHEST. CT Findings

[Matthew Reeds]

My reasoning for CT was due to the fact that the patient appeared "stable"
and CT would be a good next step to evaluate his injuries. Although I agree
a vascular injury would be the most life-threatening injury, he appears to
be haemodynamically stable and therefore, at this point, I do not consider a
vascular injury to be likely. I would be more concerned initially with a
trachea/bronchus/oesophageal injury. I might however change my mind
depending upon the findings of the CT scan or a deterioration of the patient
or change in his vital signs etc.

 

The images are not the best on my mobile (and I am certainly not in the
realms of a radiologist!) but I THINK that I can see an abnormality on the
CT near the trachea. I don't know if it is soft tissue swelling, a
haematoma, ruptured trachea, missile object, artefact/VOMIT or even entirely
normal.

 

>From the quality of the images that I have got, I cannot identify any injury
of the great vessels. I would NORMALLY expect the patient to be grossly
unstable if he had a great vessel injury (however I do appreciate that some
of these injuries can be contained by a "stable" haematoma which prevents
the patient from exsanguination.) Depending upon the quality of the CT
images and any concerning finding, I would then want an angiogram to
evaluate this further. However, I would like to more about his oxygenation
and ventilation status (AT THE MOMENT he is haemodynamically stable) as I
would not want to be detracted from treating any life-threatening
respiratory problem by performing an angiogram to evaluate a "stable" injury
BEFORE this.

 

I remain concerned regarding the ongoing haemorrhage from his chest drain.
Is this frank bleeding or continued "oozing"? What is his clotting/TEG
showing? I would NOT want to be distracted from dealing promptly with
ongoing thoracic haemorrhage which APPEARS to be stable (a fatal mistake!)

 

I shall await further information with interest.

 

 

Matthew