interesting zone I GSW

[Ronald Simon]

Depends on CXR. If completely clear you could observe, but if effusion
remained then he should be explored.
Ron simon 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of sjasmd at aol.com
Sent: Sunday, May 04, 2008 8:43 PM
To: trauma-list at trauma.org
Subject: interesting zone I GSW






I would like to present a humbling case to the group.
a 16 year old boy sustained a gunshot wound to Zone I on the left side,
medially. He presented with hypotension. A left chest tube evacuated about
800 ml and he began to stabilize. He appeared paraplegic. 
I was called to perform an arteriogram after a chest film revealed that a
bullet was noted over the six thoracic vertebra. No clavicular fracture.
Incomplete drainage of the chest. Transthoracic echo unremarkable.

I suggested exploration. Surgeon persisted? with request. 

I rushed and reached?the hospital fifteen minutes later. Blood pressure
improving, BP 130/70?ish. ?Patient continued to bleed from chest tube. As
our angio suite is next door to trauma OR, we went upstairs.

Thoracic aortography in three views with injection of 60 ml of Visipaque at
30cc per second did not show an injury to any arterial structure. . Left
subclavian venogram also normal. see attached. Esophagogram normal. 

Total chst tube volume about 1600 ml but no further bleeding and BP 150/80
after three units Packed cells.

what to do?

sal