| dc.description | A patient in his 20s presented to our trauma bay after sustaining multiple gunshot wounds to the left thorax. Upon arrival, the patient was hypotensive with a blood pressure of 95/58¿mm Hg, heart rate of 129 beats/minute, respiratory rate of 29 breaths/minute, and oxygen saturation of 94% on 10¿L non-rebreather. The patient was intubated for airway protection due to mentation and concern for his respiratory status. Focal assessment with sonography in trauma revealed a small anterior pericardial effusion. Initial chest X-ray showed a widened mediastinum and left hemopneumothorax with a bullet overlying the left hilum. Secondary survey and adjuncts created a puzzling picture. On the left side, the patient had three gunshot wounds in the mid-supraclavicular, superior mid-scapular, and posterior midaxillary regions. Additional injuries included a left scapula fracture, left second and third rib fractures, and fractures of the anterior T1 and T2 vertebral bodies. On the right side, the patient had a palpable thrill at the right neck and supraclavicular region and was found to have a mid-shaft clavicle fracture and a large subclavian artery pseudoaneurysm with concern for active extravasation. No injuries were identified in the abdomen or pelvis. After resuscitation and two units of whole blood in the trauma bay, blood pressure improved to 162/85¿mm Hg. | |
