Tuesday, July 18, 2006


GSW (gun-shot wound). It used to scare the hell out of me when I was a resident taking care of the trauma side of the ED. Really, taking care of GSW patients is not too hard for the emergency physician. You merely have to determine whether the patient has to have surgery or not... Now, admittedly, this is sometimes difficult, but when the decision is difficult the surgeon decides or you simply transfer the patient to a facility with a trauma service.

In our medium sized town there aren't too many surgeons who want to take these patients to the operating room because they fear they will be held to the standard of a fully trained trauma surgeon. Not an unreasonable fear.

When the patient has a GSW to the head and is essentially dead when the paramedics arrive however, the decision is not too difficult. But what happens when they succeed in starting the heart again? The answer is that in an otherwise healthy young patient that you send him to the trauma center with one main purpose... That he or she may "live" long enough to be an organ donor.

I had one of these patients the other night... In fact I had three GSW patients in one night! Only the head-shot patient died, but he did, in fact, become an organ donor before he did. All I did for him was shoot a one view skull film and a one view chest film. The idea here was to be able to tell the accepting facility the likely track of the missile through the skull, and to make sure the slug did not divert down into the neck or thoracic cavity.

My patient was shot just above the left ear. The patients brain matter was protruding from the entry wound. The slug, probably a 9mm, was in the opposite hemi-cranium with bits of metal left in its path. This made the wound transcortical and told me that the patient would likely never regain any meaningful existence. We flew him and he "lived" another 36 hours. The police arrested a handful of gang members the next day and charged them with murder.

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