ED thoracotomies in penetrating trauma with survival and fast recovery
Fernando Safdie, Surgery Resident
A 26-year-old male was brought to our institution as a trauma alert. He sustained multiple
gunshot wounds to his right shoulder, right axilla, right chest, right thigh and right foot. He
denied any loss of consciousness, was a GCS of 15 on the scene and a GCS of 15 upon arrival.
Patient presented complaining of difficulty breathing. He had a past medical history of asthma.
No surgical history. He was found to be alert, awake, diaphoretic, but oriented x3.
He had a gunshot wound to the right shoulder with 2 gunshot wounds in the axilla and a gunshot
wound in the right mid axillary line. Each wound was approximately 1 cm in diameter. He had
decreased breath sounds on the right. Pelvis was stable. He had a gunshot wound to the right
lateral thigh and right medial thigh, both approximately 1 cm each. He also sustained 2 gunshot
wounds to the dorsum of the right foot. Peripheral pulses were present and equal bilaterally.
Initial chest x-ray revealed the presence of a right hemopneumothorax for which a chest tube was
placed and approximately 600 cc of blood was initially obtained.
Films of the right thigh revealed no evidence of fractures. Films of the right foot revealed
fractures of several bones in the foot.
As resuscitation was continued the patient started becoming hypotensive, progressed to
becoming bradycardic, and pulses were lost. Once pluses were lost bilateral thoracotomies were
performed in the trauma room. The patient was noted to have a pericardial tamponade. As the
pericardial tamponade was relieved the patient regained heart function. He was then taken
emergently from the trauma resuscitation area to the operating room.
Patient underwent bilateral chest exploration with formal thoracotomies, resection of the right
lower lobe of the lung and repair of a right ventricle injury. He was noted to have a left
diaphragmatic tear, which was repaired. Post-op he was transferred in critical condition to the
intensive care unit. We continued resuscitative efforts in the ICU, and his acidosis started
correcting during the resuscitation process. He was subsequently able to be extubated and local
wound care was being provided.
Patient was transferred to the floor where he worked with physical therapy and occupational
therapy. He was subsequently discharged 18 days post injury with no complications or further
issues.
DIAGNOSES:
1. Gunshot wound to the right shoulder, right axilla, right chest, right thigh and right foot.
2. Right lung injuries.
3. Right ventricle injury.
4. Right talus fracture.
5. Right clavicular fracture.