EMS calls a trauma alert for a gentleman injured from a shotgun blast about 20 minutes ago. By report he was shot from more than 6 feet away and sustained injuries to his L chest, back and abdomen. On arrival, he complains of chest/abdominal pain without respiratory distress or shock. He is awake & alert and has no injuries in the head & neck region. More than fifty shotgun pellet entry wounds are spread out along the L chest, back and L abdomen without major soft-tissue loss, consistent with a shotgun injury from a distance. Vitals are P 115, BP 155/72, RR 24, sat 95% RA. There is some subcutaneous air in the L chest region, and the patient has pain & guarding in the abdomen. There is no vascular deficit.

A screening trauma ultrasound shows no pericardial fluid and no free fluid in the abdomen. Chest X-ray and plain film of the abdomen are shown, with multiple pellets visible. You speak to the trauma surgeon on call who requests a CT scan to further define the extent of the injuries.      

 

As the patient rolls to CT, you review the plain films.  What do they show?  What actions do you anticipate?  

 

 

 

Conclusion on next page