Indexing Title:

JMDEGUZMAN’s Medical Anecdotal Report [05-01]

 MAR Title:

In Extremis

 Date of Medical Observation: January 2005

 Narration:    

             A man in his 40’s was brought in at the emergency room after sustaining a gunshot wound in the subxyphoid area. Patient was lethargic and pale looking. He was tachypneic, tachycardic, and hypotensive at palpatory 60. Air entry was good in both lungs and fairly audible heart sounds. Abdomen was distended. Simultaneously the ABCDE’s of Trauma were instituted. Highly suspecting of a great vessel injury I decided to operate on the patient. My objective was control the bleeder. Prognosis and condition of patient explained to the relatives and Informed consent was secured.

            We did initially a Left lateral thoracotomy for proximal control followed by laparotomy. 3.5 to 4 liters of blood was noted intraperitoneally, clotted and non-clotted. Fresh blood was noted briskly flowing from a midline injury. Finger pressure done and distal control applied. During this time patient’s vital signs falter and despite everything we could offer he expired on our table.

            After saying a short prayer we proceeded on exploration. The Abdominal aorta at the level of celiac artery was ruptured, 80% of its circumference. A slug was recovered at the left para-vertebral area level of T6-T7.

 Insights (Discovery, Stimulus, Reinforcements) (Physical, Psychosocial, Ethical)

            The prognosis on this patient was grim even at the start. However we are doctors expected to do our duties. We do not wait for patient to die in front of us. However we must train hard to be able to save one. Case like this does not come in bundles. That was an opportunity for me but I was not able to convert. Hence, I console myself, next time I must. And so I did a post-mortem exploration and I conclude maybe not next time, some other time. Not only expertise is needed in such kind of injury but also equipment and technology.