Indexing Title:

        MJCABAHUG’s Medical Anecdotal Report [05-05]

MAR Title: 

        SHOOT OUT!

Date of Medical Observation:

        June, 2005

Narration:

A Saturday duty is expected to be busy. At around one o’clock am, I was left with a clerk to man the surgery patients at the Emergency Room.  All my co-residents-on-duty and the interns-on-duty were at the Operating Room doing two simultaneous operations.  

I heard noise outside the emergency room, which I thought was from a fireworks display at Roxas boulevard.  I went outside to investigate.  From a distance I saw people running away, there and then I realized it was a shooting incident just around the corner.

I saw two female patients approaching me saying they were hit.  I assisted them inside and assessed their injuries which turned out to be superficial lacerations due to a broken windshield hit by a stray bullet.

I asked them to sit down, anticipating more serious patient to come in.  Few seconds later, a male old patient was brought in by a male companion.  I then asked them what happened.  The companion of the patient started shouting, “you should be the one to examine the patient to know what happened this is an emergency.

I am a fiscal and my patient is a colonel”.

   I was stunned, but held my composure, and asked him not to shout.  I instructed a nursing aide to show him the way out and examined the patient.  The patient has superficial lacerations in the frontal area.

Then a policeman was wheeled in. So, I told the patient that I will be back and assessed the condition of the policeman.  I asked someone to activate the code blue of the hospital. 

The policeman had a gunshot wound in the axillary area, Right.  His blood pressure and cardiac rate were zero so I instructed intubation and cardiopulmonary resuscitation be started.

A patient was wheeled in with a gunshot wound in the right and left temporal area and the left lower quadrant of the abdomen.  The patient was gasping so I asked that he be intubated and cardiopulmonary resuscitation be done but he eventually died.

Another patient was wheeled in with a gunshot wound on the oral cavity and forearm, Left.  I then asked the residents from Ear, Nose, Throat Department to do emergency bedside tracheostomy which they did.

Next to come were two patients with multiple gunshot wounds. Their cardiac rate and blood pressure were zero, I still asked the anesthesiologist to intubate the patients and cardiopulmonary resuscitation but still they were not revived.

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

   In a situation like this, One should be ready to act as a triage officer which I did.  One should hold his composure and not panicked and be able to control the situation.

Another insight that I could give is that I could have done the emergency bedside tracheostomy but I gave it to the ENT residents instead.  This is to be able to look after all the patients and not to be hooked to one patient since I acted as the triage officer.