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Old 04-21-2006, 01:23 PM
gabriela is offline
Join Date: Mar 2006
Posts: 1,158
Originally Posted by KGS
Thanks for the replies! Once again, the SDMB is an invaluable wealth of information.

The shooting takes place at a high school, so there *should* be someone immediately available with at least basic first aid. EMTs arrive in 3-5 minutes. The victim is taken by LifeFlight to a metro area trauma center (anyone know a likely place in the San Fernando Valley?) -- exsanguination is a big problem, and his vitals are basically in "crash" mode before he even reaches the hospital.
Those're bad. You have to be young, and a fighter, to come back from those.

Originally Posted by KGS
Yes, the writer should always know these things, whether it makes the story or not. I haven't given much thought about the exit wound, or if there will even be one...exit wounds tend to be messy, don't they?
Entrances are a quarter inch wide, look like neat, punched out ovals with a continuous trickle of blood from them, and have a thin dark ring at the edge of the raw flesh (the "abrasion ring"). Exits are a quarter inch to a half inch wide, look like slits or torn slits with v-shaped ends, and have a thinner trickle of blood from them, and no abrasion ring.

The exit is only messy when you are shot with a rifle or other high velocity gun. Those exits are the classic ones which most people think of - the famous exits that are larger than the entrances. They are not typical. By no means. At all. The exit from the average handgun looks a bit like what you would get if you were playing around with a broom handle inside a pup tent, and you accidentally poked it through the top of the tent. A slit with tears at the ends.

Plus the trickle of blood, of course.

Originally Posted by KGS
I'm a bit confused as to why intubation/ICU would be used for some injuries but not others. Would the patient be intubated before surgery, if his vitals were in "crash" mode? If so, how long would the intubation last?
Intubation is used whenever we can't count on the patient to handle his breathing himself. Absolutely, anyone who's crashing will be intubated. Anyone with a flesh wound will not be intubated. In betwen, judgement call, erring on the side of intubate.

If you have elective surgery, you will be put under and then intubated. There is a danger moment right between "going under" and "intubated", which all anesthesia personnel I have ever watched handle with professional smoothness. You are extubated before you wake up. You are hoarse afterwards for a day, and may not know why.

If you have elective or emergency surgery, and you are too ill afterwards to be relied on to breathe on your own, you will remain intubated, awake or not, until you can be trusted to breathe without help. You may find this process very difficult and annoying. Picunurse, have you had many people who were awake and alert but ventilator dependent, who tore out their own ETT and died from it? I will never forget one of mine... I gave her my Sunday paper to read in the ICU and my last sight of her was reading it intently in the morning, then off to the morgue in the afternoon. Brr.

Of course that was from before I was a pathologist.