What’s new in focused assessment with sonography: ballistic trauma

Excerpt

On 13 November 2015, 130 people were killed during the Paris attacks. On top of the numerous deaths, more than 300 patients were brought to hospitals, including about 100 severely ill due to massive ballistic trauma [1]. St Louis hospital received almost 40 patients with ballistic trauma due to the fact that one attack took place less than 200 m from the hospital entrance. Among them, a 38-year-old man was admitted with thoracic ballistic trauma that had occurred about 20–30 min before. The patient was alert with a Glasgow coma score of 15, his pulse rate was 120/min and his arterial blood pressure 120/90 mmHg. The patient was short of breath with thoracic pain. His SpO2 was 95 % with oxygen 6 L/min. Hemoptysis was noted on several occasions during initial clinical examination. The bullet’s entrance point was in the left axillary region as well as large subcutaneous hematoma of the right pectoral region. Focused assessment with sonography (FAST) was performed as part of the immediate clinical assessment and ruled out a pneumothorax, a hemothorax and a pericardial effusion while a pulmonary contusion was found. A CT-scan was performed and showed soft tissue injury and lung injury. Hemoglobin level dropped from 14 to 8 g/dl, and an episode of hypotension occurred, but it was decided to manage the trauma conservatively due to mostly soft tissue damage. Tranexamic acid, fresh frozen plasma and blood transfusion were administrated. The patient was discharged from the hospital 10 days later (after extraction of the bullet under local anaesthesia). …