phuluong2k
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During a campaign appearance, a political candidate is shot point blank in the right chest with a .22 caliber revolver. The entrance wound is well above the nipple line, just under the third rib, at the level of the anterior axillary line. His motorcade brings him to the emergency department, but he makes it a point to walk in, holding his right chest with a bloody hand and waving for the news media. A chest x-ray shows a hemothorax on the right, and the bullet is seen to be embedded in the right paraspinous muscles. A chest tube is placed in the right pleural cavity, and 650 mL blood is recovered. Over the ensuing 4 hours, he continues to drain between 250 and 350 mL blood per hour. Which of the following is the most appropriate next step in management?
A. Continued observation and appropriate blood replacement
B. A second chest tube in a better position to drain the blood
C. Thoracotomy and ligation of bleeding vessels
D. Thoracotomy, ligation of bleeding vessels, and removal of the bullet
E. Thoracotomy and pneumonectomy
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| Diego Casali
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I think the correct answer is D.
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| mesh
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I go with D too.............
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| kingsofke
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why are we removing bullet? why not C?
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| ARJ
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C. Thoracotomy and ligation of bleeding vessels
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| alenka
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i'd say-D-once we are already in the chest-why not remove the bullet?plus we need to investigate where the bleeding is coming from anyway-this means going all over the chest.
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| kmp
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C. Thoracotomy and ligation of bleeding vessels
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| phuluong2k
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The answer is C
This is an emergent cause of massive hemothorax, remove bullet too, but later
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| msyamp
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i too think it is c. but if you pla for a lateral thoracotomy you can be able to remove the bullet too at the same tme.but i will go with c
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| Diego Casali
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Kaplan says that you do not have to remove a bullet if vital structures are not endangered.
So, now I agree the correct answer is C.
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