<\/a>neck zones used in assessing penetrating trauma<\/p><\/div>\n
However wounds to the neck sustained by a high-powered military style rifle such as the ones likely used in the shootout carry an immense amount of energy and generally require formal neck exploration in the operating room to rule out injury to the neck arteries (carotid and vertebral), veins, esophagus, and trachea.<\/p>\n
A missed injury to the esophagus in this situation is a devastating complication so great care was no doubt taken with likely direct visualization through a surgical exploration and then likely with endoscopy through the mouth to visualize the inside of the “goose”.<\/p>\n
If there was an esophageal injury from a bullet that was not treated for 20 hours, the situation becomes more grave with the rising possibility of mediastinitis or inflammation of the mediastinum, a condition with a high mortality.<\/p>\n
In the case of a gunshot wound to the esophagus, it would be debrided with the fashioning of a spit fistula with no attempt at a primary repair. Wide spectrum antibiotics with coverage with anti-fungals would be begun immediately. A Stamm gastrostomy (surgically placed feeding tube through a small incision in the stomach) would most likely be used to effect feeding in the case of esophageal disruption.<\/p>\n
Similarly, the airway patency of the trachea was likely directly explored through surgery and then with a bronchoscopy to view the lumen directly from the inside.<\/p>\n
Damage to the venous structures of the neck are generally easy to control through direct ligation. Damage to the carotid artery would likely be managed surgically with debridement and then with a patch angioplasty or artery harvested from elsewhere the body or from cadaver artery.<\/p>\n
There are also newer techniques such as embolization that can be used in a partial circumferential injury to a neck artery, particularly if the injury is the posterior vertebral artery.<\/p>\n
Seventh<\/strong>, the leg gunshot wound can be serious depending on where the wound was sustained. It is more than possible to bleed to death from a femoral artery wound, which runs from the groin through the deep medial leg next to the femur. An injury to the femoral artery is probably less likely as the patient did not completely bleed out.<\/p>\nIt appeared that the patient was able to ambulate enough to raise himself up from the bottom of the boat and then swing his leg over the side and straddle himself before hitting the ground. This makes the likelihood of a serious femoral fracture unlikely as it is generally not possible to bear much weight on a fractured femur. Fractures to the tibia (non weight bearing) generally are much simpler to fix than femur fractures.<\/p>\n
Gunshots to the lateral part of the leg can result in tissue loss and pain but are rarely life threatening. He will receive tetanus prophylaxis for the leg and the neck wound.<\/p>\n
Eighth<\/strong>, the suspect no doubt received a head CT and CT angiogram of his neck to check for injuries or intimal flaps to the verterbral arteries. Injuries to these arteries are difficult to treat surgically and bleeding is controlled through embolization. Intimal tears and flaps are usually treated with anticoagulation.<\/p>\nNinth<\/strong>, the suspect will likely be kept intubated and sedated for several days on while on the respirator in the intensive care unit. However, once his gunshot wounds have been addressed and his transfusion needs resolved, he will likely improve quickly owing to his youth and apparent good health. He almost assuredly will not be well enough to make a court appearance this weekend.<\/p>\nFinally<\/strong>, while in the ICU he will be at risk for transfusion-related lung injury, ventilator associated pneumonia, deep vein thrombosis, central line related bloodstream infection, and Clostridium difficile<\/em> infection (infection of bacterial overgrowth of the colon.)<\/p>\nRelated Posts<\/span><\/p>\nBoston Bomber Intubated and Sedated<\/a><\/p>\nBostom Bombing Suspect – Is He Competent for Legal Proceeding in ICU<\/a><\/p>\n <\/p>\n
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Bomb suspect’s wounds as possible clinical scenarios are discussed below:<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[29],"tags":[5558,5550,5561,5559,5560],"yoast_head":"\n
Bombing Suspect's Wounds - InsideSurgery Medical Information Blog<\/title>\n \n \n \n \n \n \n \n \n \n \n \n \n \n\t \n\t \n\t \n