Procedure for Treating Multiple Gunshot Victim in ER

Where's kayleamay?

She's an ER nurse.

I'll point her to this thread.

I'm bleary-eyed, but I'm here.

Hmm..well, assuming IV access was established in the field and a trauma was called before the ambulance arrives (as should happen), a bunch of things would happen at once but the game plan changes from minute to minute. Do you want her to die in the ER or the OR?

If you want her to die while still in the ER, have her pressure dump and lose her pulse. CPR will commence and it will probably end badly because of her wounds. But please, if she goes into asystole (flatlines), DO NOT SHOCK HER! I see it on TV. I read it in books. It does not happen in real life. It is not a shockable rhythm. Anyway, that was my own personal rant for the day.

I'm not a doc. I'm a ER nurse. But, I'll help you out if I can. Just PM me.

Wired said:

I realize the doctor is going to focus on stabilizing the bleeding first,.

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No, even in a multiple trauma with penetrating wounds, first is Airway, then Breathing, and then Circulation. That is the order of the ABC's of all trauma patients. They'd probably merely apply a pressure dressing to the shoulder and concentrate on the abdominal wounds trying to get her to the OR, or if things are backed up, get a rapid sequence CT. In an unstable patient, it would be reasonable to skip the CT and go straight to the OR. I've seen it argued both ways though.

Kaylea is right in that shocking someone will do no good if they have no blood volume, but I've seen it done. Usually someone complains, "Why'd you bother with that?"

Answers ranged from, "The crash cart was already open and I wanted to see how it all worked," to , "It's not like it's going to make her any more dead."

GeorgeK said:

No, even in a multiple trauma with penetrating wounds, first is Airway, then Breathing, and then Circulation. That is the order of the ABC's of all trauma patients.

Kaylea is right in that shocking someone will do no good if they have no blood volume, but I've seen it done. Usually someone complains, "Why'd you bother with that?"

Answers ranged from, "The crash cart was already open and I wanted to see how it all worked," to , "It's not like it's going to make her any more dead."

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I might use this at work.

ETA:

If you want a chain of events, here's one from a gunshot victim a few months back.

1. Rolls in the door with paramedics. Already has two IVs but is barely breathing.
2. Gets transferred onto hospital gurney. Remaining clothes are cut off, someone draws blood, someone hooks them up to our monitors, doc examines the patient.
3. Rapid Sequence Intubation. (Patient is sedated and paralyzed then doc puts a artificial airway (tube) down his trachea.)
4. Pressure is too low so IV fluids are dumped in with pressure bags.
5. Treatment is continued while nurses and trauma surgeon take patient to CT. Dopamine is started in CT because pressure is still dropping.
6. Patient goes directly from CT to OR.
7. Bleeding can't be controlled. Patient receives twenty-one units of blood during surgery but still codes three times. On the third arrest, resuscitation fails.

For an idea of timing, step 1-5 happened within about twenty minutes. Steps 6-7 took another five hours. You'll probably want your character to code enroute or upon arrival.

Wired said:

Once the BP falls to a certain point, does the victim go straight into v-fib, or is there something else that happens?

Thanks for any and all help.

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It depends. Young, healthy adults can tolerate pretty astounding degrees of low blood pressure. If your coronary arteries are semi-clogged, not so much.