se/b06/040: bang bang bang
Man on bed
Back to St Emlyn's Reception

1. How would you initially manage him?
He needs immediate intubation before his airway is completely occluded by the expanding haematoma. He will need blood cross-matching and surgery to control the bleeding.

Chest and neck X rays were performed.

2. Which anatomical structures would be at risk?

Larynx, trachea, carotids, jugular veins, brachial plexus

At operation he was found to have a transection of the right common carotid. The bullet track extended posterior to the vagus, which was intact, into the vertebral and pre-vertebral muscles. The bullet had caused a small chip to the vertebral body. The carotid was repaired with a patch and the bullet left in situ.

He was up and walking within a few days.

Learn more here