This case comes from Dr. Mark McKinney from the University of Ottawa. He completed a fellowship in simulation through the U of O Skills and Simulation Centre. His academic interests are in education, simulation, and translational simulation; including where simulation can improve hospital and emergency department preparedness.
WHY IT MATTERS
We recognized a gap in the opportunities and cases available for residents to work through penetrating extremity trauma algorithms acutely. This case highlights the importance of a thorough and systematic ATLS assessment identifying both life and limb threatening injuries. It also opens a discussion on penetrating extremity trauma algorithms (e.g., WEST algorithm) and recognizing hard vascular signs to impact management acutely.
CLINICAL VIGNETTE
Multiple gunshot wounds. “Minding my own business” downtown. Dropped off by car at emergency doors, drop and run. Patient intoxicated.
CASE SUMMARY
Adult male with penetrating extremity and chest trauma (gun shot wounds) with peripheral vascular compromise. The patient needs a thorough and systematic approach despite distracting injuries. For both junior and senior learners, the patient progresses from threatened limb (requiring emergent investigation) to a pulseless limb (requiring emergent OR). For senior learners, there will be an additional element of instability from the penetrating chest injury requiring chest tube.
EM Sim Cases 