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A 23-year-old malepresents to the ER after sustaining a single gunshot wound...

asked Jun 28, 2014 in General Surgery by Rajesh Bahara

A 23-year-old previously healthy man presents to the emergency room after sustaining a single gunshot wound to the left chest. The entrance wound is 3 cm infe- rior to the nipple and the exit wound is just below the scapula. A chest tube is placed that drains 400 mL of blood and continues to drain 50–75 mL/h during the initial resuscitation. Initial blood pressure of 70/0 mm Hg responds to 2 L crystalloid and is now 100/70 mm Hg. Abdominal examination is unremarkable. Chest x-ray reveals a reexpanded lung and no free air under the diaphragm. The next management step should be

  1. Admission and observation

  2. Peritoneal lavage

  3. Exploratory thoracotomy

  4. Exploratory celiotomy

  5. Local wound exploration 


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Exploratory celiotomy
answered Jun 28, 2014 by Rajesh Bahara

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