Sometimes You Need That Egyptian River

"This is Rescue 7,"said the paramedic's tremulous voice over the radio as his vehicle's siren wailed in the background.

"We are en route Code 3 to your facility with a 15 year-old female, gunshot wound lower abdomen. Pulse 120, BP 90 over 60, respirations 26. We have started two large bore IVs of Normal Saline and have 100% oxygen running by mask. ETA your location is five minutes."

Now this be badness.

It happened early in my civilian practice, before the hospital where I worked established itself as a Level I Trauma Center. An abdominal GSW mandates surgery. As the nurses set up the trauma room, I phoned the on-call general surgeon and gave him the news that he needed to leave his office full of patients and come immediately to take this young lady to the OR. He would arrive in 30 minutes. In the meantime I was on my own.

I gave the nurses a litany of STAT orders to be done as soon as our patient hit the door: "Complete blood count, chemistries, urinalysis, type and crossmatch for six - make that eight - units of blood. Foley catheter..."

The doors burst open as the paramedic team rolled through with our patient. She was a pretty caucasian female with long blond tresses. I quickly surmised that her usual complexion was probably less pallid than her currently white skin color. She'd clearly lost a significant amount of blood, which I could not see because it was inside her abdomen. So no telling how much. Undressing her quickly, we found a single entrance wound about two inches below her navel. We rolled her on her side to examine her back. No exit wound. And no telling where the missile had traveled once it entered her body. Rolling her back to supine, I noticed powder burns around the bullet hole.

I turned to the medics. "How did she get shot?"

"Appears to have been self-inflicted," they responded. A neighbor heard the shot and called 911. We found her in her bedroom. She had her father's handgun."

As I turned back to the patient, the nurses completed inserting a urinary catheter into her bladder. The drainage was red with blood. "Keep those IVs going wide open," I ordered. "And get me a central line setup. Any word on our surgeon yet?"

"On his way," replied a nurse.

I quickly started a central IV line in order to give her more fluids. Her vital signs had begun to stabilize, so at least we were matching her blood loss and keeping her intravascular volume steady. She would make it to the OR where our surgeon could definitively stop the bleeding and repair whatever organs were injured.

Another look at the girl's entry wound had me feeling her lower abdomen. Sure enough, a mass the size of a softball was palpable. (There was no such thing as ED ultrasound in those days.)

"The OR is ready and the surgeon is prepping," said the nurse.

"Good," I replied. "Tell them to call an obstetrician as well."

This pregnant teenager survived her internal injuries. The fetus whom she shot herself to kill did not fare as well.