Page 126 - JSOM Fall 2018

An Ongoing Series

Knowledge Versus Suspicion

Michael Turconi, NSCOM ; Christopher Dare, SOIDC ; Katarzyna (Kasia) Hampton, MD *
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our team of four international SOF medics has been tasked FIGURE 1 eFAST exam, RUQ view, patient B.
Yto assist partner forces with critical medical support. As
the troops advance through high­density urban terrain, they
encounter massive enemy resistance. On a warm evening, you
receive communication that a platoon of host nation forces has
been hit by a vehicle­borne IED followed by sniper fire. Three
casualties soon arrive at your casualty collection point (CCP):

Patient A: Unresponsive; gunshot wound (GSW) to the head,
parietal left; cerebral matter is exposed; agonal breathing pat­
tern is observed

Patient B: Awake; GSW to upper right flank; HR 140bpm, BP
95/60mmHg, RR 25/min, Spo 97% on room air
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Patient C: Verbal; shrapnel wound to the right anterior lower
chest; labored breathing; HR 120bpm, BP 100/65mmHg, RR
30/min, Spo 93% on room air
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MEDEVAC helicopter is en route and they can take only
one of your patients. Your junior medic, who completed the FIGURE 2 eFAST exam, RUQ view, patient C.
eFAST exam on patient C, argues that this patient has both
a pneumothorax and free fluid in the abdomen. Now, being
the senior medic, you review the images. You agree with the
diagnosis of pneumothorax on the right, and order your junior
medic to place a chest tube. You decide to send patient B first.
1. What classic finding is present in patient B (Figure 1)?
2. Based on Figure 2, can you rule out massive hemothorax
on the right in patient C?
3. Would you interpret the RUQ on Figure 2 as positive for
free fluid in the abdomen of patient C?

Join us at SOFsono.org for further case discussion.

*Address correspondence to sofsono.org@gmail.com
1 OR-4 Turconi is a NATO Special Operations Combat Medic (NSCOM) and is currently serving in the Italian Army Special Forces unit, 9th
Regiment “Col Moschin”. CPO Dare is a Special Operations Independent Duty Corpsman (SOIDC) and is currently the Navy Senior Enlisted
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Leader at 1st Reconnaissance Battalion. Dr Hampton is an emergency physician and a volunteer SME ultrasound instructor for the military
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medical community. She is currently practicing at the Landstuhl Regional Medical Center, Germany (US Army Medical Department).
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