A 19-Year-Old Shooting Victim With Complications

Janice Verham, MD

Disclosures

July 08, 2019

Physical Examination and Workup

Upon evaluation, the patient's vital signs include a temperature of 96.4°F, pulse of 150 beats/min, blood pressure of 115/74 mm Hg, respiratory rate of 34 breaths/min, and saturation of 96% on room air. He is a thin young man sitting up comfortably in bed. He is alert and oriented. His respiratory examination is notable for mildly decreased breath sounds on the right, and his cardiac examination is significant for tachycardia.

The patient's pigtail catheter is in place; the dressings are clean, dry, and intact; and approximately 75 mL of serosanguinous output from the chest tube is noted over 12 hours. The patient's bilateral lower extremities demonstrate no edema and are soft. He has a negative Homan sign bilaterally.

EKG reveals sinus tachycardia with no Q waves or T-wave abnormalities. Ultrasonography of the patient's bilateral lower extremities reveals no evidence of venous occlusion.

Laboratory analysis reveals negative troponin findings (< 0.04 ng/mL), worsening anemia (decrease in hemoglobin level from 8 mg/dL to 6 mg/dL over 12 hours), and stable elevated leukocytosis (white blood cell count of 19 × 109 cells/L).

A chest x-ray reveals an acute increase in density in the right chest at the pigtail catheter site compared with prior imaging (Figure 1).

Figure 1.

The CT scan one day after chest pain is reported indicates an expanding, loculated right pleural effusion with high-density material and layering. The pigtail catheter is in the anterior superior portion of the fluid collection (Figures 2 and 3).

Figure 2.

Figure 3.

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