He was standing off to the side, watching a fight, when he felt something hit him just below his left ear. He went down and friends noticed blood coming out of both sides of his neck. He was rushed to the Emergency Room where nurses worked to apply pressure to stop the bleeding and notified the on call doctor, Bill, of a patient in the ER.
Bill walked in to find the pt was amazingly awake and able to answer questions despite having been shot through the neck not long before. As Bill examined him, he discovered that thankfully, the bullet didn’t go through any major blood vessels, his spinal cord, bones or brain, which allowed him to be awake. However, the bullet did go through his pharynx, which was going to create problems in the near future for the patient to be able to breathe.
Normally, Bill would stabilize the patient and then call Jim and let him know of the need for establishing a better surgical airway (by putting a tube into his neck – a tracheostomy.) But on this Friday night, Jim was enjoying the last weekend he had with his kids and grandkids at Kugark, and so he wasn’t available to help. Bill considered sending him to a referral hospital in Mt. Hagen, but it was already dark and there was a chance nothing would be done in the night there, and so he decided to keep the patient here, knowing that he might yet require a better airway.
In the next few hours, the patient’s neck got more swollen from the effects of gunshot wound and his breathing got worse and worse. Bill knew this guy was going to die unless he was able to get a better airway into him, so he took him to the OR to see if he could be intubated or to try a cricothyrotomy (cutting a hole just below the adam’s apple and putting a tube into the trachea to help him breathe). Not knowing any of the above details, my phone rings at 10:30pm and Bill asks if I can help him establish an airway in a gunshot wound patient. I quickly get changed and run down there knowing that, despite having no experience in this, sometimes just having another person to share the burden with and to provide moral support is just as important as someone who can do the procedure. When I got to the OR, the patient was sitting up, struggling to breathe. Bill, David (our anesthetist), Vero (our scrub tech) and now I, were working to get everything ready to try and intubate him and if necessary to do the emergency cricothyrotomy. We prayed with him and then David tried to intubate and when he couldn’t see anything due to all the swelling and damage from the gunshot wound, Bill started to do the cricothryotomy. With a little difficulty and the patient's heart rate down to 41, we managed to get in and put the tube inside to help him breathe. As soon as he was able to breathe, his heart rate came back up and the tension of the room evaporated and we were able to get a breathe ourselves.
