TVTRAUMAVAULTCASE-BASED TRAUMA JUDGMENT
Teaching image withheldThe image will be revealed when it becomes clinically available in the case.
Operative or early postoperative bedside photograph: the patient has a temporary abdominal closure with a visible laparotomy incision and multiple large-bore cannulae or tubing consistent with extracorporeal support. The photograph is classified as OPERATIVE/POSTOPERATIVE ICU documentation rather than diagnostic imaging; the exact ECMO configuration and acquisition timing require clinical-record confirmation. teaching visual
Operative or early postoperative bedside photograph: the patient has a temporary abdominal closure with a visible laparotomy incision and multiple large-bore cannulae or tubing consistent with extracorporeal support. The photograph is classified as OPERATIVE/POSTOPERATIVE ICU documentation rather than diagnostic imaging; the exact ECMO configuration and acquisition timing require clinical-record confirmation. • TEACHING IMAGE
Penetrating traumaHigh-velocity gunshot wound traversing the thorax, diaphragm, and liver, with operative abdominal packing and temporary open-abdomen management complicated by severe cardiopulmonary failure requiring ECMO.Advanced

Ballistic Thoracoabdominal Injury With Open Abdomen and ECMO

SCENARIO

A previously healthy adult sustains a close-range gunshot wound to the right lower chest and upper abdomen. Prehospital care includes hemorrhage control, intubation, blood products, and rapid transport. In the trauma bay, the patient has penetrating thoracoabdominal injuries with hemorrhagic shock. Resuscitation proceeds directly to emergent operative management because of instability. Damage-control thoracotomy and laparotomy identify a transdiaphragmatic ballistic tract involving the lung and liver with major hemorrhage. The abdomen is packed and left temporarily open. Despite operative hemorrhage control and massive transfusion, severe hypoxemia and cardiopulmonary shock persist; the patient is cannulated for ECMO in the operating room and transferred to the ICU. The teaching photograph is obtained after this operative pathway, either during the operation or in the early postoperative ICU period, and becomes available at the second decision point.

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