Had a similar case in ED Lebonheur about a month ago..
I did not use c spine immobilization and since the kids was protecting his
own airway did not use RSI and intubate. ENT evaluated and took the patient
to the OR to repair the punctured trachea and remove the BB..
BB GSW are different than firearms because the amount of force they transmit
is much less than the bullet.. Heat generated and tissue damage from yaw is
also less. SO in fact, I think the BB is more like a deep splinter whereas a
GSW from a firearm has the potential for more problems from the blast
In the case of a GSW , I am more inclined to protect the airway...
PS, I do not get a CT on every pateint with suspected meningitis prior to
performing the LOP. I think it is a waste of money and significant sluff of
our professional judgment.." what was the incidence of lumbar herniation in
the days before everyone had a CT?"
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