Shot Through the Heart

Case Study of a Self-Inflicted Gunshot Wound to the Heart in a Very Rural Setting This episode includes a discussion of a mathematical description of the severity of the three worst injuries in a trauma patient, the Injury Severity Score, developed by Susan Baker at Johns Hopkins Hospital and Bill Long when he was a fellow at the Maryland Shock Trauma Center in Baltimore. This score was further refined by adding physiological variables such as systolic blood pressure, heart rate, respiratory rate and the Glasgow Coma Score (a neurological scoring system developed in Scotland) to become the Trauma Score (TS). The combination of these two scoring systems became the revised Trauma Score or RTS, from which the patient probability of survival could be calculated. This was the first objective mathematical system that allowed comparison of trauma patient outcomes by trauma centers and by trauma surgeons. This episode describes a woman in a rural community with only a 24 bed hospital in rural Washington state, no general surgeon living in the community, no cat scanner, a very limited blood bank, and a family practitioner covering the Emergency Room. The path of the bullet went through the right ventricle of her heart and thoracic spinal cord, making her paraplegic. The family practitioner recognized immediately that this patient was dying, and he needed help. He called the MSTT. We responded and were in the air within 30 minutes. We asked the family practitioner to move the patient to the operating room and prep her chest and abdomen with an antiseptic solution before we arrived. The patient’s heart stopped beating as we landed in our helicopter. What follows is a step-by-step description of the steps we took to revive this patient, stabilize her, and take her to our trauma center. She survived, but remained paraplegic. We did this resuscitative surgery and suture of the two holes in her heart with the family practitioner as my first assistant and the local nurse anesthetist. This was the first time he and his staff had ever seen the chest opened. We also discuss how some cardiac surgical principles can be adapted to achieve a satisfactory outcome for this patient in a rural hospital with very limited resources. To learn more about these life saving strategies and techniques, look for Dr. Long’s upcoming book, Flatline to Lifeline. Follow us on Twitter @DrLongPodcast Producer: Esther McDonald Director & Technical Support: Lindsey Kealey, Host of The PAWsitive Choices Podcast © Flatline to Lifeline 2025