A 28-year-old male (75 kg, 170 cm), Afghanian police, suffered a gunshot wound attack in the Spanish Herat Basin (Afghanistan).
It is brought in land ambulance to the Spanish Military Hospital located within that base.
On arrival to the triage room he was conscious, with pain (VAS 7/10), 98% SatO2, TA: 120/60 mmHg, HR: 80 bpm, Temp: 36.2 oC.
Examination revealed a catastrophic lesion in the left eye due to possible blast, soft tissue injury in the left ear pavilion and left nasal cavity, a gunshot wound in the abdomen (superficial wound in the right).
The rest of the assessment was normal.
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Sedoanalgesia was started with midazolam (2 mg IV) and k (+)
During 140 minutes of the surgical procedure, the patient remained hemodynamically stable.
The intervention performed was debridement and reduction of the fracture of the tibia, medial and lateral fasciotomy, placement of a negative external fixator in the right femoral wound, cleaning and debridement of the final area of the femur, and placement of a device.
To improve pain control, in addition to performing multimodal intravenous analgesia (i. e., local anaesthetics) (i. e., local anaesthetics: fentanyl,ketoprofen), 2% (i. e. optic nerve block)
An ultrasound-guided peripheral nerve block was also performed at the right femoral level (bupivacaine 0.25% 10 ml) by placing a catheter at this level.
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The patient was admitted with mechanical ventilation and hemodynamically stable in the intensive care unit.
Six hours after admission to our hospital, the patient was evacuated by medicalized aircraft to a military hospital in rearguard to complete the surgical treatment.
Finally, she was discharged 21 days after the attack.
