Paramedic Response to Gunshot Wound to the Lower Left Quadrant of the Abdomen
Immediately control external hemorrhage with direct pressure, establish large-bore IV access, initiate rapid transport to a trauma center, and avoid delays in the field—hemodynamically unstable patients with abdominal gunshot wounds require emergency surgical intervention within minutes to prevent death from hemorrhagic shock. 1
Scene Safety and Initial Assessment
- Ensure scene safety first—do not enter until law enforcement secures the area, as the shooter may still be present 1
- Perform rapid primary survey focusing on airway patency, breathing adequacy, and circulatory status with immediate vital sign assessment 2
- Assess hemodynamic stability using systolic blood pressure ≥90 mm Hg and heart rate 50-110 beats per minute as stability thresholds 3, 2
Hemorrhage Control and Circulatory Support
- Apply direct pressure to any external bleeding sites immediately—this is the first priority after ensuring airway and breathing 1
- Establish two large-bore IV lines (14-16 gauge) en route if possible, but do not delay transport for IV access 3, 1
- Begin crystalloid resuscitation with normal saline or lactated Ringer's if the patient shows signs of shock (systolic BP <90 mm Hg, HR >120, altered mental status) 3, 1
- Recognize hemorrhage classification: Class III hemorrhage (1,500-2,000 ml blood loss) presents with decreased BP, HR >120, and anxious/confused state; Class IV (>2,000 ml blood loss) shows HR >140 and lethargic state—both require immediate surgical intervention 3, 1
Critical Transport Decisions
- Transport immediately to a trauma center—do not attempt extensive field stabilization, as "scoop and run" is the appropriate strategy for penetrating abdominal trauma 1, 4
- Notify receiving facility early with patient age, mechanism (gunshot wound to left lower quadrant), vital signs, and estimated time of arrival to allow surgical team activation 1, 4
- Position patient supine unless airway compromise requires alternative positioning 4
- Avoid hyperventilation during bag-valve-mask ventilation if needed, as this increases mortality in severely hypovolemic trauma patients 1
Wound Management in the Field
- Do not probe the wound or attempt to remove any retained projectiles—this can worsen bleeding 1
- Cover the wound with sterile dressing but do not pack it deeply 5
- Leave any eviscerated bowel covered with moist sterile dressings—do not attempt to replace organs 6
- Recognize that gunshot wounds to the left lower quadrant can injure the descending colon, sigmoid colon, small bowel, left ureter, iliac vessels, and potentially the bladder 6
Monitoring During Transport
- Reassess vital signs every 5 minutes or continuously if equipment allows 3, 2
- Monitor mental status changes as indicators of worsening shock—progression from anxious to confused to lethargic indicates increasing hemorrhage severity 3, 1
- Observe for abdominal distension which suggests ongoing intra-abdominal hemorrhage 6
- Document entry wounds and any exit wounds, as trajectory information guides surgical planning 2
Common Pitfalls to Avoid
- Do not delay transport for complete IV access or extensive field interventions—time to surgical hemorrhage control is the primary determinant of survival 1, 4
- Do not assume hemodynamic stability means absence of serious injury—gunshot wounds to the abdomen have high rates of intra-abdominal organ injury requiring surgery even in initially stable patients 6, 7
- Do not rely on external appearance to predict internal injury severity—the bullet trajectory can cause extensive internal damage with minimal external findings 1, 2
- Recognize that approximately 88% of abdominal gunshot wounds will have significant intra-abdominal injuries requiring surgical intervention 6, 1