A young man sustains a gunshot wound to the base of his neck. He was shot point blank with a .38 caliber revolver. The entrance wound is above the left clavicle, below the level of the cricoid cartilage, and just lateral to the sternomastoid muscle. The exit wound is just above the spinous process of the right scapula. He has normal breath sounds on both sides, is awake and alert, is talking with a normal tone of voice, is neurologically intact, and is hemodynamically stable. Portable x-ray films of the neck and chest took in the emergency department showed some air in the tissues of the lower neck, but are otherwise non-diagnostic. Which of the following is the most appropriate next step in management?
A. Observation for several hours
B. CT scan of the lower neck and upper chest
C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration
D. Immediate surgical exploration of the lower neck through a collar incision
E. Immediate surgical exploration of the upper chest through a median sternotomy

C. Angiogram, esophagogram, esophagoscopy, and bronchoscopy prior to surgical exploration

Explanation:

Based on the information being provided in regards to the scenario at hand it can be said that the most appropriate next steps would be to first conduct an angiogram in order to determine if the heart was affected and to what degree. After this procedure, three more procedures need to be conducted in order to determine if any other organs were affected before actually going into surgery. These procedures would be esophagogram, esophagoscopy and bronchoscopy. Therefore the answer to this question would be C.

my hamster died and my second hamster i got after that one died as well. i also lost two birds named rainbow and kiwi, (they didn't die, they flew off and escaped). i lost a cat named omi, and a dog named snoopie. the best way i got over it is, paying my respects, and just thinking that they were in a happy place. as well as just remembering but not thinking about it all the time, just do fun activities and try not to think about it too much. hope you feel better. i'm sorry about your loss. : (