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KwaZulu-Natal, South Africa, operates a tiered emergency medical service and hospitals are graded according to the type of patient they can receive. The incidence of trauma is high and, owing to the mixed urban-rural population in KwaZulu-Natal, prolonged prehospital and interhospital transfer times are common.
An adult male with an abdominal gunshot wound had been taken to a rural clinic by relatives. The clinic had no resident surgeons and therefore a road transfer of at least 45 min to a trauma unit was required.
B: Respiration >28 breaths/min: no Spo2 trace was detectable.
C: Weak carotid pulse (100 beats/min), blood pressure (BP) unrecordable.
E Abdominal gunshot wound (level with the umbilicus) with no exit wound.
A 250 ml fluid challenge was administered but the absence of any response prompted a second fluid bolus and the application of the pneumatic anti-shock garment (PASG).
Following the fluid challenges …
Competing interests: None.