here you go with the medical stuff
Gunshot wounds to the chest
Similar to penetrating abdominal injuries, gunshot wounds to the chest also involves massive amounts of blood loss. The large blood vessels, the aorta and the vena cava, carry blood to and from the heart. A bullet can severely damage these vessels as well as the heart and lungs. The rib cage may also be a source of bleeding if one of the blood vessels underneath each rib has been affected, but this type tends to be bleeding of a slower pace.
When Mark and Lexie discover Alex in the elevator, even though he is conscious, they see his struggle to breathe, indicating the presence of a collapsed lung (pneumothorax). Mark wants to put in a chest tube, in order to relieve the pressure and help Alex's ability to breathe, but Alex REALLY does not want one. Why? A chest tube, a hollow and flexible drainage tube, is inserted to drain blood, fluid, or air to allow the lungs to normally and fully expand. But the insertion of a chest tube is a SURGICAL procedure, and it HURTS. With or without anesthesia it hurts, because you can only really numb up the skin and not the whole pathway into the lungs. Usually people will get pain medicine along with local anesthesia but in this incidence, they did not have that option. Hence, Alex's screaming in pain.
Now with McDreamy's case... Oh my FREAKIN' goodness, he shot McDreamy... Fortunately, Cristina somehow took charge. She managed to gather Meredith and April in order to transport Derek to the OR floor where she knew a team would be. And even though Cristina did not find Teddy or Owen, she still had the resources of a surgical team and OR, so that they could establish a stable airway, anesthetize and begin fluid replacements for Derek.
Due to the location of the entry wound, Cristina and Jackson knew they needed to open up Derek's chest in order to repair any vessel or heart damage that the bullet caused. When a patient with a gunshot wound to the chest arrives to the ER, it is the emergency doctor's and surgeon's responsibility to resuscitate, diagnose, and treat the patient within minutes. And when the patient presents with continued hemodynamic deterioration (such as Derek), the patient should be taken to the OR immediately for a thoracotomy (incision on the side of the chest) or median sternotomy (incision down the middle of the chest). Bleeding should be rapidly controlled, then the repair of the vessels and/or heart chambers may begin. And depending on the injury, the use of cardiopulmonary bypass, grafts, or intracardiac shunts may be required.
... And I'm afraid to say any more...
Jhanak
