Fifteen years ago I was working the night shift at a hospital on the west coast of Florida as an ED physician assistant. We received a radio call from an ambulance regarding a 57-year-old white male who had been shot in the chest at close range. When the police and ambulance arrived, we learned that the patient was a security guard that had been sitting in his car at a construction site with his window down. Two adult males approached him. When they got to the side of the patient’s car one of the men pulled out a pistol and shot him.

On arrival, the patient was anxious and in pain but had no respiratory distress.  His vital signs were stable, and upon examination he was alert and oriented. His eye, ear, nose, and throat exams were remarkably normal. His chest sounds were clear. He had a large bruised area over his left anterior chest wall with a linear pattern of bruising extending across to the right chest. He also had palpable masses in the anterior right side of his chest. There was no crepitus on palpation. His chest x-ray and chest computed tomography showed no evidence of pneumothorax or hemothorax. However, the images did show metal fragments in the right anterior chest wall.

The investigating officer had the patient’s security guard badge with him. The badge was grossly misshapen. Apparently the bullet struck the badge and traveled under the skin across his chest. It never penetrated below the ribs.

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When all the testing was completed, the patient was found to be stable. I removed the fragments from the chest wall, while the investigating officer observed maintaining chain of custody. The evidence was passed on to the investigating officer, and the patient was admitted overnight for observation.

The two male suspects were apprehended and the patient identified them later that night. I appeared in court three times to testify that if the bullet had not struck the badge, the security guard would not have survived.

Subsequently, the patient made a full recovery. He left his security guard position. When the trials were over, he was allowed to keep the badge.

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