A mobile intensive care unit (MICU) was dispatched to transport a critically injured patient with a gunshot wound to the spine from a community hospital to a level I trauma center. The patient transported suffered from a gunshot wound to the left posterior midthoracic region. The patient experienced transient traumatic cardiac arrest before transfer. The MICU crew arrived at the emergency department and found the patient intubated and with a chest tube. Fluid resuscitation was continued, and the patient was transported. At the level I trauma center, the patient was admitted in critical condition. The patient was declared brain-dead on postinjury day 8. Spinal immobilization in penetrating trauma is a controversial topic. This patient met the historic clinical indication for spinal immobilization. The patient's injuries included multiple cervical vertebrae fractures and spinal cord disruption from the penetrating projectile, with the bullet remaining in the patient. Interfacility management by the MICU crew was focused on adequate ventilations and immobilization while continuing to address the patient's shock state. Penetrating injuries to the spinal cord can be devastating. Being aware of the pathophysiology of penetrating spinal injuries, along with current evidence-based practice, will assist providers in making sound clinical decisions for their patients.
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