An aeromedical crew was dispatched to a local emergency department to transport a fourteen year-old female with self-inflicted gunshot wound to the head to a tertiary pediatric trauma hospital. The patient was previously healthy at the time of injury. The referring hospital reported an initial EMS GCS of 3 with one wound noted to the right temporal region. She was intubated pre-hospital and briefly lost pulses during transport, but achieved return of spontaneous circulation after two rounds of CPR and epinephrine. Once in the ED, the patient was noted to be hypotensive with significant bleeding from her head wound. The wound was packed with trauma gauze and blood resuscitation was given, including four units of packed red blood cells and two units of fresh frozen plasma. Central access was placed in bilateral femoral veins after failed access in the left internal jugular and left subclavian veins, the latter of which was complicated by iatrogenic pneumothorax requiring chest tube placement. Upon arrival at the receiving facility, initial labs confirmed coagulopathy and the decision was made to give Tranexamic Acid (TXA).

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