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My hands wouldn't stop trembling when the trauma alert blared at 3AM. Gunshot wound to the chest, systolic BP 60, that terrifying sucking sound with each agonal breath. Just six months prior, I'd have frozen - another resident once died on my table because I fumbled the new tension pneumothorax protocol. But this time, muscle memory kicked in. My fingers flew through the thoracotomy steps as if guided: intercostal space identification, pleural breach confirmation, finger sweep for clots. All dri

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