9.04.2008

Hole

I hear them before I see them. Yelling over the squeak of Stryker wheels on linoleum floors; I wipe sweat from my brow and ready myself.

They didn't give us much time to get ready. Couldn't call in a report because things were going so haywire in the back. I hear the chatter of police scanners and grip the IV catheter a little tighter.

They wheel him in and I wonder whether or not he's awake. He has a tube in his throat so he can breathe, but his eyes are open, moving around. I peer down at him and see his eyes going back and forth slowly.

"Is he..." I start to ask.
"No. His eyes have been tracking back and forth like that for a few minutes. ETOH on board, we got an 18 in his upper arm, but that's all we could do." The paramedic nods at me.
"Got it."

I see his arm is bandaged, so I go to the other arm. He's freezing cold, so his veins are small. I manage to get a 20 gauge IV in his left hand, but it's not good enough for this trauma. I let everyone know about the new IV and go back to the other arm.

"I need you to cut this bandage off."
"Sir?"
"Yeah, you. Can you cut this off?"
"Sure," I say to the doctor as I grab my trauma shears.

I cut it off gingerly, and while I don't gasp, I stop breathing momentarily.

"Oh, God," I hear the doctor say, and my breathing resumes. I look down again and see a hole. There's a hole in this man's cubital fossa, no distal pulse. He's severed the major artery in his right arm, and lost a lot of blood.

"Just hold pressure, okay?"
"Okay."

"Tell me what happened," I hear one police officer ask another outside the door.
"Drunk kid wanted to leave, couldn't go out through the front door. Went upstairs, punched a window, and when he pulled his arm out, cut a hole in his arm. Looked like a pig got slaughtered. Don't know much, though; no one spoke English."
"What'd they speak?"
"Spanish."

The doctors take note of this and look around.

"Does anyone speak Spanish?"
"I do," I say looking up.
"Talk to this kid."

The doctors start working on two femoral lines, and I hold pressure. I hold like I've never held before. My fingers tingle and wrist aches, but I hold.

"Chico, estas en el hospital. Si puedas oirme, por favor mueva un dedo." He moves no fingers, but as I hold pressure, I speak softly in his ear. I figure it can't hurt.

The trauma surgeon comes in and looks to the doctors to tell him what's going on. Lost in their focus, they don't even acknowledge his presence.

"Someone, please, I need to know what's going on."
"Male in his early twenties," I say as I clear my throat, "ETOH on board. Put his arm through a window trying to leave the house. He's got a veritable hole in the cubital fossa, and his eyes are tracking back and forth. Dr. Sykes thinks he may have some seizure activity, but there might be a closed head wound as well. PD says the room was covered in blood. We've got two femoral lines, and we're on the fourth unit of blood. 20 in the right hand, 18 in the left upper arm."

I catch my breath and look at him through my mask and faceshield while my arm trembles from the pressure I hold.

"Christ. Thank you, Dr..."
"Oh...me? No, I'm just a lab girl."
"Really? Hell, you're the most eloquent lab girl I've ever met."
"Thank you, sir. Would it be okay with you if we put a BP cuff on this guy for hemostasis control?"
"Yeah...why didn't somebody think of that before?"
"No clue, sir. Could you hand me that?"

He rolls the manual bp cuff my way, and I pump it up until the bleeding stops again.

"Well, let's get this guy to OR."

The doctors finish securing their femoral lines and he's wheeled off. I stretch my aching fingers and glance down. My shoe covers are red. They're bright red, and I see my gown is speckled with the same. Blood surrounds me, and I try not to slip on my way out. My nostrils fill with the heavy scent of iron, and I peel my shoe covers off as I leave.

"Get the line?" My eager coworker looks up at me, smiling.
"Yeah, and then some."
"Jesus you're bloody. Let's get you some peroxide."
"Thanks, but no time," I laugh as the trauma pager goes off again.

13 comments:

Chapati said...

Welcome back, and well done :~)

Nikki said...

Damn right, woman - you show those doctors how it's done! :)

Fyremandoug said...

Holy cow girl ....you rock

I like it!

Michael said...

Bravo. Well done. Awesome. Great Job.

Lodo Grdzak said...

Funny. Wait,..not funny. I mean, its sort of funny, right? I see something funny in there for some reason.

Medix311 said...

Way to go!

Bernice said...

You are simply amazing.

JS said...

Nothing like working a good trauma! JS

Philip said...

Jesus. Good work.

Rogue Medic said...

Excellent post.

It is relevant to all of the hemorrhage control dialogue that has been going on recently. I commented on it here - On the Clock: Hole.

TOTWTYTR said...

Which just goes to prove that you can't teach common sense. A co-worker of mine says, only half in jest, that "You can be smart, or you can be a doctor".

It's the common sense stuff that a lot of doctors seem to miss, but a lot of EMTs and medics seem to get.

Good work, young lady.

Polar Doc said...

Hey Sam! Muevete un dedo might also be interpreted as a command to move one's toe. Next time you ask the dude (or chico) to move a dedo, watch the toes too. I learned the hard way.

danny said...

Way to appeal to my hemophobia!
No really, that was a great post.