It was my monthly Saturday ED shift again...I am off most of the Sun and Sat but would covered an daytime Saturday ED shift once per months...well, slow and boring afternoon. I had just recovered from my AGE and disturbed by this frequent intestine movement which was does not cause any pain but produce this embarassing "KULU KULU" sound...
The ED nurse told me over the phone that 1 DOA (death on arrival) is coming over within 3 minutes. I got out from my bed, took a quick face wash and walked toward the ED. The 911 ambulance came just before I took a step into the ED resus room. As usual no cervical collar, no spinal board, no passing over. I had to asked the EMT how it happened while shifting the patient over to our bed from thr scoop stretcher. And the answer was - " I don't know, he was beside the car when we arrived. you better ask his friend outside." I did a quick primary ABCDE ... Severe craniofacial injury and rest of the body look ok. The head just a sealed plaster bed containning a broken vase and water. I couldn't intubate as the nurse passed me a laryngoscope with lamp that make the oral cavity look like a ghost house - dim light with unstable brightness. The oral cavity was filled with blood and I thought the suction with need to suck for hrs before it would be clear. Brain tissue was noted over the nose and ear. I took a scalpel and did a tracheostomy stat. I knew it was hopeless but need to comply with the local situation - I just can't certify death on the spot when the case arrived as what I could have done back in Malaysia. I need to do some resus ... and I cant ambubag the patient like that - with brain tissue and all the blood and the deformed head.... so I did a tracheostomy...
I left the patient to my team after securing the ABC and walked toward the friend. There was 2 friends sitting outside the bench. They told me that he was the driver(Suzuki Swift 1.5). The victim was spitting betel nut juice out from the window and he loss control of the car. The car than rammed into a field. The car was not severely damaged and the airbag(not equipped or malfunction ?) was not inflated. The victim had rammed onto the dashboard....I told them I would have to certify as nothing much I could do...The family had come hours later. After the explaination and hysterically reaction of the family the was this fight occuring outside the ED. 1 young guy was chased and assaulted by the victim's relative...I overheard the conversation later : the victim did not own a driving license and this young chap had rent a car for him to drive. The family was angried at the young chap for renting the car...crap la, no one point the gun at him to force him to drive....well, but the moaning relative got the privilege, so nothing much to say....insurance is not gonna pay a cent and that was the price the victim paid...
The photo below is bloody...and don't try it if you feel you can't take it.
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last chance to regret !!!!
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I did a second thought - this one is the less bloody version than the freaky big head view...remember : buckled up your safety belt and buy a car with airbag !!!!!!
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