Not a quite night it was…I was “vrooming” here and there … the rescue call station had informed us a case of “penetrating injury” – well, that was it, the details were mostly blurred. We had get use of their style of reporting… I was seeing another patient, when the ambulance arrived. The way the EMT “rusheh” the trolley into the resuscitation area means – very very serious case.
When I placed my foot into the resus area – I saw this…
“Holy SXXT”, I grumbled and started my assessment and my question round. The EMT told me that the patient was a bike rider and skidded. A wood had penetrated his abdomen and he had removed it on site. It was a big wood judging from the size of the wound.
He was comatose when the EMT found him. In our ED the patient was unarousable and only carotid pulse can be felt. The night shift Head nurse had assisted my with the CVP insertion and I got 2 pack of O neg packed RBC stat. The resus was not pleasent as the ED nurses were doing nonsense act(despite of getting large bore in, someone was exposing the patient with her best effort(cutting the very thick jacket...)
Within 15 mins, I had flushed in 2000cc of fluid plus blood via the 1 large bore and CVP -- the patient regained conscious - good sign.... The BP was still unmeasurable and I rushed him to the CT room. I had called up the surgeon and Anesthetist. Well, I think he would make it, it was an risky act, because, the pt might collapsed again and unable to make it to OT, if so , the surgeon and anesthetist would not be happy as they had to rushed from KHH….and further more I had no family to sign the permit. But I thought I need to give him a chance….
Well, we finally got a SBP of 70 mmHg and all those needed were at scene. The pt was sent into OT. However 30 mins later, I saw the OT nurse coming down to the lab and asking for more blood… Well, should be a mess and deep shxt situation. I asked the OT nurse and she told me the IVC was injured, I heart sunk…he is definitely not going to make it….
3 hrs later my surgeon came down and told me what he saw… the wood had penetrated and torn the rectus muscle into pieces and went straight through until it was stopped by the spine – thence the IVC and SMA was ripped off. The intestine look pale as no blood supply was noted . He told me that he would be losing the patient….
I did my best the rest of the night pouring any fluid/blood I could get my hand on into the CVP line….
It was not up to us… the GREAT ONE had determined what is going to happen.. I did not feel well but I think I could closed my eyes tonight piecefully as I had tried . But sometimes I wandered if I should go for a surgical trauma training, so that I could do more. I am seriously thinking about it…..
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