The Sunday shift
was a calm one until 8pm when a pair of casualty was sent to our ED. The male
was sitting on the chair when I approached my desk. The male had told me that
the girl have ridden his bike speeding and they had skidded while negotiating a
curve. Another vehicle had however run over the female casualty after the fall.
At that point, I
realized that there was another female patient who is more series. I did a
quick assessment on the young male casualty and proceeded to the resuscitation
room.
The male barely knew the female casualty... they had gone out for a inter-school dating
session. (bunch of guys from a school ask bunch of gals from another
school for matching date by bike key lucky draw...)
The young female was confused and my nursing staffs had almost ripped all
her clothes off. The deformed right thigh had caught my attention immediately.
She was mumbling that she had chest pain and she felt like dying [not again]
however I dared not promise her that she is not going to die today – she is
going to die today [I shouted in my heart]….. My staff had failed to secure a
line and I had decided to put in a central vein. There was multiple wound over
the trunk and body and she was stained with rubble and sand. I did a FAST echo but
did not found any ascites nor organ rupture. I had noticed that the girl had a
very prominent superior iliac crest but it was bilaterally symmetry and I did
not pay any attention[ok, I missed the pelvic stability check, guilty …] .
Before we moved her, I found that there was this stain of blood over her
panties. I asked that patient if she was menstruating and she said ”yes”. As
the stain was too massive, I did a speculum check and found that the blood was pouring
out from os like stream. Blood pack was hung and she was pushed to the x-ray department
for imaging.
I was busy
managing the usual Sunday crowd and I heard our head nurse shout echoing from the imaging department, “ Dr Lau, ON
ENDO…”, followed by the “hong rong hong rong” sound of the trolley wheel..
The patient was
comatose and gasping for air when I tried to insert the blade. Some struggle,
but yet I overpowered her and the tube was inserted within seconds. The BP was 60/30 mmHg and her heart rate was 130/min. She looked paler and I
asked my staff to squeeze the pRBC bag hard, even though I knew the effort would most probably be wasted....
Asystole was noted
minutes later and the automated CPR machine was installed….. I certified her 20
minutes later….
The imaging came
in later and revealed that she had multiple ribs fracture bilaterally with
pulmonary contusion but no hemorrhage was noted in her abdomen and brain CT .
open book fracture ( 3D CT...)
Her
cause of death was hypovolemic shock which cause by rt femur shaft fracture (
2000cc) and pelvic fracture(3000cc)……well, with our capacity, nothing much
could be done….
The shocking part
was not the process but the reaction of the parents. I called up the mother
during the resuscitation updating her with the progress. When I broke the news
that she had collapsed and we might lose her; the reaction of the mother was
shockingly calm….
The mother came
few hours later(she resided up north and the patient studying down south) and I
overheard part of her conversation with the other friends of the patient…. The mother
had complaint that she had worked very hard up north and the daughter had bla bla
bla bla(bad ear of my but I got the story figure out....)
Well, reminds me
of Yun and hoping that our relation won’t end up like that….
And NEVER NEVER
buy a motorbike for your kids…..
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