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basricWARNING" This is strictly a Trauma Heavy Entry. Imagery may be too much for weaker stomachs.
I woke pissed at the world for no particular reason. Just one of those nights you hate the world. The family was not at home to endure my simmering temper. The traffic coming into downtown allowed me to verbally vent some of the pent up frustration.
I pushed through the doors and shed the attitude as I walked through the organized chaos that is Trauma. I checked the board -- Rene was charge nurse, while Paula, Mike (excellent nurses) were with me in triage along with one new nurse with twenty years’ experience in Trauma from Texas and a new nurse just out of orientation. Mike was her preceptor. The Residents were third year with brains; one looked at nurses as part of his team, the other was a jackass. The jackass was secondary.
The night moved slowly with a GSW in the spine. The victim had been running away from a rape and robbery scene when shot by cops. The second and third were wounds traded between friends with knives in a fight over a ballgame. The wounds on all were stabilized and sent to surgery.
A MVA was brought in via LifeFlight, a van versus and eighteen-wheeler; the tractor trailer truck won. The first through our doors was a twenty-five year old female. She had an airbag failure and had not worn a seat belt. She had been ejected through the windshield; the top metal ridge scalped her, skull exposed with hairline fractures. Her hair and scalp were folded back and soaked with capillary blood. A nasty wound but not life-threatening. I gave her to Mike for but his student but she took one look and ran for the bathroom.
The Forty year old male had been impaled on a slice of metal sheared from the truck, then entered the windshield and lodged at an angle into his pelvis—we thought at the time of arrival. Even with the morphine he had received in route he screamed. Dr. J. placed the CVC with difficulty since the patient fought in pain. It took two very large male CarePartners to hold his head and shoulders still. Once the line was placed, labs were drawn first to keep the drug screen uncontaminated, then a sedative administered. Fluids and blood were hung as Dr. J. intubated the victim.
We cut his clothes from his body, stopped at the metal across his pelvis. “We don’t have a pulse in his feet and no there’s no femoral pulse in either thigh.
The new, ‘experienced’ trauma nurse gave a jerk to remove his shirt from beneath the metal. His lower body separated to his pelvic floor. Flesh, splintered bones, blood vessels, the bladder revealed. Before anyone could move the sheet of metal dropped back, arterial blood sprayed controlled quickly by the resident as I opened and slapped hemostats in his hand. The intestines spilled out and over the patient to the floor. There was an audible pop as the hamstring frayed loose and curled downward. Everyone scrambled to pile intestines into and on top of the patient. Those of us at the head of the bed received about two pints of blood ricocheted off the metal plate and soaking our faces, through masks and head covers along with our upper chests. The force was so strong of a couple of his heartbeats saturating gowns and everything beneath to skin. Thankfully goggles held up. New masks, goggles & head coverings when Paula yelled, “He’s going into V-TACH”
I pushed the drugs while the resident waited for CPR to circulate it; then shocked him. It took three shocks to get a viable rhythm.
Rene had, as all this was occurring, called the general Attending surgeon. He had left a surgery in the hands of his resident.
“Doctor his lower extremities have been without oxygen for over thirty minutes. There is necrosis in his feet and as you can see his legs are dull blue.”
“Clean up as much of this blood as possible and I’ll arrange for transport.”
Evie, the nurse who had pulled the shirt and caused this mess, rushed up from the back where she had been cowering, “Doctor should I push the plate back in place?”
There was a long silent moment and incredulous looks, “He’s lost the lower half of his body. Whichever of you idiots that moved that plate has probably killed him, but we’ll do what we can.”
She flushed then reached to hand me an ABD pad. I looked at the pad then at the massive amount of blood on the patient and gurney, then at Evie, “An ABD pad . . . really.” I flushed his body’s cavity and packed it with 4x4’s soaked in sterile water.
Surgical techs rushed him out of trauma and down to surgery.
It was thankfully quiet as two nurses, the resident and a respiratory therapist operating the AMBU BAG took turns showering and changing.
The remainder of the night was mild by comparison. I took Evie into the office at end of shift and explained that usually when a mistake was made I give a verbal warning but since it was a possible terminal related to her actions, I was obligated to write an incident report.”
“It was an accident.”
“That’s for the manager and possible the board to decide. I’m sorry.”
Word came up he didn’t make it and along with it my mood returned. I signed out at the desk and heard the day charge nurse ask one of the new nurses for her bandage scissors. After searching her pockets told her she couldn’t find them.
“A real DECENT, COMPETENT nurse always has her supplies on hand. Always!
I really disliked this sanctimonious bitch. The floor was busy but everyone had stopped to watch the show of Maxine dressing down a new nurse.
“So I guess that means you are NOT a decent, competent nurse, huh, Maxine.”
“I beg your pardon? This has nothing to do with you. You just take care of your night shift.”
“I do, and I don’t bully them. But my question to you is, where are your bandage scissors? Why do you need to borrow hers if you are a decent, competent nurse? Shouldn’t you have your own.”
There were snickers and she turned beet red and stormed off toward the manager’s office. I departed in a much better mood than I had arrived.
DEFINITIONS:
GSW---GUNSHOT WOUND
MVA---MOTOR VEHICLE ACCIDENT
4x4---GAUZE FOLDED INTO A 4”X4” SQUARE
ABD PAD—A LARGE 6X9 INCH PAD FOLDED IN THIRDS
I woke pissed at the world for no particular reason. Just one of those nights you hate the world. The family was not at home to endure my simmering temper. The traffic coming into downtown allowed me to verbally vent some of the pent up frustration.
I pushed through the doors and shed the attitude as I walked through the organized chaos that is Trauma. I checked the board -- Rene was charge nurse, while Paula, Mike (excellent nurses) were with me in triage along with one new nurse with twenty years’ experience in Trauma from Texas and a new nurse just out of orientation. Mike was her preceptor. The Residents were third year with brains; one looked at nurses as part of his team, the other was a jackass. The jackass was secondary.
The night moved slowly with a GSW in the spine. The victim had been running away from a rape and robbery scene when shot by cops. The second and third were wounds traded between friends with knives in a fight over a ballgame. The wounds on all were stabilized and sent to surgery.
A MVA was brought in via LifeFlight, a van versus and eighteen-wheeler; the tractor trailer truck won. The first through our doors was a twenty-five year old female. She had an airbag failure and had not worn a seat belt. She had been ejected through the windshield; the top metal ridge scalped her, skull exposed with hairline fractures. Her hair and scalp were folded back and soaked with capillary blood. A nasty wound but not life-threatening. I gave her to Mike for but his student but she took one look and ran for the bathroom.
The Forty year old male had been impaled on a slice of metal sheared from the truck, then entered the windshield and lodged at an angle into his pelvis—we thought at the time of arrival. Even with the morphine he had received in route he screamed. Dr. J. placed the CVC with difficulty since the patient fought in pain. It took two very large male CarePartners to hold his head and shoulders still. Once the line was placed, labs were drawn first to keep the drug screen uncontaminated, then a sedative administered. Fluids and blood were hung as Dr. J. intubated the victim.
We cut his clothes from his body, stopped at the metal across his pelvis. “We don’t have a pulse in his feet and no there’s no femoral pulse in either thigh.
The new, ‘experienced’ trauma nurse gave a jerk to remove his shirt from beneath the metal. His lower body separated to his pelvic floor. Flesh, splintered bones, blood vessels, the bladder revealed. Before anyone could move the sheet of metal dropped back, arterial blood sprayed controlled quickly by the resident as I opened and slapped hemostats in his hand. The intestines spilled out and over the patient to the floor. There was an audible pop as the hamstring frayed loose and curled downward. Everyone scrambled to pile intestines into and on top of the patient. Those of us at the head of the bed received about two pints of blood ricocheted off the metal plate and soaking our faces, through masks and head covers along with our upper chests. The force was so strong of a couple of his heartbeats saturating gowns and everything beneath to skin. Thankfully goggles held up. New masks, goggles & head coverings when Paula yelled, “He’s going into V-TACH”
I pushed the drugs while the resident waited for CPR to circulate it; then shocked him. It took three shocks to get a viable rhythm.
Rene had, as all this was occurring, called the general Attending surgeon. He had left a surgery in the hands of his resident.
“Doctor his lower extremities have been without oxygen for over thirty minutes. There is necrosis in his feet and as you can see his legs are dull blue.”
“Clean up as much of this blood as possible and I’ll arrange for transport.”
Evie, the nurse who had pulled the shirt and caused this mess, rushed up from the back where she had been cowering, “Doctor should I push the plate back in place?”
There was a long silent moment and incredulous looks, “He’s lost the lower half of his body. Whichever of you idiots that moved that plate has probably killed him, but we’ll do what we can.”
She flushed then reached to hand me an ABD pad. I looked at the pad then at the massive amount of blood on the patient and gurney, then at Evie, “An ABD pad . . . really.” I flushed his body’s cavity and packed it with 4x4’s soaked in sterile water.
Surgical techs rushed him out of trauma and down to surgery.
It was thankfully quiet as two nurses, the resident and a respiratory therapist operating the AMBU BAG took turns showering and changing.
The remainder of the night was mild by comparison. I took Evie into the office at end of shift and explained that usually when a mistake was made I give a verbal warning but since it was a possible terminal related to her actions, I was obligated to write an incident report.”
“It was an accident.”
“That’s for the manager and possible the board to decide. I’m sorry.”
Word came up he didn’t make it and along with it my mood returned. I signed out at the desk and heard the day charge nurse ask one of the new nurses for her bandage scissors. After searching her pockets told her she couldn’t find them.
“A real DECENT, COMPETENT nurse always has her supplies on hand. Always!
I really disliked this sanctimonious bitch. The floor was busy but everyone had stopped to watch the show of Maxine dressing down a new nurse.
“So I guess that means you are NOT a decent, competent nurse, huh, Maxine.”
“I beg your pardon? This has nothing to do with you. You just take care of your night shift.”
“I do, and I don’t bully them. But my question to you is, where are your bandage scissors? Why do you need to borrow hers if you are a decent, competent nurse? Shouldn’t you have your own.”
There were snickers and she turned beet red and stormed off toward the manager’s office. I departed in a much better mood than I had arrived.
DEFINITIONS:
GSW---GUNSHOT WOUND
MVA---MOTOR VEHICLE ACCIDENT
4x4---GAUZE FOLDED INTO A 4”X4” SQUARE
ABD PAD—A LARGE 6X9 INCH PAD FOLDED IN THIRDS
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Date: 2012-03-06 08:02 am (UTC)