His name is Chris, and he is 12 years old. He's been out for a bike ride today, wearing appropriate protective gear. He has a helmet on, and elbow and knee protectors. Unfortunately, these will only do so much when you ride straight out of an alleyway into a busy road. He's been clipped by a car, and on my arrival is lying in the road. According to his mum, who is with him before the ambulance arrived, he was out cold for a few minutes, but seems to be ok now.
I have a look at him: he's awake and talking, his pulse is strong and regular, but he does have a bump on the back of his head. He has a few abrasions, but seems to have got off lightly, considering.
I have a chat to the crew: we are about 15 minutes away from the local A&E, and I feel it's probably best to ride in the back with Chris and his mum, just in case. After all, he was "out cold" after the accident.
As we are travelling to the hospital, I am chatting to mum about BASICS, and what we do. She used to be a nurse, so she is quite interested in what I do. I keep a close eye on Chris all the time: he is quiet, but responding appropriately to questions, and his observations are fine.
About 10 minutes away from the hospital: I notice that Chris is a lot quieter. He is still responding, but just monosyllabic. Hmm. I'm getting a bit worried about this, and I let mum know that I will be asking the hospital to get a Trauma Team ready, "just routine precautions, nothing to worry about." Phone call made, I am also less communicative, watching Chris carefully.
About 5 minutes away from the hospital: Chris is hardly talking at all now. My heartrate is higher than his, as I quietly, calmly, start drawing up some drugs, "just in case, nothing to worry about, Mum." My call to the front of "are we nearly there yet?" is meant seriously.
About 3 minutes away from the hospital: Chris is looking over to his right. This is baaad. We're not going to make it. I will him to keep in there, just for another couple of minutes, but I realise that time is running out. I quietly unzip my intubation bag, "just to be safe, nothing to worry about, Mum."
About 2 minutes away from the hospital: I turn to mum, just to reassure her. I see the look of horror on her face, and know that time is out!! "He's fitting!" she screams at me. I turn back to my patient, to see a full-blown, tonic-clonic seizure. His body arches and strains against the straps, and his face takes on the blue shade of cyanosis.
"Stop the vehicle," I call, and ask Mum to step outside while I sort out Chris, "Just to get him a bit stable, nothing to worry about!" I'm not very convincing at this point.
Withing 30 seconds of his fit beginning we have anaesthetised him, and secured his airway. With no other injuries, we are able to carry on the journey to the hospital, far more uneventfully than before. Mum is sitting next to me again, and I am reminding her about extradural and subdural haemorrhage, as well as intracranial contusion. I remind her that, as Chris was fully conscious before we left, and that as we had terminated his fit and maintained good oxygenation for all but half a minute or so, his prognosis is excellent.
Arriving at the hospital, I hand over to the team, then wait with mum for the CT results - a small contusion, no need for surgery.
2 days later, Chris is woken up and extubated. 2 weeks later he is back at school.
11 months ago