Saturday, 14 January 2012

It's A Long Way To The Trauma Centre, It's A Long Way To Go

Ah, peace at last!! My gentle drive home from the hospital is in stark contrast to the week I have had.  Busy doesn't cover it.  But, at least I am free all weekend.  I have great plans for tomorrow morning - I won't be surfacing until at least noon.

Before that, however, I have an evening at home with the family.  A nice quiet, relaxing evening, that I have been looking forward to all week.

Arriving home, I am assaulted by the wonderful aromas of my dinner, simmering in the oven! Can it get any better?  RRD-Dad rings, and we have a chat about who's been busier than who.

My other phone rings.

My heart sinks as I realise that, at least for me, dinner will just have to wait.

As I ride the motorway to my destination, I muse on how long it has been since I have been called to a job.  Sure, I have been woken; on one occasion I even got to the car and started driving.  But, an actual job - well, many weeks. And then I start to wonder quite how I will manage this one.  Will this job be the one where I find myself unable to make the right decision, where someone's life depends on me, and I get it wrong?

Uneasy now, I arrive at the police roadblock, and am waved through.  The road is eerily quiet now, so unusual for a Friday night.  The mass of blue flashing lights up ahead signify I have arrived.  I get out of my car, then leave the road and scramble down an embankment to the waiting crew.

She's been thrown from the car.  That's bad.  Ejection equals serious trauma.  It also suggests a lack of a seatbelt.  The car has definitely rolled over - dents and damage to the roof make that a cetainty.

She's not moving.  Her left leg is at a very unusual angle.  But I have to ignore the obvious injuries, and search out the immediately life-threatening ones.

She is breathing spontaneously, and her chest is rising and falling symmetrically.  Her tummy feels ok, and her pelvis is intact.  But, she is not conscious.

I decide that, as she is out of the vehicle already, the best thing to do is to scoop her onto the stretcher and carry her back on to the road, where it will be much easier to assess her.  A couple of minutes later we are by the ambulance; lots of space and lots of light.  Also, being on the stretcher means she is at a much better height for me to examine her.

She is still breathing normally, and there are no sounds of snoring, suggestive of an obstructed airway.  This is unusual in someone who is unconscious from a head injury.  I file that titbit away, and carry on looking.  Her chest is clear, and the movements are still symmetrical.

Into the ambulance and some further observations:  pulse rate 130, blood pressure 170/110, oxygen saturations 98%, respiratory rate 18.  For those not in the know, she has a very high pulse rate, a very high blood pressure and a moderately fast respiratory rate.  This could all be due to the pain from her obviously broken leg.

I ask about distances to hospitals.  My own hospital is a mere 15 minutes away, with the Major Trauma Centre about 45 minutes.  I know what the right thing to do is: we need to go to the Trauma Centre.  I don't like these long journeys, but I know it is better to spend a longer time in the primary transfer from the scene to a specialist centre.  The decision is made, and the crew get ready to depart.  I think for a moment about intubating her, but decide that, as her breathing does not seem at all like that of someone with a significant head injury, we would wait and see how she goes.

We set off.  She's very cold, and the saturation probe finds it difficult to get a consistent reading.  The blood pressure is a lot better now: 110/ 60.  She starts to moan and open her eyes, and ParaGirl and I smile, knowing that this is a good sign.

She starts to vomit.  Not a good sign at all.  As she is strapped to a spinal board, if she is not conscious enough she will be unable to clear the vomit from her mouth and will inhale it.  Aspiration is a leading cause of death in trauma patients.  But not this one.  She lifts her hand to her mouth and coughs.  Good.  That means she has an intact gag reflex, that will protect her airway.  She spits out the vomit.  Good for her, not so good for us in the back of the ambulance.

She vomits again.  And again.  And again.  We have the sucker ready, but this is ridiculous.  What on Earth has she been eating?  And so much of it??

We have by now stopped on the hard shoulder while we try and sort her out, stopping her from drowning in her own vomit.  We manage, but ParaGirl is gagging.  "I don't do vomit", she gasps between hiccups.  Well, you are in this job, and in the back of an ambulance swimming in it, so you just have to.

She's now stopped vomiting, and has settled back into her previous unresponsive state.  I check the observations as we set off again:  pulse 145, blood pressure 69/50, saturations 95%.  Hmmm, her pulse rate is climbing, and her blood pressure, while initially high, has fallen dramatically.  I open up her drip, and give her more fluids, willing the ambulance faster.

It's a Friday night, and the roads get busier.  We are getting slower and slower as we approach the Trauma Centre.  The blood pressure now reads 47/20, and I am sure we are going to lose her before we get there. I squeeze the bag of fluid harder, pushing another bag into her.  ParaGirl asks if I want another blood pressure.  I shake my head, knowing that, as long as she is still breathing, there is precious little else I can do, and seeing another blood pressure will only add to my anxiety.  Her lips are pale, and I know that she is bleeding somewhere; presumably into her abdominal cavity.  I alert the Trauma Centre of our impending arrival.

We arrive.  She still has a pulse.  She begins to moan again as we wheel her in to the resuscitation room.  I wonder again whether we should have gone to the closer hospital.  But, when, 5 minutes later, she is being rushed to Theatre, a surgical team ready to save her life, I know I have done the best thing for her.


  1. Good call!
    Sometimes, you've got to take that step back and look at the big picture - what's best for everyone involved based on the resources available now and in the time it will take for the situation to resolve.

    I'm guessing that you had a solo dinner tonight, as Mini, Micros, Princess & Mrs figured you would be quite some time doing what you do best - saving someone's life. Someone who, without your volunteering, would quite possibly not have made it tonight!

  2. Thank you for posting again. As a medical student it is always interesting reading your posts and learning from them!

  3. It's reading your blg that reminds me how much I want to do A&E and PH medicine so please blog more

  4. So, presumably you made that call based on the mechanism? We often think of many 'major traumas' coming on mechanism as quite soft, but this shows how useful the trauma tree is.

    Also, consider blogging again! Your blog got me really interested in medicine 4 or so years ago, I've now completed my undergrad and a year working in an MTC and have just got my med school application off!