Saturday, August 2, 2008

Theme Night

Many shifts seem to revolve around certain themes.  Singing drunks, for example, often seem to come in sets of three.  Thursday night, my last in a string of working nine of the previous ten overnights, quickly became bloody airway night.  Compared to some people I work with, I usually don't have a black cloud in trauma, and was looking forward to an easy eight hours to end my long string of work and ease into a four day weekend.  That didn't happen.

My first trauma of the afternoon occurred early in the shift, when an older gentleman crashed into a telephone pole and rolled over his car.  The EMS patch reported intrusion into the vehicle and a head laceration.  When he arrived in the trauma bay, I was standing a the head of the bed ready to place him on the monitor.  As we transfer him to our stretcher, we notice the EMS gurney is soaked in a pool of blood.  Cutting off the dressing on his head reveals a huge section of his scalp avulsed, letting us see down to the skull.  As the resident begins an unsuccessful attempt at intubation, another full trauma rolls in to the next bed - a young female who'd been slashed over 20 times with a box cutter (mainly to her face and back) by an ex-coworker comes in screaming uncontrollably.  One of our new ED attendings successfully intubates the MVC, and then moves on to help tube the shrieking girl next door.

Bloody airway #3 was a (surprise!) no helmet motorcyclist with bilateral tib-fib fractures and a smell of alcohol about him (patient screaming: "Am I alive?!").  Another unsuccessful attempt at intubation results in a page for anesthesia to the trauma bay and the trauma attending ripping open a trach kit, holding a scalpel to the patient's throat before the ED attending convinces him to allow another, ultimately successful, attempt.  

Highlight of the evening: Trauma attending, getting impatient with his resident inserting a foley, yells out for him to grab the guy's dick, hold it up to the ceiling, and get the foley in.

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