#26: Trauma One ETA 5 minutes

Nowadays I get pages like "Trauma One 18 year old with multiple stab wounds to chest, difficulty breathing, ETA 5 minutes." (ETA=estimated time of arrival) That was the page I got just as I was sitting down to lunch yesterday. Since I was on call, it was my job to run to the trauma bay to staff the patient. We evaluated the patient, who had "5 beers and 3 shots" and whose urine tested positive for cocaine and marijuana. He had two stab wounds, one under his arm and one in his abdomen. On CAT scan he had blood pooling around his lungs, compressing half of his right lung, and I volunteered to put in a chest tube. (The only other time I'd put in a chest tube was in the operating room when the patient was intubated and sedated.) Right as we were prepping the table for the chest tube insertion, the patient's heart rate started drifting downwards and he started dry heaving, evidence that the blood collection was at the very least irritating his heart if not compressing his heart and lungs. I dissected through his chest wall, got into the lung space (blood came pouring out) and put in the chest tube and his heart rate came back to normal!

What a great feeling to be able to make a difference! However, what I didn't say above was that it took me about 10-15 minutes to be able to dissect down into the lung and it was hard for me to get the chest tube into the space. The whole process should have taken me 2-5 minutes if not faster. Also I got some blood on the floor (well, that part was pretty cool - made me feel like a trauma surgeon - and don't worry mom we wear all sorts of protective gear so no contamination.) Finally, what difference does it really make in the world to perform therapeutic interventions on cracked out drunk teenagers who get into knife fights at 1 PM on a Wednesday?

Yesterday's call had a theme: motorcycle accidents. We had three patients who came in after motorcycle accidents with serious broken bones. One guy was a college student who lost control of his motorcycle - he was this tough looking 6'4" muscular guy who was literally crying and begging for pain relief all afternoon long waiting for an operating room to open up so his leg and arm could be screwed back together. I had never had the desire to ride a motorcycle but this was a new experience. I am sure I will tell my kids about the patients I've seen with these sorts of accidents, but it never really hits home or becomes real until seeing the patients in person.

Last call nights Tuesday October 10th.
Amount of sleep last call night: 2 hours.
Currently reading: Greenfield's Chapter on Diverticular Disease.
Currently watching: Goodbye Lenin.
Next call night: Sunday October 15th.