aka Trauma Tribulation 033a
For this Trauma Tribulation, we are opening up the floor to all our wannabe Trauma-Queens, and we’re gonna put it to the people…
“What would you do?”
Have a look through the case, think about your response and let us know in the comments section what you would do.
Once we have enough responses, Scott Weingart of EMCrit.org will tell us what he would do. And despite much shame, and gaffaws of “You did WHAT???”, we will tell you what may or may not have actually happened.
One day, in a hospital quite far from here, you are locuming as an ED registrar in a small provincial hospital, in the middle of an Antipodean island. It’s been a good day, and you are certainly not earning your money.
You are 11 hours into a 12 hour shift and you have seen 6 patients. With a smug smile, you remember why you gave up the daily grind to locum your life away.
The orderly turns to you, whilst mopping a pool of blood off the floor, and says, “Nothing ever really happens around here.” You pause to wonder about the pool of blood, and how it got there without your knowledge or consent. Shaking off the surreality, you turn to the nurse in charge and say cheekily, “You know what we need now? A trauma!”
Then the Bat-Phone rings.
“This is MICA 34. We are 15 minutes away with a 16 year-old male. Multiple stab wounds to the back. He is currently Status 2. Vitals: PR 120, BP 130, Sats 96% on Hudson mask oxygen.”
The orderly throws you a glance. You think you hate him. “Cool,” you say a little nervously, “finally some action.” The charge nurse sends you a sideways look, which almost seems like a glare. Ignoring it, you decide to plan for the trauma.
“Right!” you say to the charge nurse, “How do we get some backup?”
“Are there any other doctors in the hospital?”. ”No…” she says.
“Oooohhh – Kaaaayyy,” you say slowly. ”…and we don’t have any on-call”, she continues.
“Surely there is a surgeon on call? And where is the nearest trauma centre?”
ANOTHER BLANK STARE
Hmmm… your heart rate quickens…
You know the nearest large hospital is 90 minutes away – probably too far for a Category 2 Trauma. You try to quickly familiarize yourself with the trauma bay, which also triples as the cardiac bay and the plastering room. Your trauma team consists of you, your charge nurse, another staff nurse, the radiographer and the blood mopping orderly. There is no CT scanner, but you have access to basic bloods and 2 units of O negative RBCs.
Oh, brother! Beads of sweat form on your brow. Before you have time to worry about anything else, the ambulance rocks up.
Here is your patient. Click to enlarge each photo.
The questions for you are… (and please ignore that thing sticking out of his right chest which may or may not be an ICC)
(1) What things immediately concern you?
(2) What are your immediate priorities?
and most importantly
(3) Do you pull the knife???
Find out what Weingart would do, and what may or may not have hypothetically happened here.