Trauma

Internship day 10

Medic 12, please respond code 3 to (freeway exit) near the entrance of (campground) and (lake) for an MVA.

It was 3 am, so I groggily dragged myself from my bed on the couch as soon as I heard my preceptor's tones go off in the next room. I quickly wiped the sleep from my eyes, buttoned my shirt and ran out to the rig. I grabbed gloves and slipped them on, checked my pockets for a pen and sat in the jump seat. My preceptor and her partner climbed in shortly after and we were off.

"Where is it? I can't see it on the map. Oh, there it is. Shit, it's on the pass." My preceptor was talking to her partner while looking on the computer for directions. I tensed as I heard this, the pass was a difficult road to navigate and accidents up there were usually not minor.

"Oh, dispatch is updating the info..Let's see here... Male driver is not conscious, unknown if he is breathing... There is serious blood loss.. Shit." This time, she was speaking to no one in particular, but after saying this, turned to me and spoke again.
"This is going to be bad, and I'm not saying that to scare you, okay? I just want you to know it's going to be bad. Be ready for the worst."
I sat back in my seat, buckled my seat belt and closed my eyes. Taking deep breaths, I tried to calm myself. Opening my eyes again, I saw flashing lights in the distance behind us.
I turned back towards the front of the rig.
"Tracy.. Fire is behind us. Like, wayyy behind us."
"What?! Oh, crap. We're gonna get there first."
What seemed like an eternity passed before my partner, Sarah, slowed to a stop.
"PD is here. Where is the-... Shit, there it is. This is bad."
Because I had been in the back, I had not yet seen what Sarah and Tracy saw. She pulled up further, in front of the wreck, and flashing lights illuminated a truck behind us. From the rig I could see that the truck was unrecognizable as having once been a vehicle. It looked like a ball of twisted metal, and as the lights flashed over it, I caught quick glimpses of an arm dangling from what used to be the driver's side. I jumped out, throwing my reflective vest on, and ran to the truck. A man in plain clothes approached me quickly, flashlight in hand, and started talking to me.
"We were just camping down by the lake. We heard him hit the side of the mountain and came up to make sure everyone was okay. I don't think he's breathing. We've been looking for other people but we don't see anyone, just car parts strewn everywhere."
I nodded quickly and ran past him to the arm hanging from the wreck. I grabbed it, and held his wrist for a few seconds before yelling out to Tracy, "Strong radial pulse. Snoring respirations. We wont be able to get him out though."
She came up behind me and also grabbed the arm. From where we stood, what used to be the driver's door was now a tiny opening from which we could see his head, facing the passenger side, and his arm. Nothing else was in view. The engine was in his lap, the steering wheel over his right shoulder. The truck was angled up, and access through the passenger side was out of the question. The smell of alcohol was drifing from the car, and it was strong. He was drunk.
The fire department arrived and we stood back, waiting for them to extricate him. Cables were running everywhere, loud generators drowned out any noise as they fired up the Jaws of Life. One of the firefighters, also a medic, turned to me.
"If you grab me your IV bag, I'll get a line for you on this arm. Just don't get too close, okay kid? The truck isn't stable, I don't want you getting hurt."
I nodded and ran back to the rig for my IV bag. Once there, Tracy stopped me and quickly said, "Everything out, get everything ready. Your airway bag, the gurney with a backboard. Everything." I nodded again and pawed at my trauma bag, ripping out everything, opening it and throwing it on the bench seat.
Airway kit, check.
Gurney with backboard, check.
Line spiked... Sarah is working on it, check.
IV bag..
I grabbed it and dashed back to the firefighter. He quickly established a 16 guage IV and ran it wide open, throwing the bag towards me.
"Hold this, and squeeze. It's gonna be awhile before we can get him out."
I stood back, IV bag tightly in my hands as I weaved in and out of the firefighters with the IV line, trying to untangle them all as they rushed around the truck. Tracy stood beside me, yelling things back to Sarah who was preparing the rig.
"Get the fast patches out and hooked up. Oh, and another line spiked please. Is the gurney ready to go?"
Tracy turned back to me and spoke quietly.
"How are you doing?"
"I'm okay. I'm scared for this guy. What if they take the dashboard off of him and he codes? What if he's not even in once piece under all of that shit?"
"I know. He's gonna be bad. Just be ready for him to code. We're all scared for him."
"It's been almost 20 minutes." I said quietly, dropping my gaze to the ground.
The fire-medic turned towards us. "He's almost ready, get the gurney over here."
Tracy took the IV bag and nodded for me to go help Sarah. We grabbed the gurney and backboard, wheeling it around all the cables and glass, and up to the driver's side. Suddenly, the man was plopped onto the backboard and we were all feverishly strapping him in, securing his neck with a collar while lifting the gurney and running back to the rig. "We need a rider, who wants to come?" Tracy yelled back to the firefighters. One of the younger guys, another medic, came running up and jumped in. "I'll go," he said, smiling at me, while he sat down on the bench and began cutting the man's clothes off.
"Okay. We're taking him straight to the trauma center, bypassing the local ER. Probably gonna be a 45 minute plus transport. Let's do as much as we can."
The back doors slammed shut and the chaos began. Supplies were flying, all of us yelling out findings over each other.
"Airway is patent, but he's snoring. Jaw clenched, get a non-rebreather on him."

"Pupils unequal. Left is blown and unreactive, right is reactive."

"Pulse still strong at the radial at 140, pressure is 110, lets drop another line."

"Left leg is broken, compound fractures at the tib/fib. I'm leaving the pant leg on because it's controlling the bleeding."

"Pelvis is stable, abdomen is clear so far."

"I've got another line, right bicep, running wide open." I said, with a sigh of relief. The firefighter grinned at me again and slapped my back.
"Good stick, kid." He said. I smiled meekly back at him.

Grabbing my stethescope, I attempted to listen to his lungs over all of the noise. His chest expansion looked odd, but I couldn't quite put a finger on why.
Right lung... Concentrate, listen, drown out all of the other noise and listen..
Grunting, but he was moving air.
Left lung.. Listen, concentrate.
Nothing.
I pulled the bell of the stethescope back up and tapped it to ensure it was working. I heard the "thump thump" of my finger clearly in my ears. I put the bell back down on his left side.
Nothing.
"Right is clear, just grunting. Left is absent." I said, pulling the stethescope off my ears and looking at Tracy. She stopped midway through cutting the collar of his shirt off and looked at me.
"You're sure it's absent? Maybe it's just diminished."
"I'll check again." I said.
I listened again over his left side, tapping his chest wall with my fingers. It felt full, not hollow. There was blood in his chest cavity.
"Absent. His oxygen sat is holding at 98, but there's nothing there."
She nodded again and said "Okay, since his sat is holding we'll leave it. If he starts to drop you'll have to dart him."
I nodded and gulped. A chest decompression? That's such a rare skill to utilize in a paramedic's career, let alone as an intern. I shook my fear and continued re-assessing him. The fire-medic gave a radio report, which I was thankful for because I don't think I would have been able to get the words out as fast as my brain thought them to let the hospital know we were coming. I listened intently as I tried to control bleeding and check the man's pupils again.

"Trauma base, this is Paramedic Gavin on medic 12 enroute to your facility code 3 with a 15 minute ETA. On board we have a 40 year old male involved in a single vehicle accident, truck versus side of a mountain, off the pass. Extensive cab intrusion, patient is unconscious with snoring resps. We have unequal pupils, no obvious head trauma, absent lung sounds on the left with a sat of 98 on 15 liters. Compound tib/fib fractures on the left, no other significant findings. Pressure is holding at 120, we have 2 large bore IVs established. Pulse is 140 and sinus tach on the monitor, he is positive for ETOH, unless you have anything further for us we'll see you on the other side."

"Trauma base copies medic 12, nothing further for you. Trauma team will see you in trauma bay 1 upon arrival."

"Medic 12 copies."

The remaining 15 minutes in the rig passed quickly as we continued to assess and stabilize him. When we suddenly came to a stop and I saw the lights from the trauma center gleaming into the back of the rig, I was surprised we had gotten there so quickly. We pulled him out, trailing blood and guaze and wires behind us, and into the trauma bay. The staff descended on him, and I quickly gave the doc a run down of what we found while he did his assessment, shouting out findings between my report.

"Head is normal, no obvious trauma. Pupils unequal, can we get respiratory in here to RSI him? No JVD, trachea midline. Where's that o2 mask? Lungs absent on the left, I think it's a hemo[thorax]. Abdomen is clean, pelvis stable. Compound tib/fib on the left with major bleeding, we'll need lab up here with a type and cross. Prep an OR, let's get him in."

We left the ER as the sun was coming up. The fire-medic jumped in the back and joked with all 3 of us while we drove him back to his station. I smiled and let out a few chuckles, but I was exhausted and my head was spinning. When we got back to station, Tracy handed me my paperwork for the day and I left for my 2 hour drive home.

On the way home, I pulled off the road and stopped in an empty parking lot. I slowly pulled my shaking hands from the steering wheel and into my lap as I leaned my head down onto the dash. Tears streamed down my face and I wiped them away quickly. I don't know who I was trying to hide it from, no-one was around, but I was still embarrassed that the call had bothered me so much.
I was angry that the guy was drunk. He could have easily killed someone, and he may have killed himself. I was upset with myself for not taking better control of the call, but I knew it was just a bad call and I couldn't let it get to me.

We still wonder if the guy made it. We never found out what happened to him.

I still wonder if I wish he had made it.