Disaster response B #12
So I wake up a bit late, nearly time for worship. But I want to check on my patient from last night. So I get on my scrubs and walk to the hospital tent where my patient is. We operated on him many hours last night. I walked in and as expected he is in the ICU (the left side of the main tent as I walk in). There are 4 ICU beds with monitors and 2 ventilators. He is getting ready to go the CT scanner across the street for a head CT ordered by the ER doc last night. So they get two nurses along with the ambulance crew to take him over across the street to the RAND hospital for the CT. Eventually we get the monitors on to battery power, the ventilator unplugged and hand carried, the IV drips on pumps that are battery powered and the nurses want me to go. I think that’s quite reasonable so I go. He’s moved to an ambulance gurney and we roll out the door to the waiting ambulance. I realize that the oxygen tank I’m carrying is empty about half way out to the ambulance. The ambulance personnel said it was full… So we rush out and attach the bag that I’m bagging him on- to the ambulance oxygen. We drive across the street and unload. And roll down the halls, that the nurses know, to the CT scanner. After placing him on the CT scanner with all the machines hooked back up, the ambulance people leave. They say they are going to get another patient from our ER to take to the scanner too. They will be back! I’m immediately skeptical and try to convince them to stay. Unsuccessful! Guess I didn’t think about them not staying with us and bringing us back. There is a lot of fussing about by the radiology tech and eventually he gets the scan done. I’m watching vitals and tubes and thinking about things and not watching what the tech is doing. The ambulance people aren’t back yet so we call to our own ER and try to get the doc there to get the ambulance people back. As I look through the pictures I realize that none of them were done with IV contrast like I asked. So I have to tell the guy to re-scan with IV contrast. The radiologist eventually arrives and there is lots of discussion between them and clicking of buttons. In about 20 minutes they start the scan. I hear that the ambulance has brought the other child from our ER for a scan. They say their ambulance is to small to carry our patient, and the other one went out on a call. I do my best to convince them to stay and take us. As we are finishing the contrast scans. They are in the room. Just as we are finishing they get a call from their dispatch of a code ?? some number. They say they have to leave urgently and will be back later to get us. What am I to do???? When will the other ambulance be free? They didn’t know. I do not want to stay in the CT scanner with a sick ICU patient, so I call my own ER and ask them to send someone with a stretcher. Eventually one of the ER docs comes over pushing a stretcher. I’m VERY happy to see him. WE get loaded up and we walk out of the one hospital and across the parking lot. The two SWAT guards trailing us all the way. At the road, they walk out to the middle to ensure traffic stops and we roll across. Then on to “our” parking lot and then to our tent hospital. Through the ER and down to the ICU tent. Whew, “home” at last, 2.5 hours later!!
The night before I had just returned from playing a tennis match at the local YMCA that our tent hospital had just arranged for us to be able to go to. Getting back to the hospital I was told there were some trauma patients coming. I changed and ran in. We heard there was a stabbed woman and then a man. Then we heard that one had jumped from a balcony and ambulance personnel couldn’t get to them, it was apparently a hostage situation. The patients in the triage area knew all about what had happened, and were able to tell us even before the ambulance had arrived. Apparently part of the event was streamed live online.
Eventually we got a patient who was in his 30’s and had blood and cuts all over and 4 stab wounds with omentum hanging out of one. He apparently had jumped or fallen 3 stories to the ground after an altercation above, in which a girl had died. He arrived with police and SWAT members. As you know, we don’t have CT scans, it’s across the road. He was unconscious and we intubated him. Then full exam and a chest x-ray and pelvic x-ray. His pelvis was an open book fracture- splitting wide open in the front. Blood kept bubbling from the chest wounds. On ultrasound, he didn’t appear to have blood around his heart, but it sure seemed likely that his heart was stabbed. Dr. J and I took him to the operating room. We started in his abdomen and would extend to the chest as needed. As I entered the abdomen there was only a small amount of blood. We packed off all four quadrants. There seemed to be more blood in the pelvis. I ran the small bowel (looked at all of it), and then the large bowel. There was a small hematoma on the colon at the area the omentum was hanging out of the abdomen. After opening this area, I identified a small serosal injury and repaired it. Then unpacking the rest of the abdomen, there was a retroperitoneal hematoma and blood oozing from that.
Next we explored retro-sternal (behind the breast bone) to the anterior surface of the heart. No blood was seen in the pericardium (heart sac). I was grateful for the man, that his heart was not punctured. We got control of the oozing from that area. Then we closed up his abdomen. Now to stabilize his pelvis. As Dr. F (the orthopedic surgeon) and I worked on his pelvis, Dr. J went to sewing up the many lacerations on his arms and neck. Dr F directed how to put in the two screw tipped posts into each side of his pelvic bone. Then we used the carbon fiber tubes and clamps to create a rectangular structure that connected the two sides of the pelvis together clamping to the two posts on either side. (For a detailed example of something similar see https://www2.aofoundation.org/wps/portal/!ut/p/a1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKN_A0M3D2DDbz9_UMMDRyDXQ3dw9wMDAzMjYEKIvEocDQnTr8BDuBoQEh_QW5oKAD4ENaS/dl5/d5/L2dJQSEvUUt3QS80SmlFL1o2XzJPMDBHSVMwS09PVDEwQVNFMUdWRjAwMDcz/?bone=Pelvis&classification=61-AT&method=External%20fixation&segment=Ring&showPage=redfix&treatment=Operative ) After we were finished with the pelvic fixation we finished the skin closures and took him to the ICU. We finished about 2 or 3AM. It takes me a while to wind down and go to sleep, but when sleep comes, I am deeply asleep._______________________________________________
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Disaster Response B #11