Being on hand when a trauma rolls into the emerg is quite an experience. The emerg usually has a few minutes notice before anyone gets to the hospital because the ambulance or helicopter paramedics will have been in touch with the basics of the patient's condition. Most tertiary care centers have a dedicated Trauma team, who are on call 24/7 and carry pagers that will start beeping and speaking instructions insistently when a call comes in. In Halifax, that means that anyone who is deemed a serious trauma is greeted by a senior physician team leader, one or two emerg residents, the general surgery team, an orthopedics team, the neurosurgery resident, anesthesia, 3-4 nurses, paramedics, xray techs and any stray med students. All of us were crammed into the trauma bay to help if needed.
If you get queasy reading about this sorta thing, maybe better to skip the rest of this post.
The trauma team was activated twice on Sunday. The first was a young person who'd been ejected from a car that had rolled on the highway. He/she was in pretty rough shape when he/she arrived and needed most of the team there to help him out. The team goes through any trauma in the same way: start with airway, then check breathing, then assess circulation before checking neurological status and looking for less obvious injuries.
This patient needed support of his/her airway in the form of an endotracheal tube down into his lungs and ventilator to help him/her breath. Additionally, she/he was having a hard time breathing because of massive bruising and bleeding in the lung. The ribs had taken a hit and a hole was open into his lung space, which meant we needed to get another tube through the skin to suck out any air or blood that was building up. While someone was taking care of that, someone else was starting an IV to begin transfusing blood and fluids to replace some of the volume in the blood vessels. Concurrently, we were taking a look at the CT scan, which showed a pretty serious spinal cord injury. Everyone's hearts sinks seeing something like that because it will likely mean they won't walk again. Because he/she was moving their arms a little when they came in, we're hoping the patient will retain upper limb function.
At the end of the day,the patient was stabilized but will obviously have a long road of recovery ahead. Unfortunately this a is common scenario, played out over and over again in our country's emergency departments. I don't know if this patient was belted, but I can't imagine he was... makes you wonder what shape he'd of been if he had. Small decisions having huge consequences...
I'm not going to say that I enjoyed the experience, because I don't feel that word does justice to the gravity of the situation. I will say that I like providing care to patients who are very sick and need immediate help. Decisions need to be made quickly and treatment needs to be effective if we want to give our patients the best shot. This type of medicine appeals to me.
