Thursday, November 08, 2007

Weekends Are Fun. Right? (2)

And so to Saturday.

It can't be any worse, right. Not worse, maybe, but just as bad in a different way.

The Dept was as busy, if not more so. I think the second board was out on arrival. (This means there were so many patients in the department, that we'd run out of space on the regular board. It is not a good sign)

Again, the details are beginning to escape me. I'm not sure if my memory was always this shaky. I can't remember.

A heaving department, but resus call after resus call. Once again the department becomes crystallised into this small room. Outside I know we're up shit creek without a paddle, but I can't do anything about it. I can't get out of here, they won't stop coming.

Tonight's featured cases are trauma, again.

First up an RTC. High speed, head on collision. Two victims. The driver was the subject of a prolonged extrication; a BASICs doc was on scene and asked for a surgeon to be waiting. The BASICs guys, and gals, are pre-hospital docs, working in their own time. They embody the spirit of the orange jumpsuit.

Anyway - we had a fifteen minute heads up, but that didn't translate well to the duty surgeon, who was crash bleeped to resus, and slightly nonplussed on his arrival. Eventually the patient rolled in. His entrapped state had required ketamine on scene. This is a 'battlefield anaesthetic'. Can be given intramuscularly, and produces analgaesia and dissociative anasthaesia. There is an occasional view among the ED regs that the BASICs guys are a bit too liberal with it.

So, the guy is boarded and collared. His airway seems ok, but I'd better check.

--'Sir?, Sir? Can you tell me your name?'

He opened his eyes, very slowly, looked me dead in the eye, and said:

'Wow!' (I'd like you to imagine this being spread out over about five seconds. That gives you the idea)

I guess there's something in this drug being used illicitly.

Primary survey revealed a tender abdomen and pelvis, with hypotension, transiently responsive to fluids. Chest X Ray showed pulmonary contusion, with possible haemothorax, and FAST scan was negative.

As per usual, my knife wielding colleagues wanted a CT scan, but the patient's blood pressure intervened, and straight to theatre he went.

One ExLap later, and all that could be found was significant retro-peritoneal bleeding. He continued to behave in a labile fashion, and I can't help but wonder if there was some other injury, but haven't heard yet. More or less a tick in the positive box; ah, but the night was yet young...


emergencyemm said...

I like this series...

you've got some great stories. Sounds like you had a, for lack of a better word, fun weekend.

manchmedic said...

Interesting use for Ketamine, I must say....

Try not to have too many more weekends like this one, okay? :-)