Thursday, April 28, 2005
Scenes From A Call Weekend.....
Friday a 50-ish struck by a drunken driver. Prolonged extrication with the loss of pulse enroute. The weather was bad so it was about a 15-minute ride in. He arrived still with no pulse. Asystole on the monitor. 8 french femoral sheath inserted and fluids through the rapid infusor. Compressions, epi, and atropine oh my! The ED physician and I agree that we will give one more round of drugs and then call it. He has been down for about 20 minutes at this time.
He then regains a pulse and BP.
Oh $h!t, what do I do?
He maintains a pressure of 110 or so for awhile, FAST shows a small amount of fluid within the abdomen, but not much. I contemplate a trip to CT while he is still stable but he then becomes what the ATLS book calls a "transient responder". As long as the fluids and blood are running in full tilt he is able to maintain a pressure of about 90. His rectal temp is 94. He doesn't appear to be about to arrest again. I consider the options and figure the guy came back from a blunt arrest so the least I ought to do is head to the OR to see if there is anything fixable.
Off we go. Sorry, no pictures.
Found a relatively minor splenic injury and a renal contusion. Had to place an aortic occluder at the start of the case but despite transfusions of blood, FFP and a great deal of crystalliod I could never remove the occluder and have the patient maintain a BP. Since long-term clamping of the aorta at the diaphragmatic hiatus is poorly tolerated I had to call it a day. He died about five minutes after the occluder was removed.
The drunk that went across an interstate-grade median and hit him, and several others got his workup and was hauled to jail.
Saturday was pretty quiet, watching the NFL draft.
Sunday was highlighted by an amputation, this case, and a five month old, unrestrained and in the front seat, involved in a rear-end collision. The latest nominee for mother if the year was arrested for an outstanding warrant as well as for possession of methamphetamine.
The child, fortunately was unhurt. |
Friday a 50-ish struck by a drunken driver. Prolonged extrication with the loss of pulse enroute. The weather was bad so it was about a 15-minute ride in. He arrived still with no pulse. Asystole on the monitor. 8 french femoral sheath inserted and fluids through the rapid infusor. Compressions, epi, and atropine oh my! The ED physician and I agree that we will give one more round of drugs and then call it. He has been down for about 20 minutes at this time.
He then regains a pulse and BP.
Oh $h!t, what do I do?
He maintains a pressure of 110 or so for awhile, FAST shows a small amount of fluid within the abdomen, but not much. I contemplate a trip to CT while he is still stable but he then becomes what the ATLS book calls a "transient responder". As long as the fluids and blood are running in full tilt he is able to maintain a pressure of about 90. His rectal temp is 94. He doesn't appear to be about to arrest again. I consider the options and figure the guy came back from a blunt arrest so the least I ought to do is head to the OR to see if there is anything fixable.
Off we go. Sorry, no pictures.
Found a relatively minor splenic injury and a renal contusion. Had to place an aortic occluder at the start of the case but despite transfusions of blood, FFP and a great deal of crystalliod I could never remove the occluder and have the patient maintain a BP. Since long-term clamping of the aorta at the diaphragmatic hiatus is poorly tolerated I had to call it a day. He died about five minutes after the occluder was removed.
The drunk that went across an interstate-grade median and hit him, and several others got his workup and was hauled to jail.
Saturday was pretty quiet, watching the NFL draft.
Sunday was highlighted by an amputation, this case, and a five month old, unrestrained and in the front seat, involved in a rear-end collision. The latest nominee for mother if the year was arrested for an outstanding warrant as well as for possession of methamphetamine.
The child, fortunately was unhurt. |
