A head injury day...
It was barely 8 but the day had already begun.
The young man on the trolley was awaiting theater. He had been the front seat passenger in a car that had crashed onto a wall. His friend, drunk, was in police custody. They had been drinking at a party until early hours. The injured boy did not appear that drunk. He was smart and was inspecting his surroundings with a dull interest.
Helani approached him with a friendly smile. She spoke to him merely to start a conversation as she flipped through his notes. He was an engineering student. He had tried to warn his friend before the accident but it was too late. His friend was a good guy. Yes, his arm was painful- it is broken, he had been told. And the hip which was dislocated hurt too. Yes, he had been given some injections for pain, thank you.
Helani was glad that she touched his forearm for a pulse- there was none. She quickly called the nurse to release the splint, pulled the hand and checked again. The pulse returned. She checked the leg as well before moving on.
Roy accompanied a young unconscious man from the CT room. He was in full spirit, despite a heavy night shift.
"Hello! Good morning!"
"Good morning, and who do we have here?"
"Hah ha! Interesting case!" Roy declared as he connected a new saline bottle. "Nobody knows what happened exactly. There are no eye witnesses. He is from a construction site and the crew had been drinking throughout the night. They slept on the second floor. Then they found him on the ground this morning- probably he went to pee from the second floor, which they do according to his mates, and fell down. 25 feet or more."
"Goodness! How are his vitals?" Helani asked, noting that Roy has not taken the transport monitor. She pulled the multi-monitor wires.
"GCS was 3. BP was marginal. We intubated and rushed him for CT. No obvious haemorrhages there. Lucky guy."
Helani palpated his pulse while the cuff inflated- it appeared weak. The patient was cold and pale.
"He must be bleeding inside." stated Roy, looking at the low BP recording. "Lungs appeared alright on admission. Equal air entry with good saturations. Systolic was 85 mmHg on admission, I gave him a pint of saline before CT."
Helani was already scanning the abdomen- one touch of the probe showed the abdomen was full of free fluid.
"Does the surgical team know?"
"Yes, surgical registrar came just as I was going to the CT so he said he'll return after CT. I'll call him now."
"Please. And do we have blood?"
"I'll check, doctor." The nurse offered. She had finished the morning equipment check. The night nurse had told her that blood sample had been sent for cross-matching.
They pumped another pint of saline before the blood arrived. The surgical registrar discussed with his consultant and informed that if the patient stabilizes, they want a 'proper' ultrasound scan and CT. Jay had taken over duties from Roy and asked "Aren't you happy with our improper USS? Should we give normal or abnormal saline to stabilize him?"
"Boss's orders, not mine." surgical registrar humbly said. "I'll tell him the patient is too unstable for CT."
"Tell him that we want to take the patient to the theater in order to stabilize him."
"Another surgery is going on in the theater- he's repairing that ruptured bowel that came at night. We'll take this guy as soon as it's over."
"We can get down the radiology registrar for USS." Helani offered. She preferred cordial relationships at workplace. Besides, the surgical registrar looked innocent and helpless.
The radiology registrar was nice and prompt. "Grade 3-4 splenic laceration." She wrote down. "Suggest CT scan if the patient is stable."
They had already given 2 units of blood and the blood pressure was fluctuating around 90mmHg. They had received another unconscious patient following a fall from a height and Jay was busy arranging for CT. The triage nurse peeped in and mumbled in Helani's ear.
"Doctor, there is an unresponsive patient but I think she's just pretending to be unconscious. It looks busy here. Shall I send her to the treatment bay?"
"What is the GCS?"
"3, but she's pretending, I think. Would you come and see?"
"Send her in." Helani said.
The woman was wheeled in and two of her friends came in as well. They were so eager to show their concern by caressing the unresponsive woman, talking to her, wiping her with their handkerchiefs and smiling nervously at the staff.
A quick assessment showed that she had stable vitals, and the nurse was probably right- the woman was trying to keep her eyes shut and avoid responding to anything.
"What happened?"
"We took part in a staff race. She fell halfway through it."
"Did she slip and fell?"
"May be. Yes, I think."
"Does she have any other illness?"
"No, she recently joined our staff- about 2 months ago. She seemed healthy."
"Did she talk after the incident?"
"No, she was like this since then. Now for about 45 minutes. May be an hour."
"Check the blood sugar." Helani requested. "And get an ECG as well."
"She's just pretending." the nurse objected. "Who asked to bring her in?"
"I did." Helani said. "Triage is not the place to exclude causes. Check the sugar and get an ECG."
And then she pinched the patient while still talking. "If she does not wake up, we will have to do a CT, which increases her cancer risk, and even affect her fertility, so..."
Patient slowly responded to the pinch now. The nurse chuckled.
"Shall I cut open her clothes, doctor, these seem too tight..."
Now the patient was fully awake and looking around shyly. She asked what happened and said she felt better, much better! Blood sugar was normal. Helani sent her to treatment bay, requesting to check an ECG before discharge. The young woman probably felt too ashamed when she fell in front of her new workmates but they did not want to take any chances.
Meanwhile, the splenic rupture patient had been taken to the theater. The door opened to bring a young child, transferred from a local hospital for CT scan. He was intubated.
"What happened?" Helani asked from the transferring team.
"Pillion rider without a helmet. GCS 3 on admission. Unilateral pupillary dilatation. 3 episodes of convulsions. Haemodynamically stable."
"Finally, looks like something for us!" The neurosurgery doctor, Brian laughed. Helani liked him. He would come and wait in the R room if he knew a patient was being transferred to their unit- which was often the case as this was a major trauma center. He was friendly. He would go and wait in the CT room if the patient's injuries suggested a definite bleeder so that he can alert his team from then and there.
The patient was 7 years old. His uncle had fetched him after school. The woman who was with the child did not seem to care.
"Is that the mother, or somebody else?" Helani asked.
"The mother. They don't care, you know. They just reproduce." Somebody said, referring to the ethnicity of the woman.
"May be she does not understand the gravity."
Helani spoke to the woman. It was her 4th child. She knew the child's condition and probable outcome. She did not know when the child had last eaten. She did not know when the kid got his lunch break at school. She asked if she can go home once the child is taken for surgery.
"There's nothing we can do, isn't it? My family is here, waiting outside so I can go with them..."
That sort of people do exist!
Helani needed a break.
"I'm going for a snack." she said, instead of asking if it is alright for her to go. Jay was in a good mood.
"Ah, seeing so many head injuries did something to your head, dear? Ha ha! Bring me something sweet on your way back."
"I will." said she, as she slipped through the metal door, feeling a moment of relaxation.
The young man on the trolley was awaiting theater. He had been the front seat passenger in a car that had crashed onto a wall. His friend, drunk, was in police custody. They had been drinking at a party until early hours. The injured boy did not appear that drunk. He was smart and was inspecting his surroundings with a dull interest.
Helani approached him with a friendly smile. She spoke to him merely to start a conversation as she flipped through his notes. He was an engineering student. He had tried to warn his friend before the accident but it was too late. His friend was a good guy. Yes, his arm was painful- it is broken, he had been told. And the hip which was dislocated hurt too. Yes, he had been given some injections for pain, thank you.
Helani was glad that she touched his forearm for a pulse- there was none. She quickly called the nurse to release the splint, pulled the hand and checked again. The pulse returned. She checked the leg as well before moving on.
Roy accompanied a young unconscious man from the CT room. He was in full spirit, despite a heavy night shift.
"Hello! Good morning!"
"Good morning, and who do we have here?"
"Hah ha! Interesting case!" Roy declared as he connected a new saline bottle. "Nobody knows what happened exactly. There are no eye witnesses. He is from a construction site and the crew had been drinking throughout the night. They slept on the second floor. Then they found him on the ground this morning- probably he went to pee from the second floor, which they do according to his mates, and fell down. 25 feet or more."
"Goodness! How are his vitals?" Helani asked, noting that Roy has not taken the transport monitor. She pulled the multi-monitor wires.
"GCS was 3. BP was marginal. We intubated and rushed him for CT. No obvious haemorrhages there. Lucky guy."
Helani palpated his pulse while the cuff inflated- it appeared weak. The patient was cold and pale.
"He must be bleeding inside." stated Roy, looking at the low BP recording. "Lungs appeared alright on admission. Equal air entry with good saturations. Systolic was 85 mmHg on admission, I gave him a pint of saline before CT."
Helani was already scanning the abdomen- one touch of the probe showed the abdomen was full of free fluid.
"Does the surgical team know?"
"Yes, surgical registrar came just as I was going to the CT so he said he'll return after CT. I'll call him now."
"Please. And do we have blood?"
"I'll check, doctor." The nurse offered. She had finished the morning equipment check. The night nurse had told her that blood sample had been sent for cross-matching.
They pumped another pint of saline before the blood arrived. The surgical registrar discussed with his consultant and informed that if the patient stabilizes, they want a 'proper' ultrasound scan and CT. Jay had taken over duties from Roy and asked "Aren't you happy with our improper USS? Should we give normal or abnormal saline to stabilize him?"
"Boss's orders, not mine." surgical registrar humbly said. "I'll tell him the patient is too unstable for CT."
"Tell him that we want to take the patient to the theater in order to stabilize him."
"Another surgery is going on in the theater- he's repairing that ruptured bowel that came at night. We'll take this guy as soon as it's over."
"We can get down the radiology registrar for USS." Helani offered. She preferred cordial relationships at workplace. Besides, the surgical registrar looked innocent and helpless.
The radiology registrar was nice and prompt. "Grade 3-4 splenic laceration." She wrote down. "Suggest CT scan if the patient is stable."
They had already given 2 units of blood and the blood pressure was fluctuating around 90mmHg. They had received another unconscious patient following a fall from a height and Jay was busy arranging for CT. The triage nurse peeped in and mumbled in Helani's ear.
"Doctor, there is an unresponsive patient but I think she's just pretending to be unconscious. It looks busy here. Shall I send her to the treatment bay?"
"What is the GCS?"
"3, but she's pretending, I think. Would you come and see?"
"Send her in." Helani said.
The woman was wheeled in and two of her friends came in as well. They were so eager to show their concern by caressing the unresponsive woman, talking to her, wiping her with their handkerchiefs and smiling nervously at the staff.
A quick assessment showed that she had stable vitals, and the nurse was probably right- the woman was trying to keep her eyes shut and avoid responding to anything.
"What happened?"
"We took part in a staff race. She fell halfway through it."
"Did she slip and fell?"
"May be. Yes, I think."
"Does she have any other illness?"
"No, she recently joined our staff- about 2 months ago. She seemed healthy."
"Did she talk after the incident?"
"No, she was like this since then. Now for about 45 minutes. May be an hour."
"Check the blood sugar." Helani requested. "And get an ECG as well."
"She's just pretending." the nurse objected. "Who asked to bring her in?"
"I did." Helani said. "Triage is not the place to exclude causes. Check the sugar and get an ECG."
And then she pinched the patient while still talking. "If she does not wake up, we will have to do a CT, which increases her cancer risk, and even affect her fertility, so..."
Patient slowly responded to the pinch now. The nurse chuckled.
"Shall I cut open her clothes, doctor, these seem too tight..."
Now the patient was fully awake and looking around shyly. She asked what happened and said she felt better, much better! Blood sugar was normal. Helani sent her to treatment bay, requesting to check an ECG before discharge. The young woman probably felt too ashamed when she fell in front of her new workmates but they did not want to take any chances.
Meanwhile, the splenic rupture patient had been taken to the theater. The door opened to bring a young child, transferred from a local hospital for CT scan. He was intubated.
"What happened?" Helani asked from the transferring team.
"Pillion rider without a helmet. GCS 3 on admission. Unilateral pupillary dilatation. 3 episodes of convulsions. Haemodynamically stable."
"Finally, looks like something for us!" The neurosurgery doctor, Brian laughed. Helani liked him. He would come and wait in the R room if he knew a patient was being transferred to their unit- which was often the case as this was a major trauma center. He was friendly. He would go and wait in the CT room if the patient's injuries suggested a definite bleeder so that he can alert his team from then and there.
The patient was 7 years old. His uncle had fetched him after school. The woman who was with the child did not seem to care.
"Is that the mother, or somebody else?" Helani asked.
"The mother. They don't care, you know. They just reproduce." Somebody said, referring to the ethnicity of the woman.
"May be she does not understand the gravity."
Helani spoke to the woman. It was her 4th child. She knew the child's condition and probable outcome. She did not know when the child had last eaten. She did not know when the kid got his lunch break at school. She asked if she can go home once the child is taken for surgery.
"There's nothing we can do, isn't it? My family is here, waiting outside so I can go with them..."
That sort of people do exist!
Helani needed a break.
"I'm going for a snack." she said, instead of asking if it is alright for her to go. Jay was in a good mood.
"Ah, seeing so many head injuries did something to your head, dear? Ha ha! Bring me something sweet on your way back."
"I will." said she, as she slipped through the metal door, feeling a moment of relaxation.
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